Jill Billions

“Almost everybody knows somebody who’s had a problem with addiction. People have the idea that a drug addict is someone with a needle hanging out of his arm or someone who’s high, out of his head. But that’s just not always the case. Most of the time, we see people who begin drinking alcohol—or taking a prescription drug like Lortab—because it makes them feel good. They don’t act impaired, they act like they have energy and they feel good, and they usually are getting their work done. In the beginning, no one knows there is a problem. But then the person gets so far into the addiction that his tolerance for the drug or alcohol grows, so he starts taking more and more—or adding other stuff to it. That’s when the situation becomes very bad.”

Billions’s interest in addiction medicine grew from a health crisis of her own. She was practicing internal medicine six years ago at UAB Medical West when she awoke one night paralyzed from the waist down. Her husband, Bryan Billions, M.D., is a neuroradiologist at Baptist Medical Center Princeton, and he rushed her to Princeton, where a CAT scan revealed a ruptured cerebral aneurysm. She was immediately transferred to UAB Hospital, and neurosurgeon Winfield Fisher, M.D., performed surgery that day.

On brain surgery and family history: “I had a huge hemorrhage, and I really should not be here. My neurologist thought I would die, or certainly not be the same. “My family has had a history of headaches, and since my surgery, my sister has had surgery for an aneurysm. It apparently runs in our family. Dr. Fisher did my sister’s surgery, too, and she is doing very well.”

On her developing interest in addiction medicine: “I really liked internal medicine, but I felt pushed to see patients fast. And when I came back from surgery, it was better for me to take a slower pace with people. Plus, addiction runs in my family, and I began to see how personal pain—the hurt we have from childhood and throughout our lives—affects people physically. Almost dying certainly changes your perspective on life, and Dr. Skipper thought I was well suited for addiction medicine.”

The UAB program offers inpatient detox, a residential stabilization unit, partial hospitalization, and intensive outpatient and aftercare services.

On the UAB program: “The duration of the recovery program usually is eight to 10 weeks. We try to tailor the program for each individual patient. We offer a trauma track for those who have been traumatized. We have family therapists who help bring cohesiveness for the family and patient. We do neuropsychiatric testing if that is needed.”

On the challenges of recovery: “Recovery is about getting over the denial and enabling that go with addiction. Getting off of drugs or alcohol is one thing. But patients have to learn to draw boundaries. And they have to learn healthy coping mechanisms. A lot of that involves emotional and spiritual issues, dealing with parts of their past. It’s a multifaceted approach, and it works. And it’s very healing.”

Billions sees patients from throughout the population in her practice at the UAB Addiction Recovery Program. But the program specializes in health-care professionals, especially physicians, nurses, pharmacists, and veterinarians.

On the problem of addiction among health-care professionals: “Health-care professionals are susceptible just like anybody else. Statistics say their rates of addiction are about the same as the general population. But I think the problem in health care is a little more common because of the availability of drugs, high levels of stress, and the fact that health-care providers are so sheltered and so enabled in many ways.”

On the psychological makeup that can trigger addiction: “A certain personality tends to be drawn to the health-care professions. We see a lot of people-pleasing, codependency, perfectionism. Health-care professionals tend to carry all the weight, but they don’t know how to take care of themselves. They don’t know how to say ‘no.’”

On the process of addiction: “Addiction is a dopamine disease of the brain, and you can’t just turn it off. If it’s there genetically, and you’re trying to take care of everybody else and don’t know how to take care of yourself, you can go down the slippery slope. “There’s a snowball effect, and people get into denial and don’t know how to get out of it. Most of the time, people stumble into the problem innocently and then get caught up in addiction. They feel guilty and ashamed, and they didn’t know how to set boundaries in the first place. We hear that story over and over.”

On the keys to recovery: “With health-care professionals, the success rates are very good because we have a five-year monitoring program that is mandated by state boards. More than 90 percent of them will recover without relapsing. With the general population, the recovery rate is probably in the 20 to 30 percent range. With the accountability we have with health-care professionals, the rate goes way up. “In the general population, so much depends on how motivated the person is and the support he has from family and friends. If the patient is ready, and is willing to take direction and be honest, he will do well.”

On the special challenge of insurance: “Insurance often will pay for only a couple of weeks of treatment, and it takes much longer than that to get better. That’s a big problem in recovery, and I would like to see insurance companies start paying for the care our patients need. When someone is addicted, we know the number of ER and primary-care visits for both them and their family go up. In terms of health-care dollars, it makes sense to treat this disease so whole families can get their quality of life back.”

On the beginnings of a career in medicine: “We started an intensive physical therapy program for my daughter, and through that experience and meeting so many people who’d had similar experiences, I began to get interested in medicine and primary care. “My experience showed that people often are sent to specialists, but there is no one person who is willing to walk them through something that is so big and challenging. I felt there was a need for someone who could bring everything together and educate patients through the process. “I signed up for classes at Pensacola Junior College and started volunteering at a hospital emergency room. I had never really had any science classes; I thought DNA was a rock band. My counselor said I just needed to read some books, catch up, and get into it. I started doing well in school because I had a real focus and a purpose.”

On her days as a single mother of two, going to medical school: “It was tough, but it was also a great experience. I had to be creative with my studying. The kids and I would go to bed early, and I would get up at 2 in the morning to study before I got them up. My mom and dad kept the kids on weekends, and I had a lady who helped me during my clinical years. It was really a family working together.”

On life outside of work: “I have four kids, so a lot of my time is with them. My husband and I both love to cook, and we are active in our church (Riverchase Community Church). We just built a house, so I’m doing a lot of decorating. I love to read, and I’m looking to take some painting classes; I want to keep that going. My oldest daughter is in a wheelchair, so we have to think about access for her. We do a lot of entertaining, and we love to have people come to our house.”

Billions has seen steady progress in the field of addiction medicine. Naltrexone, an opioid receptor antagonist that blocks the pleasurable effects of alcohol and reduces craving, is a major step forward. One of the biggest challenges is the prescription drug Lortab, a painkiller that is similar to Oxycontin.

On the trouble with Lortab: “The number-one abused prescription drug is Lortab, and it’s a huge problem. It’s what you usually get when you’ve had surgery, had your wisdom teeth pulled, any acute pain. It’s in the same class of drugs as Oxycontin, but Lortab is prescribed more frequently. “This drug is so sneaky. Patients usually get it for legitimate reasons, but they take too many and become dependent on it. I saw a lady recently who had gone to her doctor with a sore back and got 120 Lortab. She went back about a month later and got 200 more. She could get as much as she wanted, and four years later, she was isolated, separated from her family, totally addicted.”

On the need to educate physicians: “A lot of doctors don’t know about the dangers of addiction. It’s hardly taught at all in medical school, although we are starting to teach it more at UAB. This is a particularly big problem in small towns; doctors are doling it out way too much. “You don’t give these drugs without a valid reason, and you don’t give them long-term. Lortab is a short-term drug, for five to seven days. A patient taking it for chronic pain needs to be monitored for signs of addiction. Education about prescribing practices is a huge part of the solution.”

On public perceptions about addiction: “For years, people thought it was a weakness. Of course, we also thought schizophrenia was caused by poor parenting. Addiction spans stigma, prejudice, and misunderstanding. But we know it is a disease of the pleasure pathway, the dopamine system, of the brain. With all of the major drugs of abuse, their sites and receptors have been mapped; we know where and how they work. We need to continue to educate people.”

On the spiritual side of addiction recovery: “We have a 12-step program at UAB, which does have a spiritual component, and we do cognitive therapy. I’m a very spiritual person, and I believe we all have pain. Whether it’s big or small, it’s all on a continuum, and we all do things to try to make it better, to get relief. The people who pick up drugs and alcohol and continually go back to that don’t know how to reach for something healthy. If you go to drugs and alcohol, and you are genetically predisposed, it will become an addiction. “In the 12-step program, teaching the patient about healthy coping mechanisms is part of the spiritual process. Patients are taught to look toward a higher power to lean on rather than a drug. “It focuses on things that make good psychological sense. Talking to other people, making restitution to those you’ve wronged, taking daily inventories, being honest, talking about fears and anger. People who do these things, get better. I see it work over and over.”