[00:00:00] Speaker A: Welcome to the Heart Rate Variability Podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness.
Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and Optimal HRV. Check us out at optimalhrv.com Please enjoy the show.
Welcome to the Heart Rate Variability Podcast. My name is Matt Bennett and I have three guests today talking about an article that I was really excited to see, probably read through a couple of times just to try to figure out everything that was going on in this article and with the research. And I'm so thrilled to have Greg, Wendy and Andrew on the podcast today to talk about their use of HRV and mental health assessments for folks in treatment. So really excited to welcome you all to the show and to really nerd out about the article. So as always, I love my guests to introduce themselves and I'll just kind of throw out. I'd love to know when you kind of first got interested in heart rate variability. So Greg, we'll start with you go to Wendy and then Andrew.
[00:01:34] Speaker B: Thank you, Matt. Great to be here.
My name is Greg Hobleman. I'm the co CEO of Ashley Addiction Treatment in Haberda Grace, Maryland.
I'm an addiction psychiatrist by training and I got interested probably in hrv. The first when I first heard it was in medical school or maybe I did anesthesiology before this. It was either in my early residency or in medical school, late 90s, early 2000s and strange concept to me. What are you talking about? You know, the heartbeat sounds pretty regular to me. So, you know, it kind of piqued my interest, but I didn't think too much about it for many years. And then really the next time, I mean, I heard about it and understood a little bit about it and how, you know, it evaluates to some degree the autonomic nervous system. And then when I got involved in biometrics for myself, honestly around 2019 or 2020, and was considering what to get, you know, I had a variety, I tried a variety of wearables that weren't really changing my behavior. But when the HRV was thrown into the mix, I started to think, well, these algorithms might have a little bit more information and might help me a little bit more. And so I did. I put on one of the wearables that had HRV and it was great. You know, it was used for their Recovery algorithm. And it really did start to change my behavior. So I then, you know, speaking with Andrew early on and how we might think about it or use it in treatment really got me excited about it. So, you know, we've been thinking about it since then.
[00:03:16] Speaker A: Awesome. Wendy?
[00:03:19] Speaker C: Hi, Matt. Yeah. So I'm Wendy M. Sulaco and I am an addiction psychologist and new researcher at Ashley Addiction Treatment. I serve as the senior director of clinical quality outcomes and and model of care.
So in terms of my introduction to hrv, I would have to say it was when we started this study at Ashley, I, along with a number of other people, volunteered to wear a wearable device so that we could understand better how it would function for the patients in our care while they were wearing them. And I found it really fascinating to track my outcomes every day.
I became much more aware of how poor my sleep quality has been and the different things that I do throughout the day, like meditation, exercise, what time I go to sleep, those types of things and how they could influence those numbers.
[00:04:22] Speaker B: Awesome.
[00:04:23] Speaker A: How about you, Andrew?
[00:04:26] Speaker D: Hi. So I'm Andrew Hoon. I'm an associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine.
And I first became interested in heart rate variability while I was working on my PhD in neuroscience and was exposed to kind of laboratory measures of heart rate variability.
And then in my dissertation work we used wearable monitors to better understand sleep and stress and circadian rhythms in people with opioid use disorder.
And I've been fortunate to be able to carry that line of research in some form or fashion into my current research portfolio and especially at the research that we're doing at Ashley Addiction Treatment.
[00:05:14] Speaker A: Awesome.
So I love Greg, you might be the right one to answer this, but feel free to kick it over to Wendy as well. So let me just give the article's name here and we'll put the link in the show notes as well. So tracking the longitudinal course of physiological. Sorry, it's Friday, so my pronunciation is a little off. Physiological and mental health functioning among individuals with substance use disorder treatment.
And you know, one of the interesting things is, you know, following people throughout. I believe the 28 day tree inpatient treatment stay, if I, if I'm remembering correctly.
So Greg, I think one of the things I would love to know is for those that might not be as familiar with substance use treatment, what would this experience sort of look like in the facility that in the individuals who were studied here, what would that stretch sort of look like for them?
[00:06:20] Speaker B: Sure. So the participants of the study were in residential treatment. Residential treatment is where people with a substance use disorder, it's a higher level of care.
So their substance use disorders tend to be more on the moderate to severe level. They come into treatment for a period of time. Our treatment period is typically about 28 days.
And during that time, they may or may not go through withdrawal management, but they get involved in really treating the whole patient, you know, so we're looking at it in a variety of domains. So we want to treat them physically, mentally, emotionally, socially and spiritually. And our schedule is set to treat those different domains.
And typically, what has happened, if you look at research in this field, it's done based on self report.
And that's. It's tough to get. It's easy to get when they're in treatment, but it's hard to follow up with that afterwards.
But when we were trying to think about what we could do several years ago, and this was when Andrew and I started to get together, maybe 2017 or 2018, we said, could we look at some sort of objective measures of recovery? We didn't know if those objective measures would be beneficial or not, but as we evaluate them, of course, we look fit physiologically at what might be useful. And so we decided to start using these wearables and getting a variety of biometrics. And HRV is one that's particularly interesting to us. And that's why in this case, that's what the paper was about.
[00:07:57] Speaker A: Excellent. Wendy, I'm curious.
They may have came to you with this idea as you.
I'm sure in your role, you're tracking outcomes, you're looking for programmatic improvement as well. So I'm curious, kind of what you thought initially about bringing in something called HRV into tracking, kind of matching it up with outcomes and patient or client success in the program.
[00:08:29] Speaker C: Well, the truth is, Matt, that I came into this study on the later side. It was Greg and Andrew that really masterminded the project, designed it, implemented it. I came into the project rather late because at that time I was working on my PhD. So when I finally finished that, I immediately threw my hand in the air and said, I want to work on this project. Because I knew that we were.
We had it in motion. And it's just an exciting privilege, really, for me to be able to contribute in some meaningful way.
[00:09:08] Speaker A: Awesome. So Andrew and Greg feel to jump in here as well.
Let's start to talk about, you know, the study itself. And, you know, Andrew, as you were thinking about this from an HRV research perspective, I'm Just curious, you know, in setting up the study, you know, what were you thinking about it? Maybe share a little bit with the audience about how you set this up and what you were hoping to measure along the way.
[00:09:41] Speaker D: Yeah, that's a great question. So I would say, you know, the major drivers of this were like, practicality and ecological validity for our patient population. So Greg and Wendy and I all share a vision that will be better at tracking treatment outcomes for substance use disorders and definitely within the Ashley treatment facility, but also being able to educate other treatment facilities and improve this kind of treatment outcome tracking across the board.
I think that the patient reported measures, you know, mentioned in this paper, which are anxiety, depression and stress are incredibly important.
But we also would like to see, I think, more objective measures incorporated into substance use disorder treatment and really understand how people do recover, what that recovery looks like, where are places that we could intervene. And so this study was really like, how can we set up, set up a research study, but also like a model of care that can, you know, inform the way that we practice at Ashley addiction treatment, but also inform the broader field
[00:11:06] Speaker A: and why, you know, so you were using a whoop device and really, which if I'm correct, still measures hrv. I think it's a five minute snap snapshot during sleep, which gives you a great baseline for folks.
And I'm curious because some of the results I'm just kind of looking at my summary here, looked at anxiety, depression, stress, resting heart rate and hrv. And Andrew, I'm curious, when you started looking at those numbers together, what sort of maybe insights, surprises did you see as you started to really look at that data?
[00:11:54] Speaker D: Yeah, so I think my initial thought on the data was that frankly the relationships were a bit messier than we had anticipated.
And that's often the case in substance use research. The whole, the whole thing is messy. And so it's our job to kind of make sense of it and figure out, you know, how to be more rigorous in the future.
So kind of what we settled on with our analytic approach was to try to understand like these trajectories between the kind of HRV and the patient reported outcomes as phenotypes, basically.
So, you know, are there subgroups of patients where, you know, for example, their resting heart rate or we'll say heart rate variability is going up, which would generally, you know, we would think of as better health and their anxiety is going down and they're kind of that relationship is as expected.
And then there are folks who are flip flopped in the relationship business. Not as expected. So there's got to be something else going on to explain that. And I think that's probably the focus of future research for us. But it's important, I think, in the scientific literature that we don't just show the best results from a study and leave out the parts that are complicated or confusing. I think it's best to show the whole picture and that oftentimes that's really where discoveries happen, that's where major improvements can happen. And so that was kind of how we decided to conceptualize the results of this study.
[00:13:37] Speaker C: And if I can just add to that, Andrew, for myself, I've been a clinician in the field of substance use disorder treatment for over 30 years now, and only recently have we had the ability to even look at recovery in these scientific ways.
You know, I've seen this field evolve tremendously over the last three decades. So it's really exciting to me to think that at some point in the future we're going to have some very precise ways to predict how patients will progress in their recovery so that as clinicians we can step in promptly and really support them in the ways that they most need for a long term stable sobriety.
But quite honestly, it didn't surprise me at all the findings that we, that we derive from this study to see such variability from person to person. Because, you know, our patients are all individuals, everybody has their own journey.
And to me, of course, it's going to look different in each individual person. And for me, it just reinforces the idea of being very individualized, meeting patients where they are and addressing the symptoms, the struggles that they're having in the moment. Because no two patients with substance use disorder, no two people in early recovery are going to need the exact same things. And as treatment providers, we really need to be responsive to that and be able to adapt to that.
[00:15:28] Speaker A: I appreciate that. Greg. I'm curious, you know, I really. And if you were an ethical provider, you would say no to my request? I really, I think there were, was it 29 or 39 individuals that maybe qualified with something like that? But I wanted the files on each of these individuals and hopefully you would tell me, no, I'm not going to send you the case files on each of these. But, but I'm just curious, as you looked at the data, you know, did you, was there any insight to the journey through your programs and you know, at your facility? Because I mean, that, that to me is what, what was fascinating here is you got, you got nightly data on heart rate variability. I Assume and probably a lot more data than it was, maybe easy to look at. But I'm just curious, as you looked at this, along with the anxiety, depression, stress, these other scales, did it highlight anything, reinforce anything, challenge anything of how you might think of your client's experience in the program?
[00:16:39] Speaker B: Yeah, well, I think Wendy said it well. A great insight is, look, you know, these, these are individuals. Their, their paths are very different physiologically, emotionally, they're.
And the way they're feeling and the way they're going to rate their own symptoms is different. You know, So I guess an insight that came to me is, you know, this is very early on. You know, this is the tip of the iceberg with what might come and how do we use this information to help folks, you know, and we may find that these things never line up, you know, but to some degree, HRV improvement is at least we'll be able to speak to people and say, as your HRV improves, your autonomic system is improving. We can talk more about it. We can discuss it with them.
And if that is enabling us to have those conversations and helping to motivate people to stay on track and change their behavior, keep, you know, because when they see that, and they see that improvement, not just in hrv, but another, you know, biometric data that we might get, you know, we can change their behavior. And I think that may be ultimately, at least early on, the most benefit. If we can create at some point some sort of predictive algorithms, wonderful. We have a long way to go before we get there. So for, for me, it's how do we use this, what we're seeing now, to inform our current treatment and to help people stay on the path of recovery, not just in treatment, but also after they leave and are discharged and go on to the next level of care.
[00:18:15] Speaker A: I love that, Andrew.
[00:18:17] Speaker C: I would love.
[00:18:18] Speaker A: Go ahead.
[00:18:20] Speaker D: No, I would just add on to that, that I think the flip side is also important. So sometimes you have patients in early treatment who are overconfident and they are reporting that, you know, they're feeling better and, you know, they feel really confident that they're, you know, that this is going to work out this time. But if your body's telling us something different, then that can be a really important data point to show participant, and especially to kind of help them understand why they might need a higher intensity level of care for a longer period.
[00:18:52] Speaker C: Absolutely. I totally agree with you there, Andrew, because we're not always the best assessors of our own wellness, especially early in recovery.
How Somebody's feeling stress, depression, anxiety that can fluctuate from day to day depending on what's happening in their treatment and what's happening in their world. And same goes for the physical body. But I find that the patients that are most interested in understanding what's happening, not only in their minds but in their physiology, we have the ability now to give them some insights into that. We have the ability now to tell them with some certainty, you know, this is what we're seeing for you.
And it's not a guarantee of what's going to happen next week or next month or a year from now, but that that kind of information can be very reinforcing to Greg's point, also that it helps to reinforce patients continuing to do what they're doing, continuing to work on their recovery in the ways that we recommend because it's showing an improvement in their body or not.
Maybe some of this is explaining why people may feel like they're struggling a lot, little more than they think they should.
[00:20:19] Speaker A: And Wendy, I'm curious and if you're not the right person, please kick it to who might be.
One of the things that drove my passion for heart rate variability was it was a substance use study of that a three day significant drop in HRV can predict relapse. And just having worked in and around the field, whether I was doing direct substance use treatment or, you know, working with populations where substance use was a part of the presenting problems, you know, always, you know, that that idea of relapse, especially in a time of opioids where a relapse, you don't survive that a lot of the times, you know, that, that really drove my passion for this. And I wonder, do you see this if it, if it is already or see it in the future of, you know, being able to kind of see that. Hey, Matt, Matt's HRV, my arm SSD has been 25% lower than normal for the last day or two.
Maybe I need to check in what's going on with Matt. You know, do you see this kind of driving and giving professionals insight, you know, deeper into the tr, the treatments experience?
[00:21:39] Speaker C: Isn't that an exciting possibility?
I mean, just to think about that, it thrills me really that someday as treatment providers we might have tools like this that we can, with some level of accuracy, determine, you know, who needs what kind of support when.
I just, I'm thrilled by that idea and I think that's really, really what motivates this whole line of research is so that eventually we can have more precise ways of predicting those outcomes and therefore intervening in a more timely manner rather than after somebody's relapsed.
And then we're there to help kind of pick them up and help them start putting their life back together, if we're able to, with some accuracy, see that before it occurs.
I mean, that's, that's the name of the game as far as I'm concerned.
[00:22:39] Speaker A: I love that.
[00:22:40] Speaker B: Yeah, I'll jump in real quick, Matt, because we do see a lot of people claiming a lot of things, you know, and I'll tell you, that's not us.
I mean, the reason that we collaborate with faculty from Hopkins, like, you know, Andrew and a few others that we have on board and we're creating this team is because we're really looking at what can we show with some certainty. So we don't want to make any claims. We hear it throughout the industry, to be honest with you, without the treatment world people saying, and we're not going to do that, we're going to say, hey, look, we have a little bit of information here. How do we take this and grow it into something that ultimately does have meaning? I mean, like Wendy, like Andrew, we're all thrilled with that idea, you know, and I think we can implement some. You, you said it well when you said, hey, maybe this is a time to check in, you know, it's a time to talk to somebody, a time to increase the, the, just the touch points with the person, you know, or really dig into what's happening.
But we don't want to make any claims to say, hey, this is where we are when we're not.
[00:23:45] Speaker A: I love that. And, and we don't know too, like, is it a culture cold or is it a potential relapse? You know, it's, you know, that's where hrv, you know, in outpatient work, at least where I got really excited is, you know, hey, a phone call, like, if I'm not going to see you for another week, you know, and I see your HRV tank, hey, maybe you're sick, maybe you had a fight with somebody or maybe, you know, you're at that risk and a phone call could in some situations be, hey, I'm sorry you're, you got a cold, but hey, I'd much rather make that phone call and just offer support for that. But, you know, also maybe disrupting a behavioral cycle that could lead to pretty detrimental, if not potentially life threatening outcomes is I think, the exciting future of where we could go here with some of this research and data that you all are providing us.
[00:24:46] Speaker C: Right. Well, and likewise, Matt, I don't think we would ever want to be overly confident or overly reliant on any tools such as this. We would never want to assume that just because somebody's HRV is remaining stable and healthy and strong, that therefore they are somehow immune to relapse or to the struggles that that come. I think that that's a, that would be a dangerous, slippery slope for us to go down.
[00:25:18] Speaker A: Absolutely. Andrew, I'd love to bring you in, in here. And one of the things I'm fascinated with, with both the brain and the autonomic nervous system is states versus traits.
And a lot of times we know that neuroplasticity exists, but usually doesn't happen overnight for a whole lot of people, for better and worse, depending on the nature of what you're trying to help with. But I'm curious, when you look at the length of this study, which was, you know, while they were in inpatient treatment, I think most neuroscientists would say it's probably enough to see some beginnings of neuroplasticity. In other words, could your vagal tone, how much better could it get in 21 days, you know, if everything else is held consistent and knowing that they're in substance use treatment for a reason with that. So I just love that as we look at this, just kind of love to get your thoughts on the 28 days.
What we could realistically expect with HRV changes and neurobiologically speaking, a relatively short period of time.
[00:26:36] Speaker D: Yeah, no, that's a really good question. So in this study in particular, we did see like an overall improvement, you know, significant improvement in hrv. How much more room for improvement is there beyond the residential stay where we don't know that.
And if you start to think of these different neural systems, like you mentioned vagal tone and the autonomic neural system, but there's also the brain's reward system, there's neuro hormonal systems. These things don't change and adapt all at the same time and in the same way. So it's really complicated.
And also kind of relating it to a person's actual lived experience and what they're going to do in recovery becomes further complicated.
But certainly you have, you know, people who are, you know, have, you know, we'll say a trait of high anxiety. I think we all know somebody who's an anxious person by nature versus somebody who's in a state of high anxiety and might come out of that, you know, much more Quickly, this is definitely something that we're interested in, that we continue to look at. And in other studies that we're doing longer term, kind of what does this restoration look like? And I think, you know, the two other things we're looking at that are kind of directly related are sleep behaviors and patterns and also diurnal cortisol measures that we've incorporated into other studies at Ashley Addiction Treatment as well. So.
And there's, you know, some. We've seen some fascinating stuff with that. And in general, you know, just some. Some research highlights, like, in general, people who are improving their sleep, you know, no longer showing signs of insomnia. That's generally protective against relapse. The. The opposite is pro relapse, pro, you know, potentially overdose. And we've published on that topic.
The same is true with cortisol that generally people who are restoring, you know, normalizing patterns of diurnal cortisol, that seems to be protective against relapse. The opposite is pro relapse. So, you know, understanding, I think from our perspective in the residential facility, like, how to get to kind of maximize that early part of recovery, how to set people up with tools to continue in the outpatient phase, you have to change a lot of things about your life to really achieve and sustain recovery. And I kind of think about early stage of recovery like, you know, you got the monkey off your back, but the circus is still in town, so you're not out of the woods. Even if you can start to feel really good and like, oh, you know, maybe I'm cured, something like that. Like, it takes work, continued work for these folks to maintain it.
[00:29:37] Speaker C: Yeah. If I can just add to that, Andrew, I think that really speaks to the value of residential treatment as a place to start with substance use disorder, because there is. It's such a profound impact on the body and the mind and the spirit and giving people some time. And we know that, you know, 28 days is not enough time, but if we can give people that time to really get them into the best possible condition to continue in a positive path of recovery, then it's. Then it's worth it. So we try to pack as much we can into that first 28 days in hopes then that patients will continue some of those healthy habits, healthy patterns after they leave residential and move into their next level of care, whatever that might be.
But that's why these kinds of tools, the HRV measures, are a way that we can. It's kind of like peeking under the hood and getting a clearer sense of what's really going on with somebody.
[00:30:53] Speaker D: Absolutely.
[00:30:54] Speaker C: In that time when they're so vulnerable in early recovery.
[00:30:58] Speaker A: Yeah, that peak underneath what's going on underneath the skin. Because again, I would never advocate for HRV replacing a depression scale or anxiety scale or the surveys that we use.
That would be a ridiculous argument. But complementary to it. I think it belongs right there. And so while you wouldn't give up your depression scale for an assessment, if you're not doing hrv, I think you're missing a substantial piece of information that just can give you a different level of insight than our traditional approach approaches do.
Awesome. So I would love to hear.
You know, Greg, maybe we can start with you of where do you kind of see this going? It's one thing to say, hey, you know, we're going to be a cutting edge treatment center where we're going to have wearables on our folks. It's another thing to work with folks like Wendy and Andrew to do pure peer review journal articles.
That's something that is a whole different level than your typical probably treatment center would do. So I'm curious, with this innovation that you've started, not just to bring it on, but to really do serious evaluations, where do you see this going, you know, in your facility and where do you see it kind of leading us as a field of residential substance use treatment?
[00:32:41] Speaker B: Yeah, we look at it really as our North Star, honestly, and we say that, I mean, it's wonderful to do the work we've done for many years.
It's also we're in a privileged position to be a nonprofit facility with a mission.
And, you know, our mission is to not only treat those individuals, but do our best to advance the field. And so we are thrilled to have the ability to do that in the backing of our board and so forth, to put a lot of energy and resources into this.
It's very difficult to do it in this field just from a financial standpoint.
Residential treatment centers are not typically, you know, affiliated with academic centers. And there's a whole history behind that, which is very interesting.
So we are thrilled to be able to collaborate with incredibly intelligent people like Andrew. And then we also have an internally very talented group of people like Wendy to kind of do two things. And one is to say, let's continue to gather data, you know, let's look at data in general.
Wendy recently brought some data to us, which is fantastic. And that's looking at the group cohesion and therapeutic alliance, you know, and we realize that if we have that and we're doing well there, the outcome will be better. So we're tracking that over time. We're also tracking patient report and how they're doing. And we can look at this, you know, in a variety of other things as well. We can look at this on a day to day basis and then tailor our treatment depending on what is happening. So that's sort of the moving part that we'll keep doing and look to improve and improve and improve over time.
Ultimately, the way we advance the field though, is by doing that serious, scientific, rigorous research, you know, and that's the partnership. I mean, you know, the folks from Hopkins partner with us in all of this, you know, but for us, unless we have that piece, you know, to help us get those NIH grants, to help us design studies, to help us really think about those important questions, and how do we design a variety of studies to get little bits of information that we can then grow, you know, and we kind of see it as, let's look at some of these things. We're happy to start with smaller pilots, ask some questions, get some information, and hopefully that sparks larger interest, you know, and then the studies can be replicated and they concord and other people will be, you know, doing similar things. We are not alone in this, in the treatment world, but it is fairly rare to have a program as robust as ours and as dedicated as we are. But we do see it here, you know, really as our guiding star. Because this is, you know, with regard to our mission and getting people better and getting them better quicker, you know, without this information, we can't do it. You know, the other part of that too, is so that we can demonstrate the benefit of not only treatment, but residential treatment, you know, and what are the benefits at that level of care versus the next level of care versus the next level of care? Because we intuitively know that residential treatment is a true privilege for people and it's a true benefit to people. It sets a foundation that is so strong if we do it well, and we don't want that to disappear or go away. And in order to continue this good model, this good quality care, we have to prove that it works.
[00:36:06] Speaker A: Yes, I love that. Wendy, I would love for you to put on the clinician's hat for us here.
Where do you see, as somebody who is relatively new and caught the HRV bug, my assumption was, and this was probably now about seven years ago, is that all people needed to do was hear that we can measure things like recovery and post traumatic growth and the autonomic nervous system and you know, everyone at this point clinically would be using this. Like, of course they would. And so when I found it, I thought everybody else would be as excited as me. So this is why I love finding you all and talking to you all with this. But I'm curious as from that, that clip clinical perspective, where do you kind of see the access to this data, autonomic health playing a role in the future of the clinician's role in the treatment healing and growth process in residential treatment?
[00:37:10] Speaker C: Well, we're certainly not stopping at Ashley addiction treatment, you know, continuing to measure biometrics, including hrv, with a vision of someday being able to really implement this in real time monitoring so that a clinician working with a patient in early recovery from substance use disorder can review their weekly assessments, you know, their mental health indices alongside their biometric health, their biometric indices, and use that information together to help inform the treatment interventions, to help shape the treatment plan, to help determine the length of stay, to help determine what makes best sense for the next level of care as patients move through the system.
I think once we can understand more about heart rate variability and other biometric measures, how they tend to progress in recovery, eventually I see it being kind of an industry standard that treatment centers will, it'll be kind of like going to the doctor. You know, they have you step on the scale and they take your temperature even if you're not there for a fever. Like those are standard practices in medicine. And I think we need to really elevate substance use disorder to the same kind of standard where we have easy and affordable ways that are just part of the standard of care for substance use disorder treatment.
[00:38:55] Speaker A: I love that. Andrew, I'll give you the final word here.
Where do you see, you know, this goes. Is the, you know, kind of the HRV nerd of the group along with me, like, where do you see this going?
What, what an amazing partnership for Hopkins to, you know, study this sort of out in the wild instead of a laboratory setting. You get really real data from real people, you know, going through a difficult but hopefully transformative process and in their life. I'm just curious where you see this work going and the interest that it's kind of sparked in you for future research.
[00:39:39] Speaker D: Yeah, well, I definitely, I think there's multiple avenues. I think, you know, as Wendy touched on better understanding people's health and recovery kind of recovery trajectories while they're treatment. And as treatment kind of steps down from higher intensity residential sober living environments to, you know, outpatient that may taper off over time.
You know, how do we keep people from kind of escaping this vicious cycle of relapse and remission over the long term? And so I do see HRV as a, definitely a tool, maybe one of many tools that can be used to achieve that.
And you can start to imagine scenarios where, you know, your clinician can, you know, see your results on a dashboard and can be coaching you, but also where you can interact yourself with an app or you know, kind of taking more control and accountability over your own recovery in the long term, understanding better understanding your own triggers and your own health goals long term.
I definitely see a place for HRV in the predictive modeling of relapse risk in this population and in kind of, you know, devising just in time interventions to prevent relapse and perhaps also, you know, medication response. And you know, addiction doesn't exist in a, in isolation, in a bubble that there's often co occurring disorders.
A lot of people with chronic pain, you have a lot of people with co occurring major depressive disorder, history of post traumatic stress disorder, you know, so really kind of understanding HRV in that kind of context. And then, you know, you know, especially like, you know, I would use medication development as a, as an example, like how long should somebody be on a certain type of medication?
You know, is one class of medication better than another in the long term for kind of whole health for these folks?
So those are, I would say that's the three main areas I see it going and I've been really fortunate to, you know, to be able to collaborate with the folks at Ashley Addiction Treatment. It almost.
Collaboration is almost too weak of a term for us. I think, you know, we're kind of fully integrated at this point. It's relatively rare for a researcher to be able to enter an organization like this and really have a lot of input, a lot of collegiality.
Other treatment centers I work with is not necessarily the case. So it's been a really good relationship and I think, you know, we're really showing how to, how to bring like a true precision medicine approach to substance use disorder treatment. That's our goal.
I love that.
[00:42:47] Speaker A: And really that predictive piece of it is where I think so much of the research is trying to establish. And we got to be careful because we don't want to make claims out there where it's not backed up by solid research. But it seems like we have enough, like I said, you know, to make the phone call if they're in our aftercare program. And we see it crash that, you know, hey, a phone call may discover they have a cold or it may be discover that they're well on their way to a potential relapse. And it's just so, so great to talk to you all doing this really innovative work and I thank you for doing that. I cannot wait. Sounds like we got more papers hopefully coming out shortly. So I am excited. And please, please, please, I hope you come back and share your findings with our audience because this is amazing work that you're doing.
[00:43:49] Speaker C: Well, we would love to do that, Matt, and we're grateful. I know I speak for all of us. We're grateful for your interest and for just the community's interest in this type of work. And we're grateful that you've given us the opportunity to come on here and talk about it. And we hope that this kind of research can inspire other scientists to really look at understanding substance use disorder recovery better because the more we understand it, the better, the more effective we can be in helping people when they're suffering. So thank you for your interest as well.
[00:44:27] Speaker A: Absolutely. Well, you keep writing the research, I'll keep sharing it as far and wide as I can. So Greg, Wendy, Andrew, thank you so much, so much. I'm really looking forward to the next paper and our next conversation around the great work that you're all doing.
And thanks as always for our audience for joining us. You can find show notes, we'll put a link to the paper, give some information on Ashley, Greg, Wendy, Andrew as well in our show notes that you can always
[email protected] thank you everybody. And Greg, Wendy and Andrew, thank you so much for your time and the great work you do.
[00:45:06] Speaker D: Thanks for having us.
[00:45:08] Speaker C: Thank you, Matt.
[00:45:10] Speaker A: Awesome.
