Read the transcript of the fifth episode of the Resiliency in Disaster Behavioral Health podcast. Moderator: Welcome to Resiliency in Disaster Behavioral Health, a six‑part podcast series from the Substance Abuse and Mental Health Services Administration. The goal of this podcast is to inform local behavioral health agencies on strategies for building resiliency in individuals and the community before, during, and after a disaster. The series discusses specific behavioral health interventions across the stages of disaster response, in addition to focusing on the needs of specific populations. Dee S. Owens served as the Single State Authority in Oklahoma during the Oklahoma City bombing in 1995. She has since deployed to numerous disasters, including 9/11, Hurricane Katrina, and the Henryville, Indiana, tornado. She trains internationally in disaster response, especially related to substance use disorders. She is currently Special Assistant to the Director in SAMHSA’s Center for Behavioral Health Statistics and Quality. Dee Owens: I’m Dee Owens. There are specific needs for those with substance use disorders during disaster preparedness and planning. And it’s important that we learn these as part of our overall disaster response structure. There are many factors for which we need to prepare and plan, and that includes knowing about those with substance use disorders. Because, if newly in recovery, say 6 months or so, that person may relapse. And those who are on the edge of addiction who are abusers but not yet addicts, they may go over the top, because use tends to go up during disaster. Also, anyone in active treatment will likewise be affected, and when a disaster happens, access to medications may be unavailable for a period of time, and those with comorbidities have great issue with that. Self-help meetings may be interrupted, or facilities may not be available. In New York City after 9/11, for example, when merchants were able to get back to their shops and reopen in lower Manhattan, they offered free alcohol to the responders and to those who were working at the site. This obviously is not good for someone with a substance use disorder. And so, those are items that you need to pay attention to for anyone who may have a substance use disorder. There are factors that contribute to resiliency during disaster, and those include items such as the length of time since treatment was completed; those with shorter time in recovery are more vulnerable to relapse, although anyone can relapse. The available support networks before and after a disaster are important for resiliency for anyone, as well as those with substance use disorders. Access to necessary medication for substance use disorders is a problem and can be a problem if you are reduced to a place where only the Strategic National Stockpile can provide items for you, they do not necessarily and likely bring medications that are necessary for those taking them for substance use disorders. Places of safety to which to retreat are important during disaster. In New York City, we found that people who didn’t have anywhere to go after 9/11 went back to treatment centers—sometimes they would relapse in order to enter the center because that was where they felt safe. Also, the ability to maintain employment and housing as I just noted with anyone is important during a disaster. There are strategies on partnering with first responders during immediate response. And, first of all, one of the strategies is to include those first responders in planning. When you include them in planning, they will be your partners in response. Training those first responders about substance use disorders facilitates resilience in those populations. For example, I led the mental health and substance use response to the Henryville tornados several years ago, and a person in command there, when I walked in and announced I was with the mental health/substance use response, very loudly and to everybody said, “Well, have you got a year?” They do not take us seriously necessarily and because that person in charge had not been trained, had not been brought in to understand that these are very real issues, he tried to make a joke of it. In fact, I’ll tell a story just a bit later of how that turned around. But participating in tabletop and virtual exercises builds teams that last well into response. And this is why it’s so important for agencies and for counselors and for others to participate in those exercises, even though they seem silly at the time, they’re anything but silly. They’re team building, and they’re very important for disaster response. Also, another strategy is credentialing systems. These will allow specially trained responders to work with those with substance use disorders quickly. In Indiana, for example, where I’m from and where I’ve been on a team since 2002 to respond to disaster, we train our people not only in Psychological First Aid but also in substance use disorders so that they can understand both issues with which to deal. Training in Psychological First Aid builds relationships as well as skills and both are needed to facilitate resilience after disaster. Now these responders, these first responders demonstrate resilience, but they also fall victim to compassion fatigue. The same fire chief that I told you about earlier then came to us after several days of trust building and said, “My people are pretty tight, can you please work to debrief them?” So we got the state fire marshal and we got the state police chaplain and we sat down and we debriefed those first responders who had not only had to respond during the tornadoes, they had been affected themselves. They had been out taking care of people by the sides of the interstates and had been hit by debris and a flying road sign for example, and they were working with their arms in slings and other things. They were well beyond what needed to be and we needed to help them to understand that drinking was not a solution to their issues but rather learning some skills would help them with that. So partnering builds those relationships and it helps all to remain resilient, the responders as well as those for which they’re responsible. Now, there’s information for clinicians and agencies on how to reduce and prevent relapse and how to contribute to resiliency for your clients after disaster. One of the first things is to have a medication management plan for each client, especially including methadone maintenance clients. You can bet if you’re in a situation where the Strategic National Stockpile has to bring in medicine, there will be no narcotics. And so you really need to have a plan for that. In Biloxi, Mississippi, where I deployed with a team from Indiana, under an EMAC after Katrina, there was not anything for those clients and that proved to be problematic, as it did in New York City after 9/11. Another way to believe it or not facilitate resilience is to include policymakers in your planning process. This helps make for rapid grant approvals and for flexible funding. The president, under the Stafford Act, can order items in to help you; the Secretary of Health and Human Services under the Public Health Information Act can also order in people to help you under public health emergency. This is how we get our CCP programs and other state funding that comes in to help after a disaster. However, having local grant approvals and flexibility to get things done as you need them is highly helpful and speeds resilience. Otherwise, you’ll be slow providing resources and people feel further stress. You need to have duplicative records agencies and duplicative methods of communication, in other words, a continuing operation plan. Having an evacuation policy and a plan for residential programs and then training staff on how to use that policy is highly relevant to resilience. People feel safe and therefore resilient when they know what to do if there’s a problem, when they are following staff who are highly trained in what to do if there’s a problem. When you see those disaster plans and evacuation plans hanging on the wall, pay attention to them, read them, and insist that you be trained in how they are going to be used so that you can provide that sense of safety to your clients. Be sure and plan for memorials and anniversaries after traumatic events. Anxiety is heightened at these times, and when you have these events and people who were affected help plan them, it reduces their anxiety and increases their resilience to further problems. There is a great deal of lessons learned literature and it’s very helpful. There are a few resources attached to this podcast. One is the New York report that I was lucky to participate in helping to write, and it talks about some of the lessons we learned in New York City after 9/11 as to what could help with resilience and what wasn’t necessarily a help there. There’s also of course the SAMHSA Disaster Technical Assistance Center, which has years of resources that are collected, and you can review them at samhsa.gov/dtac. So, to close, it is important for you to participate in training and tabletops and pods and whatever team building there is, and it is important to bring substance use disorders and the information about them and how to spot them and how to ask about them to those who are unaware, especially first responders. Be a part of your emergency response team locally or statewide. This will help you to understand the bigger picture. Of course getting trained in the ways that we operate is important and any kind of training actually is important especially Psychological First Aid and substance use disorder training. You finally need to remember to take care of yourself if you’re deployed. You can’t help anyone else if you don’t take care of yourself. I can speak from experience on that, and we want you to be resilient so you can help your people and clients to be resilient. Continue to search for resources. Thank you, and good luck out there. I know you can do it. Moderator: Thank you for listening to the Resiliency in Disaster Behavioral Health podcast series. If you would like to learn more about the topics and materials discussed in this episode, contact the SAMHSA Disaster Technical Assistance Center at firstname.lastname@example.org or at 1-800-308-3515. For products such as tip sheets, webcasts, and collections of research materials, visit our website at www.samhsa.gov/dtac. If you or someone you know are experiencing distress related to a natural or human‑caused disaster, call the Disaster Distress Helpline at 1‑800‑985‑5990. References Frank, B., & Owens, D. S. (2002). The impact of the World Trade Center disaster on treatment and prevention services for alcohol and other drug abuse in New York: Immediate effects, lingering problems, and lessons learned. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. McCabe, O. L., Semon, N. L., Lating, J. M., Everly, G. S., Jr., Perry, C. J., Moore, S. S., Links, J. M. (2014). An academic-government-faith partnership to build disaster mental health preparedness and community resilience. Public Health Reports, 129 (Suppl. 4), 96–106. Mendez, T. B. (2010). Disaster planning for vulnerable populations: Mental health. Critical Care Nursing Clinics of North America, 22 (4), 493–500. Owens, D. S., McKernan, B., & Framingham, J. L. (2012). Disaster and substance abuse services. In J. L. Framingham & M. L. Teasley (Eds.), Behavioral health response to disasters (pp. 319–336). Boca Raton, FL: Taylor & Francis.