Guest: “Steve Bisson,
LMHC Therapist, Coach, Author, Podcaster”
Learn about recovery courts and how they differ from recovery programs most healthcare professionals go through. Steve reminds us of the need to offer understanding, accountability, and program individualization. One size does not fit all and individualizing the approach will improve success.
Transcript:
Terri: Welcome back everybody, today my guest is Steve Bissell. He is a therapist, coach, author, and podcaster. He’s done a lot of work with those with substance use disorders and I’m really looking forward to our conversation today. Welcome, Steve! Let’s get started by you sharing a little bit about your background.
Steve: Well hi Terri, thank you for having me on. I’ve been working in the substance abuse field since 1999, so that’s about 24 years – if you count my family it’s been 47 years. You know, I don’t think it’s out of the ordinary if you have more than four people in your family, directly or indirectly, you’re probably involved with substance use in some way shape or form. So for me, it’s not a way to put down my family but rather to show that we probably all have faced it at some point in time. I’m a person who did substance abuse counseling in jail, I did substance abuse counseling in parole, probation in the community, in the community services that I worked for as well as now my private practice, and working with that I also was able to open two drug courts in Massachusetts and am very proud of that, so I’ve done a lot of work with substance use, and I think that it’s a process but we definitely – everyone can get into recovery or at least sobriety.
Terri: That sounds great. Did your experience with your families impact you wanting to get into this field at all?
Steve: Ironically not at all, it made me want not to be in this field.
Terri: Interesting.
Steve: When you’re you’re with your family they don’t really listen to you, so I’m like, if that’s going to be the case why would I do this if nobody’s gonna listen to me. Yeah, you know you go into a different place and I think it’s interesting when it’s not family how much people listen more, but that’s my experience.
Terri: I know, you give advice and I know for me, your kids or what have you, and they don’t hear it and then somebody else tells them the same thing a year later and it’s like “excuse me, you know I told you that.” Okay, never mind. I know when we talked previously a lot of your background is with First Responders and those types of things – I don’t know if you can tell us a little bit about that because I think it reminds us that – you know my focus is mostly the healthcare professionals – but there’s a lot of high functioning people out there that have this problem. Healthcare professionals are just one small factor.
Steve: Well I think that having worked in an emergency room on and off for 15 years, I also know that from that medical perspective, but because of my work on the crisis team I ended up doing some ride-alongs with cops and have been around firefighters, so I ended up being a source of referral for people because, “Oh he knows how it is.” Obviously, I’m never going to claim I was a cop, I’ll never claim I was an EMT or a firefighter or paramedic, but I certainly have been there and have thought a lot of people in those situations, and sometimes dealing with, you know, people say it’s trauma, and they always go to trauma just like they do for veterans which I work with too. Ultimately it’s not necessarily trauma, it’s everyday stressors sometimes that really make you turn to alcohol to deal with it, or substances because you know sometimes it’s that ability, just like in the medical field, to get away with it for lack of a better word.
Terri: Yeah, they do deal with a lot of stressors daily – you know I hear about the trauma load in people and some of us are more susceptible than others – do you think the same plays out for people in that first responder category or do you think that because they do see so much more on a regular basis that maybe there are some that don’t have those high trauma loads that still succumb to substance use as substance use disorders?
Steve: I think trauma and substance use are usually very connected and for First Responders I’ve always had the thought that it’s not the first trauma that really triggers you, it’s the 27th one, and when people say “Well you need to see 27 traumas” – no it could be vicarious trauma, you know, I know if someone is triggered, I’m not trying to trigger anyone here, but you know you can carry your first blue baby so to speak and that doesn’t bother you, get to number three or a third firefighter telling you about it, that might screw you up, and then you don’t know how to deal with that thought process and how to deal with it so you turn alcohol, you turn to drugs and it’s a way to cope because sometimes it’s hard to open up among colleagues in regards to that. So I think that between trauma and what I would call mood issues it’s not like you can tell someone at work, “I’m really struggling with some of my Suicidal Thoughts,” as soon as people hear that in that field it’s like “oh you can’t have a gun” because you have a gun or you have access to stuff because you’re a paramedic or what have you, so I think that there’s a lot of stigma of talking about it because it’s not only trauma, it could be, like I said, you know you’re having domestic issues at home – not necessarily violence but domestic issues at home or neighbors or other family members – and where do you turn? You can’t turn to your colleagues because your colleagues might report you – now you lose your your place at work, possibly unable to work ever again in that field just because you mentioned offhand that you had some suicidal thoughts for example.
Terri: Right yeah, I know that that makes perfect sense, and especially those that do carry the firearms and stuff. You said something else that made me think too – when I think of substance use disorders and Healthcare Professionals, in my mind I think more of the stressors outside of work – yes work plays into it because you’re there, but you talked about seeing death and I think that we can’t forget that, right? I mean I remember my first experience in the ED, code blue on the table, could not save them – I was the pharmacist at the bedside, and you know I’m in my 20s and it’s like – “oh this is the first time I’ve seen this right in front of me” – and so we can’t forget about that, especially those that are newer to the job and when you have that first one, I used to try to remember that when I worked with new people, you know Pharmacy residence or what have, it’s like okay we can’t just dismiss this, let’s sit down, “Are you okay, let’s talk this out because that is a big deal when you go through those things.” You mentioned Recovery Court – tell us a little bit about that because I still am not very familiar – you explained a little bit to me – but for those that really aren’t familiar we’re going to talk about recovery court and what you see, and then we’re going to contrast that to recovery programs for healthcare professionals and how do they differ – and I know that there are certainly cons – I’m not sure if there’s pros and cons to each one, but I know you have some opinions on the difference, so walk us through Recovery Court – what does that look like, how do you get there, what does that look like?
Steve: I’m pretty sure it’s not a three-hour show so I’m going to try to make it as quick as I can
Terri: So, bulleted points…
Steve: You’ve got to have a collaboration between the D.A., prosecution, a judge, police as well, as treaters in the community in order to make a very effective treatment Court – that’s one of the first things you’ve got to have. If you don’t have all of those individuals on board you’re already not going to have a good successful drug court or treatment court or Rehabilitation Court – they have all different names in different places – that would be number one. Number two, I think that what you also need is a willingness from the participant, so drug court in some ways is a lot harder than doing probation or parole because you have to go to many meetings, go for more urine tests than the typical person, you have to also come to court once a week to just talk about, are you going to therapy, are you getting medication, due to your issues there’s a lot more that has to be done in a drug court or a rehabilitation court than you do anywhere else – so there’s that process there, but you know we choose people based on willingness to participate and if it’s the right thing and what I mean by that is this: a lot of people have the misconception that recovery courts are going to take someone who’s distributing substances. No, we’re not taking those guys, you don’t want someone who is causing crimes, they’re not necessarily users, they’re just selling. You also don’t want the low-level people and what I mean by that – and this is not to play it down, the person on their first DUI are not people who are high risk-high reward – that’s what we call the important people, so you got someone maybe on their third DUI or their third arrest for a possession of a Class A B or C – different states have different names, that’s what we call it Massachusetts – and they just can’t kick it, they go to jail and they kick it while they’re in jail for you know 90 days, a year, two years depending on how long the sentence is, but they come back into the community, they just can’t keep sober, so we call them high risk- high reward individuals. So we don’t want people who are not at risk and we don’t want people who are distributing, so that’s kind of one of the first things I would say those people are usually identified either by the judge, the prosecution and or the D.A, it’s brought into a meeting we have once a week before court and say, “All right Jane Doe, blah blah blah blah blah, and why do you think it’s a good candidate, blah blah blah blah blah, here’s the opposition and we can oppose it or if not we can say no this is a great candidate, let’s take them on and then we review every week, let’s say there are 20 participants in the drug court – “How is Bruce Smith doing? There’s no such Bruce Smith, maybe there is one, it’s not my guy – and then we talk about Bruce Smith, what is he doing well, you know, three times the cops will call his house in the last week and the cop talks about what was the content of those interventions – or no, we haven’t heard anything from him, he’s showing up for treatment and he has these very defined therapists and treaters because those are the ones who will understand where it’s coming from. So it’s not that, we can’t send them willy-nilly to any therapist but sometimes, you know, we know John and Jane and Julie and Frank do all great jobs so we’re going to send it to them, so we tend to have those meetings once a week. And once you pass the 90 days you can come every other week or every month depending on how well you do, and at the sixth month, you come in once a month and if you graduate it takes a minimum of a year of doing all the right steps. Typically people don’t graduate in a year – why? Because there are relapses and lapses – I call them lapses, some people will call them relapses – and that definition of relapse is going back into old behavior, lapses are you made a mistake, and for me it’s important to realize that. I’m not gonna bore you too much about motivational interviewing but part of motivational interviewing, one of the stages is relapse. You know if you’re going with substances it’s going to be hard to stay away from it for a long period of time, not because we’re ill-willed or not good, it’s just difficult and I think the drug courts take that into consideration. So if someone you know tests positive for THC, for example – just making it up – maybe we put them back to day one of the program. Maybe we say, okay get a clean urine in two weeks or we’re not just gonna attend more meetings that week, for example, it’s all voluntary so the individuals who are in drug court are not forced to be there. They’re voluntary which is important to remember and so if they’re clean after two weeks, maybe you say all right we’re going to continue where you’re at but we are keeping in mind that you lapsed at one point so there’s flexibility and it comes with that. I’m not saying we’re doing that with everyone I’m just giving you a very wide example, but the point of the drug court is that we have a collaboration with different disciplines. We also have, I think, a flexibility that you don’t necessarily get anywhere else and it’s not a flexibility that’s, you know, not smart, so you know if we have someone who you know regularly commits violent crimes on cocaine for example and they test positive for cocaine they may not get a chance to stay in the community. They may actually go back to jail for a week or two or whatever to just give them that jolt of waking up or if they don’t wake up and stay in jail we are we know that the drug courts are about 80 to 90 percent effective; when I say effective, it’s roughly 80 something percent that people do not show back up in the system. The typical number in – I haven’t looked at numbers for about 10 years, but at one point it was 60 that would recidivate within six years, now recidivating within three years – and that’s why drug courts do work but it takes time. It takes a lot of people on board but I also think that it gives enough space so that I’m going to make a mistake while I’m doing this podcast, I’m going to make a mistake not because I wanted to but because I slipped or what have you and it gives you that leeway to slip and have a mistake that I think sometimes people do not understand the chronic issues with substances.
Terri: Okay, so it sounds to me like it’s a large group of people, more so – the group is larger to hold you accountable and walk you through that process and then be there – they understand and they’re forgiving, but they’re still going to hold you accountable depending on what the misstep was – it’s kind of that community, so obviously law enforcement had to be involved in the first place for you to get there. Does drug court – is it ever in lieu of going – I mean if you mess up you could, like you said, end up back in jail – but is it ever, like “okay we’re gonna put you out on probation, you agreed to do drug court and you just saved yourself a couple of years, assuming you don’t end up back in there?”
Steve: Absolutely, this is the goal – to prevent people who have what we would call a chronic health condition – which is substance use – going into jails which they’re not equipped to take on people with health issues – the jail is about different things – or House of Corrections depending on where you live – but at the end of the day you’re trying to keep someone out of jail by making them accountable and one of the things I forgot to mention is if you’re in law enforcement, you’re sticking to law enforcement – you’re not saying this is what I think of treatment because that’s not your job – your job is to be law enforcement, my job is now to tell the police to arrest or not to arrest someone, my job is to talk about treatment. The judge is impartial and has to make a decision based upon his knowledge of drug courts or recovery courts and how that works, so everyone keeps to their lane, but it’s a collaborative effort so that you know I’m not going in telling the prosecution that they’re idiots and they don’t come in and say your program sucks. So – and I’m making that up, making very broad statements here – that never happens really. Ultimately you stay in your lane but also, you know we have people who understand more of the Chronic process of substance use so if we can keep someone out of jail – let’s go with easy numbers – I think keeping someone in drug court is about twelve thousand dollars, thirteen thousand dollars, depending on what insurance and the time and all that; putting someone in jail I know Massachusetts numbers is about 65, 000 a year.
Terri: A lot less expensive, and better outcomes in terms of recovery. I mean, that’s not your goal in jail to get them to recover, although I imagine there are probably some programs.
Steve: There are some programs but they also don’t have the accountability that the recovery courts do, and the other fun part is when you’ve had a drug court or a recovery court for three, four, five years you have alumni that come in and talk to these guys who actually – you know I say guys – women are obviously, sorry for my sexism here, but um it just gives you accountability because you know John Doe who’s been through it can tell you, “Hey you know what? I know this part is hard and there’s kind of like that peer support system that is created based upon that.
Terri: Right okay, so for healthcare professionals where law enforcement did not get involved, they have either confessed or been found out and then confessed, and they’re going through a recovery program – probably through their state, their professional licensing board – I can see up front you don’t have your judge, you don’t have your law enforcement, but they are in recovery and they are in a program surrounded by people that are trying to keep them accountable – other than those differences that I mentioned what do you see about the pros and cons, because I suspect you’ve had some experience with the licensing boards and Healthcare professional recovery programs.
Steve: My experience with licensing boards is they change from one discipline to another. What I mean by that is we’ll stick to Health Care, sometimes they can be supportive but they’re highly likely corrective and corrective basically means that if you diverted a hundred pills you get treated exactly the same as someone who diverted seven pills. To me, treating them as equals is not fair to the individual because someone who diverted seven times that we know of obviously and someone will always argue that with me well maybe they need more of support in regards to their using, their slipping, how can we give them that process? Should they be suspended? A hundred percent I get that the version is a problem in the health care field, to suspend them as long as the person who diverted 100 times that we know of seems to me that there’s that’s not exactly the same type of issue you know and I think that that’s one of my biggest complaints about licensing boards is that even in mental health if I say if I did something wrong – XYZ name it – I go to my licensing board based upon what I did, they’ll either give me some classes to go to, they might take away my license, they might also just give me a slap on the wrist depending on what it is and that to me is more of a supportive rather than a corrective method. Sometimes people need corrective and I get that but we need to find ways to be not only supportive but also set up some times where you’re also preventative so if you have someone who you suspect of diverting why aren’t we trying to support that – “okay we caught you once we don’t want you to lose your license we don’t want you to lose everything, how can we help you get back in a corrective system where there’s maybe some support that you need, maybe you need a little more discipline around XYZ” but not put them at the same level.. And when I’m saying 100 you know –
Terri: You saw chronic versus more of an acute – a new thing that has started, yeah.
Steve: And if you did seven diversions in seven years, yeah still a problem – do not get me wrong, that is a problem, I’m not arguing that, but I’m arguing that it’s way different than a person that lifts 100 pills in one shot, and unfortunately in my experience with licensing and I don’t want to pick on one particular license but you know my experience with a particular board which is nursing is that they treat it the same exact way, and that is the problem. I also feel that the other problem that happens in licensing board is that if they do have someone they’re going to be skewed towards the licensing board, if not, then they send him willy-nilly to different people that they don’t even know if they’re getting the support they need or not – they don’t have designated people in general – and so I think it’s finding that neutral partner because as a mental health counselor and a substance abuse counselor someone comes in with a substance abuse issue, I got to be neutral, I can’t be like, the licensing board wants me to do this. I can’t do that same thing in drug courts, I didn’t go in saying the judge wants me to keep him out of jail or the judge wants me to put him in jail, no I got to look at him as an individual. I don’t think we have that necessarily on different licensing boards across the board so to speak – no pun intended – and it’s learning to be able to treat people for what they’re doing. Drinking on the job is different than diverting pills – not that I’m okay with someone drinking on the job – I’m just saying that it’s different and there’s no space I find in the licensing board to make that difference between them.
Terri: Yeah well I think it goes to what you were saying, if somebody is taking a couple of benzodiazepines occasionally to somebody who is in the fentanyl on a regular basis and using it while at work, as opposed to taking it home to help them sleep – and I mean it’s diversion, they could still have a substance use disorder depending on how far they’ve gone with their benzodiazepines – but it is different. Not that they shouldn’t be held accountable, but I think what your point is that treatment looks different, right, and that’s what we should be doing, we should be holding them accountable, but we should be getting them the treatment that they need and that looks different depending on what the situation is.
Steve: I agree with accountability a hundred percent, but I would also argue that there are clinics, hospitals, whatever you want to call them that sometimes are very tentative on reporting some diversion until it gets chronic and then it’s out of control, so I think that there’s a lot of layers. I agree about the accountability but if I’m stealing 100 fentanyls so I can sell them on the street that’s way different than two diazepines because I’m having trouble sleeping at night what have you so I think that that’s where I’m saying that having different levels of corrective programs would be beneficial to so many people.
Terri: Yeah it does need to be individualized so from your experience and what you’ve seen what do you think is the best approach to handling a healthcare provider who has admitted – whether completely voluntary on their own or who has been caught and then admitted – that they need some help. What do you think is the best process for them to get that help?
Steve: I think that there’s such a difference between someone who volunteers that they’re struggling with that or they have done some diversion or what have you versus getting caught and then confessing, and to me there’s a big difference between the two because one becomes a lot more corrective and concerning someone who offers that information and does it on a volunteer basis, like I need help. You know, I work in the substance abuse mental health field and if someone comes to me and says I need help – “No, wait till you get in trouble with the law then come back and see me” – it’s screwed up when you think about it that way so I think it’s finding a way that there is a volunteer service where people can say “Look I’m struggling with this I want help” so that they’re not losing their license, losing their good name, and having to go through the same thing as someone who diverted a hundred fentanyls.
Terri: So I’ve talked to people before that have admitted that they have a substance use problem and they’re struggling and they’re a healthcare professional and the therapist has said “Okay well you know just don’t do this at work and then let’s talk through this and let’s work through it” and it didn’t work. You know the healthcare professional was not being honest with their therapists and yes, so as a therapist if someone were to come to you and they were licensed and they were working and they’re admitting to you they have a problem, is there some sort of contract or accountability or connecting with their employer or making them connect and prove that they have connected and taken themselves out of the workplace that you would require as their therapist?
Steve: I mean I don’t have that ability to do that, but let’s play in a nice dream world I would like to have: a professional comes to me and says “I’ve been diverting because I have a substance abuse problem, I don’t know where to go from here but I don’t want to lose my job.” Okay so let’s come up with a plan of you telling someone and letting them know that you know if you want some supportive and preventative treatment versus a corrective treatment – so in the la la land that I live in, there would be different levels where they report themselves but after a week – this is standard even when I worked with the law enforcement field – you tell them you look like a hero, I tell him you look like a jerk, you choose, right and most people don’t want to look like jerks, and so I this is why I would say you always give a little leeway for people like “Okay you report yourself, here’s what you want but there’s such a stigma of if, I report it I’m screwed – I don’t know if I’m supposed to swear here so I’m keeping it nice and PC – but at the end of the day that’s where the problem lies in my opinion is that you know if I was diverting and I don’t deal with medication anymore, hope I never divert either, but we don’t have safety, we have fear and what do people do out of fear, they shut down or they don’t report until they get really caught and then it’s out of control, and then we’re in a corrective mode and they’re stuck at a point where they’re highly likely not going to get their licensure back.
Terri: Yeah, they’ve got to be really confident in their employer before they’re going to go admit it so I guess you could take a leave without telling them, you could quit but then you lose any insurance, but to face it and say “I need time off to deal with this” – that is very scary unless you know you can trust that employer and that culture is there.
Steve: Right and I just want to go back to a little bit of law enforcement and correction versus what you’re talking about just quickly, if someone in correction admits to a substance use problem what they do is they send them to a specialized program that work with correction and First Responders and then they say you got to be there for 30 days, and after your 30 days we can come back and reassess if you can reintegrate into the work community, that’s brilliant. To me, that gets you the specialized treatment and you’re not losing your job because you admitted to a problem. I think I see that in not every department that I work with but several departments that I work with there’s a lot of support on that. If you go tell your nurse director that you’re having – and I’m picking on nurses I’m sorry I’m not trying to pick on nurses – but the nurse director looks at her liability, what’s going to happen to her and then reports quickly and then becomes a big problem so I don’t blame the nurse director either because she doesn’t want to get in trouble, but we just got to find a way to get where, “Okay great you told us, let’s do treatment but you gotta do district 14 Nation or what have you and then we reassess where you’re at, if we’re gonna report you, if you’re doing the right thing or if we’re going to be able to put you on disciplinary action and you’re not able to touch medication for six months, six weeks, or whatever, and then the disciplinary board doesn’t have to be done by them but rather the employer – again, I live in la la land and I get it.
Terri: Well yeah, that is ideal. I think, I don’t know, I feel like we’re making strides but maybe I just feel like that because in my circle of people we all feel that way and we’re trying to disseminate that message and we’re seeing some more buy-in but I think we have a long way to go. Now would it be fair to say that if somebody has a substance use disorder, it is oftentimes or maybe all of the time a manifestation of other coping or mental health issues that they kind of came into their adult life and their profession with, and if that is the case then I suspect that’s really where you want to go as a therapist, right, you’ve got to get them to the point that they can deal with those stresses and then find a different coping mechanism, but you can’t really do it when you’re trying to get them off the substances, right, so this is a long process.
Steve: I mean at the risk of sounding like I’m plugging my podcast but I think the podcast you had to listen to with Jake Nichols and Pat Rice, that’s exactly what we talked about. 99% of the time it is a manifestation of some sort of mental health issue that’s underlying to the substance use, and the biggest issue is that you’re not going to get to the mental health issue especially with chronic users for at least six months to a year because they’ve got to sober up, their brain has got to stop lifting that fog, and really start making those connections as it should, but not a lot of people have that patience to wait – that’s six months to a year for treatment so and the mental health part is in my opinion, as I have said before to someone else, is that I think of all my clients I’ve had at the risk of sounding cold, I’ve had one straight drunk, no mental health issue, just likes his drinking, and the rest of the time they always had some sort of underlying mental health issue.
Terri: Okay interesting, yeah so it can happen but not very likely. Okay, so given that there’s probably a coping mechanism type thing, some of that trauma in the past, they don’t know how to deal with it, now we’ve got to work through the abuse, What would smart reintegration for a healthcare licensed Healthcare professional or really anyone – somebody that’s carrying a firearm too – what would that look like to you in terms of how long – and everyone’s different I know – but typically the process in a healthcare facility, what would that kind of look like to you professionally and intuitively – how long does this typically take and when can – I guess another way to say it is if a facility was interested in doing the reintegration piece of it – what do you think they should be looking at in terms of, “Okay if this person goes through the program and you know a year from now or two years from now, when should they start to consider reintegration?”
Steve: Well, I think it would be this: unfortunately just like we said earlier, it would be a case-by-case basis, number one. Number two, I would say it’s a little bit as when we have a physical health issue – to me physical health, mental health, and substance use – all the same when you have a physical health issue. Let’s say I break my foot and my job, it doesn’t really matter, but if you’re someone who is a police officer, for example, well you got to go through six weeks of protecting your foot and so on and so forth and then for the next two to three weeks you do rehab or something like that, you don’t go back to standing, you know and doing directing traffic, you probably have light duty for lack of a better word and then after that they reevaluate until you’re ready to go into your physical job of any kind to make sure that you’re physically okay, I think it goes a little bit with the treatment of mental health – if you’re a chronic fentanyl user for the last three years I think putting you back to work in a month and a half is probably not likely at all but it may be something like for that may be taking six months again, individual assessment of individual needs, someone diverts a couple of times because they can’t sleep because they’re afraid of domestic violence at home, then yeah and treatment again is key, but at the end of the day – maybe for them after a month of treatment – they get to slowly reintegrate with the light duty for, like a better word, maybe they’re not distributing medication, maybe they’re sitting at a desk answering the phone, I really don’t know and I’m not trying to choose a job for them, but they do light duty and then reassess until they’re ready to go back to that, so again the difference between two diazepines versus you know 100 fentanyl a day – and I’m exaggerating to make a point – I think it’s got to be individualized instead of looking at it as well one size fits all. I mean if I break my foot it’s going to look different than what Terri does when she breaks her foot. Why? Age, weight – there are a lot of different things that we keep in mind, but when we do that with substance use, no, everyone’s the same. It seems really crazy to me.
Terri: No, that all makes sense. To what you’re saying – and what is the name of your podcast?
Steve: My podcast is “Finding your way through therapy.” Been doing that since May 2021 and really enjoy it so hopefully people can catch it.
Terri: So more from a different perspective and I’m sure you have a lot of great discussions on that. Okay, well this has been good I learned a lot, it was very applicable and I think it just gives another once again another perspective that not everybody that is caught is the same and we do need to individualize even that piece of it which really kind of brings home it’s important if we can to learn even more about how they got there and then that will help us whether that’s you know us in the interview phase or whether it’s the employee health or the therapist that takes over and then shares that with the facility itself as much as they’re allowed to do so that they can make an educated plan about how to reintegrate them if they’re willing to do that and how long that might take and what it might look like.
Steve: That’s what we would do with students, right – in school – so it’s the same thing we should do with our Healthcare Professionals in my opinion.
Terri: Absolutely, makes perfect sense. Okay Steve, thank you so much for your time today I really appreciate it!
Steve: Thank you, Terri.
