Podcast: Dr. Michael Zona – Forensic Psychiatrist

Gina: Hi everyone, welcome to the Harmony Foundation podcast series, and I’m pleased today to be joined with Dr. Michael Zona, who is a forensic psychiatrist out of Boulder, Colorado.
Welcome, Dr. Zona.

Dr. Zona: Thank you.

Gina: Nice to have you here.

Dr. Zona: Thank you.

Gina: Well, first of all, we appreciate you taking the time to come up and visit us here at Harmony. Obviously we’ve been working hard to get you up here, so it’s great that we’ve had a chance to meet you and learn more about your practice.

Before we get into some of the specifics about your practice, we’d like to talk with you a little bit more about who you are, and what kind of prompted you to get into the field of working in psychiatry, but specifically forensic psychiatry and some of the specialty areas you focus on.

Dr. Zona: Okay. Well, when I was a lad, I was more interested in biology, fishing, wildlife biology. And that led into medicine. I became interested in medicine maybe my senior year of high school and then through college.
I’m not from a medical family, so I wasn’t exposed early. As I went through undergrad, University of Massachusetts, I then went to St. Louis University, medical school, it’s a Jesuit school in Missouri.
You go through your first two years and it’s mostly lectures and so on. I remember going to the psychiatry lectures, and there’d be a psychiatrist there, somebody Einstein-like here, talking about things. They basically would read from the DSM, that’s a manual that talks about different diagnoses.  And I think it was the DSM-3 at the time maybe, I’m not sure. And I thought, boy, I love all aspects of medicine, but I know for sure I won’t be doing psychiatry.

Gina: Interesting.

Dr. Zona: And then in your third year, you start doing eight weeks OB/GYN, eight weeks peds, eight weeks psych. And everything I did, I was like, “This is what I’m gonna do.”
I did the psychiatry rotation, and I was hit like a ton of bricks. I just knew right then and there, that’s what I had to do the rest of my life.

Gina: So what was specifically about that particular rotation that made you say, this is the one?

Dr. Zona: An excellent mentor, firstly, which is critical in career development. And then secondly, what I found out was that it wasn’t this dry stuff, and it wasn’t Freudian. Which back in the day, it was all psychodynamic.
Actually, this was the time when psychiatric medications were coming out, where you could actually make diagnoses and you could use a medication for the diagnosis. And it was so dynamic, and so lively, that I was just smitten with the whole issue.  In retrospect, I think if it was all say, Freudian, and a lot of theory, which is not in my opinion scientific, I would not be in psychiatry. But over the last 40 years, 4-0, 40 years, it’s really lent itself to a medical model.

Gina: Yeah.

Dr. Zona: And the dynamic aspects of it, the fact that so many people are in need for a cure, and it was largely ignored, I think those are the kinds of things. Maybe my countertransference, which is the therapists’ feeling toward the patient, and it could be good or bad, but I’ve always been the kind of person who’s for the underdog. And I think that lent itself to that as well.

Gina: That’s great. Well, and there is so much more science behind the brain and how it functions, and I heard statistically that we know only maybe 10 percent or 20 percent of what the brain’s capacity really is.
So it’s almost like uncharted territory as far as what we’re learning about brain science and working with human capacity, which is really interesting.

Dr. Zona: Yeah. I think there’s like three frontiers: space, under sea, and psychology that exist out there and are still largely unexplored. And I like that aspect as well.

Gina: Yes. It really is a great opportunity for us. And one of the things you do also, and obviously this is going hand in hand with our conversation about moving into the world of psychiatry, is this issue of addiction medicine.
Addiction medicine is probably on par with that timeframe of, we’re looking at maybe a 30 year window of when addiction medicine really became such a significant part in treating addiction. And yet, that’s one of your specialty areas is looking at an addiction, specifically around medically assisted treatment.

Can you talk to us a little bit about why you decided to infuse the concept of medically assisted treatment, or MAT, into your practice? And also, what are your approaches in working with people who have issues with addiction?

Dr. Zona: Great question. I think that about 60 percent of my patients have substance use disorder. And I think as a psychiatrist, if you do not focus on looking at addiction related issues, and it doesn’t have to be a substance. It could be porn. It could be computer gaming, which I see in a ton of adolescents and youths these days. If you miss that, you’re not doing your patient proper service, because that part is, if you’re looking at a piece of pie, that could be 60, 70 percent of it. So you could hit somebody with the best medication and be the best therapist, but if you miss the addiction part, you lose and you do a disservice to the patient.

Gina: Which I think in many cases, what we’ve struggled with over the years, between this push/pull between mental health and addiction, is that there’s always this idea of isolation, you only treat the mental health, you only treat the addiction, but you never look at both together. And I think that once we start to blend those two together, you’re gonna start to see greater success. So I’m glad to hear that you address the addiction piece, because it is, like you said, such a pervasive part of what people are coming to the table with.

Dr. Zona: When I listen to patient stories, and you know, being in the field, that relapse is part of the disease, unfortunately. Guess what? Relapse is part of the disease in psychiatry too.
So we’re used to working with the concept of relapse. What I have found, when you listen between the lines to a story, a lot of relapses occur because the underlying psychiatric condition hasn’t been tucked in or went awry. And if you can get the underlying psychiatric condition stable, your success rate at treating addiction is much higher.

Gina: That makes sense. So as a medical professional, and working with people with addiction treatment, obviously we’re seeing this crisis of opioid addiction and the pervasiveness of it.
What do you think we need to be doing more of in addressing the opioid crisis in our communities?

Dr. Zona: That is the $64,000 question.
I think that doctor education is critical, and dentists by the way, because I’ve had many patients who have gone in and had two wisdom teeth taken out, and they leave with 60 Percocets, with a refill, for a month later. This kind of thing.  So I think doctor education is critical. And a lot has been done already. You cannot pick up a medical journal these days and not see tons of things on opiates.
I think in-services, training doctors is critical. I think public awareness is critical. I think programs like the needle exchange program is very helpful. And I think that I would like to see more doctors using MAT, not fewer doctors seeing more MAT patients. Because you’ve heard of these pill mills in Florida. They open up a strip mall, and have some doc there, and it’s like, script pad, script pad, they might process 40, 50 patients in a day.
That’s assembly line medicine, minus the word medicine. Because that’s not fair to real doctors to say that.

Gina: Sure.

Dr. Zona: Nowadays there are people out doing Suboxone, but I call it reverse pill mills, where all they’re doing is providing prescriptions for Suboxone, but they’re not looking at the underlying issues, they’re not helping a patient find AA or NA grounds, and they’re talking about, “Wow, I can cram in five patients in an hour.” All they’re doing is, in my opinion, a reverse pill mill type of thing. So I would like to see more docs doing it, if I was king of the world. I would mandate medical school training in addiction, medical school training in- nobody graduates from medical school without their XDEA, and training, so they’re ready to help their patients.
Because all too often, docs don’t want to do that part. And they make referrals, and there’s simply not enough addiction psychiatrists around to see people in the proper way.

Gina: Right. And it’s interesting, because when you talk to some primary care doctors, they struggle with even having the conversation with their patient, because they don’t know where to refer them to. So sometimes the conversation doesn’t even come up at all. So now you’ve got both sides of it.  You’ve got somebody who thinks the solution is just to provide a pill, and then you’ve got the others that are not willing even to have a conversation because they’re afraid of opening Pandora’s box, and they just don’t know what to do with the patient or the client if that happens.

So great strategies, and certainly think that we need to have more education in our medical schools. Even our pharmacy schools, around this issue of addiction and what the role is of the provider in addressing the issue, which is important.

So we like to always get to know the people behind the practice, so I’m gonna ask you a couple questions that may not necessarily pertain to the practice per se.
So what do you think you have become better at saying no to, and what approaches have worked for you in doing that?

Dr. Zona: I think that over time, you develop a sense of who you are as a professional, and a sense of right and wrong. As you become more comfortable with that, you become more comfortable with saying no.
An example not related to addiction, but somebody came in last week, and wanted me to sign a form to get him out of jury duty. And we talked about that, and I said, “Look, there’s no reason why you can’t. Of course it’s inconvenient, but I can’t do this professionally.” So there are some things that even though you have a good rapport with the patient, there are some things you can say no to.

When you believe in patient autonomy, part and parcel with that is exploring risks and benefits of decisions. But I feel very uncomfortable telling people what to do.
I don’t think being a psychiatrist gives somebody any special knowledge about life advice. I have lots of special knowledge in the medical realm, psychiatric realm.
But I have an ability now to explore something without necessarily having a patient do A or B. If I tell them no, and they do something against my advice, that, I think is distancing in terms of working with somebody.
If I tell them yes and then they do that, then they’re coming back the me saying, “Okay, you gave me good advice before, what’s the advice now?”
And I don’t think that’s appropriate. I think a physician-patient relationship should be about teaching, taking care of them and encouraging them to develop their own decision making.

Gina: Empowering them to do that. That makes sense. Being a facilitator, if you will, of decision-making.

Dr. Zona: I like that. I could’ve said that, and not answered the whole paragraph way.

Gina: We got there, which is great.
So if we’re playing off the idea of the word Harmony, what do you think it means when I say “to live a life in harmony”?

Dr. Zona: I believe that harmony is about inner conflict and attachment, and a life of harmony is a life where you’re at peace with yourself, and you make efforts to detach from psychic or financial connections with things, and you’re more in touch with your spirit, or the things that help others on the planet.

Gina: Very nice. Thank you for that. And if someone wanted to access your services, how could they get in touch with you?

Dr. Zona: In our office, anybody who wants to speak with somebody, to inquire, they just call me directly on my cell phone. So that telephone number is 310-261-0035…310-261-0035.
I have a website, it is www.michaelzonamd.com, like Mary David, .com.
That’s the best way. If someone calls me on my cell phone, I answer the phone. If I’m with a patient, I never answer my phone. And I encourage people to call me up til 9 o’clock at night. I’d say about 90 percent of my calls, I can get back to within 24 hours.

Gina: Very nice. Well, thank you so much for taking the time to visit with us today, we’re excited about working with you, and wish you best of luck in all your future endeavors, including your fly fishing.

Dr. Zona: Thank you. Bye.