Blog & Announcements

Denver Mayor Mike Johnston declared a homelessness state of emergency on July 18 — his first act as the city’s new mayor. According to the U.S. Department of Housing and Urban Development, Denver ranks tenth in the nation for homelessness and third for sheltered homelessness — rates higher than Las Vegas and almost as high as San Francisco. This week, the Denver city council voted to extend the state of emergency to August 21 in light of new data indicating higher rates of homelessness than previously known. As of this writing, an estimated 9,065 people are homeless or sheltered homeless in the Denver metro area. “The homeless population has grown 31% over the year before. The number of those experiencing homelessness for the first time rose by 51%. The greatest percentage increases were among families, increasing 64%,” according to CBS News.

Homelessness and behavioral health disorders are strongly related. Addictive disorders and mental health conditions can lead people to become homeless or housing insecure, and these conditions can be the result of becoming homeless. However, evidence suggests that social determinants of health, including housing affordability and employment status, are the primary drivers of homelessness. This week's Dow Jones MarketWatch report indicates that rising rents are the leading causes of homelessness nationwide. The article cites Steve Berg, chief policy adviser at the National Alliance to End Homelessness, who says the "number of people who lose their housing and become homeless is [going] up faster than the number of people who are homeless and move back into housing." Berg goes on to say, “rent is the No. 1 issue…for 75 years, the long-term trend has been that the cost of modest rental housing has been going up faster than modest income."

The U.S. Department of Health and Human Services identifies “five domains” of social determinants of health, including economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Deficits in any of these domains can mean significant adverse life events for entire family systems, including medical problems, limited opportunities and upward mobility, mental and behavioral health disorders, housing insecurity, homelessness, trauma, suicidality, and more. As has been widely reported, social determinants of health, especially those linked to purposeful employment and a sense of community belonging, maybe a significant driver of the epidemic rates of suicidal ideation and deaths by affecting the nation in recent years — so-called “deaths of despair.”

As behavioral healthcare providers, we often treat clients who experience housing insecurity and homelessness, and subsequent trauma. Many experienced mental health professionals and policymakers know that traumatization resulting from financial setbacks and insecure housing can make drastically reduce the odds of rebounding.

Foundry Chief Clinical Officer Michael Barnes, Ph.D., suggests that mental health conditions and trauma can be precursors and results of homelessness, and acknowledging the role of trauma is vital to helping homeless individuals and families become safely rehoused. “As a medical community and public, we are just beginning to fully understand the profound role trauma plays in a multitude of health problems. People can become traumatized far more readily than we realize, our culture perpetuates and normalizes countless traumatic stimuli, and there is a general lack of treatment resources up to the task of treating traumatized people. When it comes to the issue of homelessness, we must understand that becoming homeless immediately reprioritizes our hierarchy of human needs and changes our patterns of behaviors and beliefs at a deep subconscious level. Homelessness is absolutely traumatizing, and trauma must be addressed, processed, and resolved before people are once again able to respond normally and restore emotional well-being.”

“Homelessness and addiction are inextricably linked. Regardless of the root cause of becoming homeless, there is almost always a mental health or substance use component involved. People who are otherwise healthy are less likely to become homeless because they oftentimes have the agency and cogency to seek available resources, though this is not always the case, and not enough resources are available. For many people, unfortunately, the experience of becoming homeless is a sea change so devastating that they feel the need to use substances to self-treat the symptoms of severe anxiety and depression. Many homeless people also use stimulants to stay awake for very long periods for fear of being victimized while asleep,” says Barnes.

Dr. Barnes believes that addressing the homelessness problem in Denver and elsewhere will benefit from trauma-oriented approaches. “We still do not have enough truly trauma-informed treatment providers for the housed patients seeking mental and behavioral healthcare. My hope is that policymakers anticipate the need for trauma-informed approaches to helping homeless people because without adequately treating their underlying trauma, other interventions are less likely to succeed, and they are more likely to end up back on the streets.”

Foundry Steamboat and other high-quality providers are beginning to assess client recovery capital to evaluate their prospects of successfully maintaining recovery and developing recovery-supportive lifestyles. The program instituted the Recovery Capital Index measure in 2022, which measures individualized social determinants of health and other extra-therapeutic factors to indicate advantages or potential areas that need to be addressed using available resources.

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Men were significantly more vulnerable than women to overdose deaths involving opioid and stimulant drugs in 2020–2021, according to a new study analyzing data from across the United States.

The study, published in Neuropsychopharmacology, found that men had a two to three times greater rate of overdose mortality from opioids (like fentanyl and heroin) and psychostimulants (like methamphetamine and cocaine). The study was led by researchers from the Icahn School of Medicine at Mount Sinai in New York City and the National Institute on Drug Abuse (NIDA).

While we know that men use drugs at higher rates than women, the researchers found that this alone could not explain the gap in overdose deaths, noting that biological, behavioral, and social factors likely combined to increase the mortality risk for men. From 2020 to 2021, men had a rate of overdose mortality from opioids and psychostimulants that was two to three times greater than the overdose mortality rate for women, according to a recent study.

“Though men and women are being exposed to the modern, fentanyl-contaminated drug supply, something is leading men to die at significantly higher rates,” NIDA Director Nora Volkow, MD, said in a news release. “It may be that men use drugs more frequently or in greater doses, which could increase their risk of death, or there may be protective factors among women that reduce their risk of death compared to men. Understanding the biological, behavioral, and social factors that impact drug use and our bodies’ responses is critical to develop tailored tools to protect people from fatal overdose and other harms of drug use.”  

After controlling for sex-specific rates of drug misuse, researchers found that overdose death rates by sex for the following drugs were:

Synthetic opioids, such as fentanyl: 29.0 deaths per 100,000 people for men, 11.1 for women;

Heroin: 5.5 deaths per 100,000 people for men, 2.0 for women;

Psychostimulants, such as methamphetamine: 13.0 deaths per 100,000 people for men, 5.6 for women; and

Cocaine: 10.6 deaths per 100,000 people for men, 4.2 for women.

Higher overdose death rates for men were consistent across states, even when accounting for other demographic factors. The difference in overdose mortality between men and women was significantly more significant than in reported drug misuse between men and women. For example, men had a 2.8 greater rate of cocaine overdose mortality than women while having just a 1.9 greater rate of cocaine misuse.

“These data emphasize the importance of looking at the differences between men and women in a multi-layered way,” Eduardo R. Butelman, Ph.D., assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai and a lead author on the study, said in a news release. “Moving forward, it will be important for researchers to continue to investigate how biology, social factors, and behaviors intersect with sex and gender factors, and how all of these can impact addictive drug misuse and overdose deaths.”

The authors hypothesize that it is a combination of biological factors (e.g., men may have a greater vulnerability to the toxicity of drugs than women), behavioral factors (e.g., men may use these drugs in a riskier way than women), as well as other social- and gender-related factors.

The Loneliness Crisis

One possible factor is the lack of mitigating social connections. A 2019 study found that “females find same-sex social interactions to be more rewarding than males, and females are more sensitive to the rewarding actions of oxytocin than males.” As we reported on this blog, approximately one in five American men say they do not have a close friend. “Only 30 percent of men reported having a private conversation with a close friend when they divulged personal emotions in the past week,” wrote psychiatry professor Charles Hebert in a 2022 Newsweek article.

This comes at a cost. “Loneliness increases the risk of mental illness among men,” warned Hebert. “Persistent loneliness independently predicts risk of Alzheimer's disease. Additionally, psychiatric illnesses such as major depressive disorder often go unrecognized in men due to reluctance to discuss one's symptoms.”

Persistent social isolation, depression, anxiety, and trauma are major drivers of substance misuse and addiction. “Addiction is an illness of escape. Its goal is to obliterate, medicate, or ignore reality. It is an alternative to letting oneself feel hurt, betrayal, worry, and—most painful of all—loneliness,” Patrick Carnes wrote in Facing the Shadow. “Escaping reality for even the briefest time brings some relief. When escaping becomes habitual, we have a mental illness known as addiction.”

In a famous 2016 TED Talk, Johann Hari provocatively stated that the opposite of addiction is not sobriety but human connection. Surgeon General Vivek Murthy warned in May that “widespread loneliness in the US poses health risks as deadly as smoking up to 15 cigarettes daily. About half of US adults say they’ve experienced loneliness, Dr. Murthy said in an 81-page report.

Foundry Treatment Center Steamboat operates a specialized men’s treatment program for adult males experiencing substance use and co-occurring mental health disorders. This report resonates with Clinical Compliance Director Jasmine Aranda, LPC, LAC, LAT, TTS, ADS. Aranda, who has years f experience focusing on male clients and the issues they relate that have led to the development of dual-diagnosis conditions, sees evidence that loneliness and purposelessness may play fundamental roles in this crisis.

“Cultural and socioeconomic shifts affecting all people started well before the pandemic, but the pandemic seems to have worsened and accelerated the effects of these issues. We regularly hear clients who feel financially insecure, uncertain how long they can remain gainfully employed or hold on to housing. They fear mostly for the future of loved ones. Many men we treat feel less cohesion with family, friends, and neighbors. It can be very difficult for people, especially those in rural parts of the country, to make a living as they used to or to carry on family-owned businesses. Women, men, and adolescents are affected mentally, emotionally, and physically by these problems,” says Aranda.

“Among our male residential clients, who tend to have families and careers, today’s culture is challenging their long-standing narratives. Societal sentiment and economic realities are making it harder for men to be sole breadwinners and fulfill the role of protector. Purposelessness is a major problem for many men. Fathers can feel like they don’t understand how to navigate a rapidly changing world and lack the knowledge or skills to help their children navigate it. They may feel displaced and devalued because of increased economic disparity and the inability to earn a living that affords them a good quality of life despite working hard. Even the values of ruggedness or toughness and stoicism that were prized by previous generations are seemingly being questioned as our society becomes more open to discussing hardship and mental health disorders — which is a very good thing.”

Aranda suggests that increased rates of death by overdose correlate to increased rates of despair and perceived uncertainty.

“This program focuses heavily on the resolution of trauma and the ability of people to naturally self-regulate their autonomic nervous response to stress. Many of our clients live with a constant, debilitating rate of anxiety, hypervigilance, and panic that may, in part, be the response to increased uncertainty. We can help men by making it safe and comfortable for them to seek help, increasing awareness about the rise in uncertainty and anxiety, and helping them connect and feel valued. Doing these things could go a long way in reducing the perceived severity of the issues that drive them to misuse substances to feel normal or relieved.”

Pharmaceutical innovations continue improving the quality and longevity of life, even when beneficial side effects of these medicines are discovered unexpectedly. Numerous medications created to treat specific illnesses have found new applications because they were found to be effective at addressing completely different problems. One example is Prazosin, a medication originally developed to treat hypertension. After its FDA approval for use in 1988, the drug was found to reduce nightmares associated with Post-Traumatic Stress Disorder (PTSD), and is now sometimes prescribed for this purpose.

Ozempic (semaglutide) a diabetes drug introduced in 2017, was later FDA-approved to help people with diabetes and obesity lose weight. Recent reporting suggests that the drug could help people lose more than the desire to overeat. It may also reduce people’s desire to overuse substances, making it a promising target for treating addiction.

Semaglutide is a GLP-1 receptor agonist, mimicking the action of the human incretin glucagon-like peptide-1 (GLP-1), thereby increasing insulin secretion and blood sugar disposal and improving glycemic control. Side effects include nausea, vomiting, diarrhea, abdominal pain, and constipation.

As semaglutide increased in popularity (as a weight-loss medication), patients have been sharing interesting effects beyond appetite suppression. “They have reported losing interest in a range of addictive and compulsive behaviors: drinking, smoking, shopping, biting nails, picking at skin,” wrote Sarah Zhang in The Atlantic. “Not everyone on the drug experiences these positive effects, to be clear, but enough that addiction researchers are paying attention.”

Some physicians report that the effect of reduced alcohol use is the most common thing they hear from people taking Ozempic or similar drugs. Lorenzo Leggio has been studying the phenomenon at the National Institutes of Health. His team recently published a study indicating that semaglutide can reduce alcohol drinking in rodents (this effect has not yet been studied in humans).

“GLP-1 analogs like semaglutide may influence interest in psychoactive substances such as alcohol because they have an effect not just in the gut but in the brain, Leggio told CNN. “We believe that at least one of the mechanisms of how these drugs reduce alcohol drinking is by reducing the rewarding effects of alcohol, such as those related to a neurotransmitter in our brain, which is dopamine” he said. “So these medications are likely to make alcohol less rewarding.”

Asim Shah, a professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor University, heard similar things from people he treats. “Patients do say that they feel a benefit on their addiction, whether it’s alcohol or smoking or anything like that. People are even saying they’ve decreased their gambling,” Shah told the Houston Chronicle. “Is it true or not? We don’t have proof.”

Should that proof emerge in future research, it would yield further support for the disease model of addiction. “Discovering how the new weight loss medications alter appetite and the compulsive behavior that can be associated with it could offer new insight into the nature of pleasure and addictions,” addiction expert Maia Szalavitz wrote in The New York Times. “Adjusting brain systems that regulate desire may also affect the stigma that society pins on people with conditions that can lead to loss of control. When drugs can significantly ease weight loss or addiction recovery, it’s hard to argue that the problem is moral rather than medical.”

In her influential book Unbroken Brain, Szalavitz explained that desire comes in two flavors: the “pleasures of the hunt” and the “pleasures of the feast,” also described as “wanting” and “liking.”  Drugs such as cocaine and methamphetamines engage the wanting circuits of the brain, while heroin and alcohol are about sedation and satisfaction.

“The positive side of wanting is feeling empowered and focused on getting what you desire; the negative side, of course, is craving that goes unsatiated,” Szalavitz explained in The New York Times op-ed. “The second kind of pleasure [liking]...  is linked with the satisfaction and comfort of having achieved your goal.”

The wanting circuits tend to rely on the neurotransmitter dopamine, while liking is more associated with the brain’s natural opioids and serotonin. Having these common currencies of emotion allows our brains to modulate what we want, depending on what it perceives as our most pressing needs.

Szalavitz explains how medication-assisted treatment utilizing opioid agonists such as buprenorphine or methadone satiates “opioid craving by providing a consistent level of a drug similar to the one that is wanted, without the chaos that can prevent people with addiction from living well.”

Other medications, like naltrexone, do the opposite and prevent opioid receptor activation. These medicines, however, can reduce the experience of pleasure overall. GLP-1 drugs act differently. They modulate the motivational dopamine systems but apparently without depressing desire overall. So far, the data on using GLP-1 drugs for substance addictions are mixed. Some studies showed positive results in animals and humans, but others found no effect.

Nora Volkow, the director of the National Institute on Drug Abuse (NIDA), is funding research on these medications for drug addictions. Szalavitz quotes Dr. Volkow as saying they might work “by interfering with that urge to have more.” It will be fascinating to determine whether it is possible to alter or even create a set point that signals that “enough” drugs have been taken. People with alcohol use issues seem to lack such an off switch, while those who drink moderately report knowing when to stop.

Szalavitz hopes the research will eventually yield medications that help people “change with ease” after years of struggling. The experience with methadone—first studied as a treatment for opioid addiction in the 1950s and 60s—shows that full recovery from addiction usually takes much more than just taking a single medication.  

While medications that can help stem the desire to use substances or reduce their ellative effects can be highly effective treatment aids, experienced medical and behavioral health providers know that substance use disorders and their co-occurring mental health conditions can result from complex underlying issues that cannot be resolved with medicines alone. Essentially, reducing the effect of a substance does not necessarily address the factors leading that person to seek substance-induced relief. When considering messages promoting the promise of medications, it is important to include the fundamental concept that addictive disorders have biological, psychological, and sociological components that can lead to their development and exacerbation. Stopping people from feeling the effects of substances or being able to stop taking them does not always mean that the underlying issues causing them to misuse the substance are reduced. Creating the perception that a medication alone can comprehensively “cure” addiction should be carefully avoided.

Foundry Treatment Center Steamboat, like other experienced behavioral healthcare providers, avails clients of psychiatric medications to help control cravings and restore mental health while taking a holistic approach that considers the bigger picture affecting clients. As a program that emphasizes the outsized roles that trauma and family system issues play in developing a range of health problems, including addiction and mental illnesses, Foundry Steamboat clinicians suggest taking a judicious approach to the role of medications in personalized treatment plans.

“The problems our clients are facing are often the underlying reasons that they developed substance use disorders in the first place,” says Chief Clinical Officer Michael Barnes, Ph.D. “Medication can certainly help people feel better and help them establish a baseline from which they can deal with underlying problems, but medication is very rarely a complete answer to this very complex disease.”

Medication-assisted treatment (MAT), which has been promoted as the gold standard for addiction treatment and has been used for decades, is a case in point. While medication-assisted treatment tremendously benefits many people, others relapse and overdose, divert their medications, or change the substances they use to achieve a high. This is not because MAT is ineffective or without merit, but because many of the people prescribed medicines to reduce their ability to feel the elative effects of alcohol or opioids still face daunting problems that make them feel deeply stressed, anxious, and depressed. Problems such as family estrangement and divorce, abandonment, housing insecurity, financial instability, legal entanglements, physical health problems, and victimization are some of the many reasons that people have difficulty entering and maintaining recovery, regardless of medications they may be prescribed.

“The potential benefits of semaglutide are certainly welcomed, if studies prove its efficacy to safely reduce cravings. We need as many tools in the toolbox as we can get,” says Foundry Chief Medical Officer Dr. Jim Shuler. “But when treating addictive disorders cohesively and fully, we need to consider social determinants of health, medical and trauma histories, and lifestyle factors and treat for these. Medication, while potentially very helpful, doesn’t treat these issues. These take a different set of therapies, skills, and supports. We do not want to instill the idea that medicine is the answer because, in the vast majority of cases, the answer lies in identifying and addressing a much deeper set of issues than one’s inability to stop using substances despite wanting to. In other words, medication is just one spoke that can help keep the entire wheel of the patient round.”

“In some cases, not even the most well-tuned medication plan is going to help a person dealing with the profound effects of trauma and negative life experiences,” says Dr. Barnes. “Some problems simply cannot be medicated away. Many people simply do not have the ability to regulate their autonomic nervous response to stress naturally, and without that ability, they will either always be dependent upon medications that attempt to control it or will not experience relief. The answer, in these cases, is to teach them how to achieve homeostasis and make important lifestyle changes that moderate stressors.”

Foundry Steamboat takes a holistic approach to treating substance use and co-occurring mental health disorders, including trauma. Psychiatric prescribing, which is provided to clients in the program’s residential and intensive outpatient programs, makes a significant difference to many clients. However, the program employs thoughtful assessment, psychotherapy, fitness and nutrition support, recreation and wellness services, and specialized trauma therapies with the aim of helping clients develop recovery-supportive lifestyles and learn to reduce the potential triggers of substance use disorder.

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An inspirational article written by Foundry Steamboat Wellness and Recovery Coach is published in Steamboat Pilot & Today. This piece celebrates Mental Health Awareness Month, which is the month of May, and provides practical suggestions to support positive mental health.

Read the full article here: https://www.steamboatpilot.com/news/sarah-coleman-i-see-you-i-hear-you/

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Many people in rural America are on their own when it comes to mental healthcare. Nearly half a million, or 14 percent of, Coloradans are affected by mental health challenges, a 2016 report from the Colorado Health Foundation revealed, and many of them lack access to care. A 2020 report by the Colorado Rural Health Center (CRHC) found that of the state’s 64counties, 22 don’t have a psychologist or psychiatrist working there. 

According to the CRHC’s2022 Snapshot, “Nine rural counties in Colorado have no pharmacy, while eleven other rural counties have only one pharmacy.” Thirty-seven of Colorado’s64 counties (all rural or frontier) do not have any ICU beds.

The region around Durango in southwestern Colorado is a good example. Although many residents suffer from substance use disorder, treatment options are sparse. “The region has no recovery homes, no medical detox, and no inpatient substance use treatment facilities,” reported the Durango Herald in May. “While treatment resources do exist, those demanding inpatient care must usually travel to the Front Range.”

Many residents of rural America feel generally isolated and left behind by the modern world. In 2015, two Princeton economists argued that middle-aged white Americans without a college degree were now facing “deaths of despair”—suicide, overdoses from drugs and alcohol, and alcohol-related liver disease. They suggested that distress caused by globalization and rapid technological change probably drove those deadly outcomes. Middle-aged whites are now more likely than their predecessors to report pain and mental health problems and are experiencing symptoms of alcoholism at a younger age.

Middle-aged white males in rural areas are often also affected by so-called “man rules.” The rugged and self-reliant frontiersman is supposed to be able to “hold his liquor” and not “go on” about his feelings. Men, in general, face different expectations than women, which can impact their mental health and substance misuse. In the 2022 CRHC Snapshot, 21 percent of adult rural Coloradans reported drinking excessively.

Foundry Steamboat Rural Community Connection Effort

The Foundry Steamboat men's residential program treats adult men experiencing substance misuse, co-occurring mental health conditions, and trauma. The program offers comprehensive, coordinated treatment, including medical care, psychiatry, psychotherapy, fitness, and wellness coupled with gender-responsive and trauma-informed approaches. Its focus, milieu, and expertise make this program especially appropriate to men for whom previous treatment episodes have been successful. Foundry Steamboat also offers a virtual intensive outpatient program for men and women in Colorado and Wyoming and operates Chrysalis Continuing Care, an in-person IOP in Denver’s RiNo neighborhood. 

Foundry Steamboat team members are experienced with the challenges facing rural Coloradans, including steep rises in suicide and untreated mental health disorders. In 2022, Foundry Steamboat outreach representatives Amber King and Amanda Buckner, who hail from rural Colorado hometowns, established monthly virtual meetings to make connections between therapists and other behavioral health stakeholders in these rural communities. 

This rural community outreach and networking effort is beginning to yield results. Therapists, case managers, and peers are identifying new resources, and more people are being referred to treatment. The group’s recent discussions indicate that therapists are seeing positive changes that could make it easier for people in some communities to seek care. 

In Vail, for example, therapists have noticed that young people are becoming more vocal about experiencing mental health conditions, such as anxiety, depression, and suicidal ideation. Vail community members are also building a peer recovery system, which can help people seeking treatment and support those living in recovery.

Vail offers an important example of how problems facing rural Americans affect communities across the socioeconomic spectrum. Although Vail is a small community of 5,000 full-time residents, the town receives more than1.3million visitors per year who ski its slopes in winter and hike its mountains in summer. Tourism makes Vail a relatively affluent community and supports a range of businesses and healthcare facilities.

Despite its resources and infrastructure, Vail struggles from a lack of mental and behavioral healthcare and experiences stigmas affecting many rural communities, some of which are stubborn remnants of longstanding rural culture. And like many so-called mountain towns that attract a high population of visiting tourists, residents can struggle with forming lasting relationships or feel isolated despite being surrounded by people.

“While life in mountain towns and agricultural communities can differ greatly, rural communities can sometimes perpetuate unhealthy cultural cues by normalizing substance use as part of daily life. It can be easy for families to inadvertently keep cycles of substance misuse going by enabling or even encouraging substance use to overcome boredom, pain, or as a social lubricant. When communities are isolated from major population centers by hundreds of miles, it’s easier for ideas and behaviors — both good and bad — to remain unchanged while these thoughts and behaviors may be changing in the broader population,” says Foundry SteamboatCommunity Relations Manager Amanda Buckner.

"As a voice in rural recovery work, collaborating with community leaders throughout the state has transformed inspiration into action and helped build the recovery community organization in our mountain town,”says Rob Shearon, Founder of Reconnected, an app that helps people recovering from mental health and addiction to connect with others. Before foundingReconnected, Shearon was a program manager for the University of ColoradoCollegiate Recovery Center.

"At Reconnected, we're not just providing peer recovery coaches through our partnership with the local hospital, we're building a supportive community through a variety of social events, from non-alcoholic happy hours to mountain bike rides with the local rec district.We're creating a network of like-minded individuals who are there for each other every step of the way in their recovery journey," says Shearon.

“The fact that Vail is starting a peer recovery support network and getting community involvement happening represents major progress,”says Buckner. “When we started these Zoom meetings, we weren’t sure how responsive people would be or if it could help to make a change. It is still very early. But when we hear colleagues like Rob telling us about these successes, or that young people are feeling more comfortable talking about their problems, that’s a big deal. It shows that change is possible and that this effort can help to make change.”

Join the Connecting Rural Community monthly calls, which take place on the second Monday of each month by emailing amanda.buckner@foundrysteamboat.com.

The animal tranquilizer xylazine has become the latest scourge in the American addiction crisis. The substance often pushed under the names “Tranq” or “Tranq dope” is a non-opiate sedative, analgesic, and muscle relaxant only authorized in the United States for veterinary use, according to the federal Food and Drug Administration.

Xylazine—currently not a controlled substance—“was first noted as an adulterant in Puerto Rico in the early 2000s,” reported the Drug Enforcement Administration (DEA) in October. “Xylazine, reported as an adulterant in an increasing number of illicit drug mixtures, has also been detected in a growing number of overdose deaths. It is commonly encountered in combination with fentanyl but has also been detected in mixtures containing cocaine, heroin, and a variety of other drugs.”

“The drug causes dangerously low blood pressure, slow heart rates, blackouts, and skin wounds so severe they can lead to amputations,” reported Axios Denver on March 15. “The sedative, which makes the effects of fentanyl even deadlier, is also unresponsive to common overdose-reversal treatments, like naloxone.” The reason: naloxone (Narcan) only counteracts the effects of opioids and not of other psychoactive substances.

Tranq started to appear in Philadelphia about three years ago. The more powerful synthetic opioid fentanyl has edged out heroin in the Pennsylvania city, but the fentanyl high fades more quickly than heroin, so xylazine is being added to make the effects of fentanyl last longer. Exposure to xylazine is common among people addicted to heroin, fentanyl, and cocaine, as the tranquilizer is often added without the knowledge of the addicted user.

Misusing xylazine can have serious consequences. CNN recently reported that “the drug has side effects like ‘tranq walk,’ where people seem unaware of their surroundings, along with sores and wounds.” The sores frequently turn into horrific ulcers on the extremities and are associated with copious purulent drainage and foul smell. Necrosis of subcutaneous tissues and abscesses are common.  

Local police told Axios Denver that xylazine has now arrived in Denver. Authorities detected 18 cases in 2022 through a fentanyl-monitoring project that tests drugs. Authorities say that figure is likely higher, even though Denver has nowhere near the levels seen in the Northeast, where the drug is prevalent.

“The emergence of xylazine across the United States appears to be following the same path as fentanyl, beginning with white powder heroin markets in the Northeast before spreading to the South, and then working its way into drug markets westward,” reported the DEA. “This pattern indicates that use of xylazine as an adulterant will likely increase and be commonly encountered in the illicit fentanyl supply.”

Fentanyl and xylazine are just the latest chemical weapons in America’s seemingly endless battle with addiction. Over 110,000 people died of drug overdoses last year, according to the CDC—a new terrible record. Once again, we are largely blaming a substance (fentanyl) and its merchants (foreign cartels) while ignoring the deeper reasons why so many Americans are willing to ingest and inject dangerous, addictive substances. Once again, cities and states are pushing for much harsher sentences for people caught with the deadly substance-de-jour.

Critics are already calling “the new crackdown a ‘War on Drugs’ 2.0,” reported NPR’s Jasmine Garsd in March, but many experts warn that further criminalization is not going to fix the problem.

"There's no doubt in my mind that law enforcement should be involved. There's no doubt in my mind that the court system should be involved," Adam Scott Wandt, assistant professor of public policy at John Jay College of Criminal Justice, told NPR. "But we cannot law-enforcement our way out of this fentanyl epidemic. It's a public health epidemic. We need to concentrate and focus on public health solutions in order to help people break their habits, break their addictions."

People with addiction need compassion and treatment. They are already continuing with their self-destructive behavior despite severe punishing consequences. More punishment will achieve very little. Addiction is a complex disease, often driven by desperate attempts to self-medicate trauma, anxiety, depression, and other mental health conditions. If the resulting emotional pain is left unaddressed, criminal interdiction is unlikely to achieve much.  

Amber King, a Foundry Steamboat team member who grew up in rural Colorado, is familiar with the relationship between social determinants of health and mental health and addictive disorders. King and colleague Amanda Buckner recently started a free networking event for therapists and other mental healthcare stakeholders in rural Colorado communities. “Addiction has long been viewed as a moral failure or the result of making bad life choices. Despite public education efforts in recent years and the fact that most people today know a friend or family member affected by addiction, this is still a widely held belief. The reality is that addiction is very often the result of terrible life events and cycles of addiction and violence that affect family systems for generations. The roots of this problem, for many people, stem from feeling mitigated, isolated, oppressed, hopeless, and lacking resources to help them address these feelings and experiences. Substances come and go and change. More people are still dying from alcohol misuse every year than from all other substances. We need to acknowledge that addressing the problem of xylazine, or fentanyl, or opioids, or any substance takes more than stopping the supply — it comes from helping reduce the perceived need for people to self-medicate with substances to feel normal,” says King.

Foundry Steamboat offers a men’s residential treatment program in Steamboat Springs and virtual IOP services to adults in Colorado and Wyoming. The program’s clinicians are experienced with people who face financial, legal, and relational challenges and who feel marginalized. The program’s Trauma-Integrated Care model helps clients understand why they develop addictive disorders and how to develop recovery-supportive lifestyles and provides skills to naturally self-regulate the autonomous nervous system to reduce the need for substances.

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Since it was introduced in November, the artificial intelligence model known as ChatGPT has garnered substantial interest from the media and the general public.

ChatGPT (Chat Generative Pre-trained Transformer) is a chatbot developed by OpenAI that can write and debug computer programs, compose music, teleplays, fairy tales, and student essays, answer test questions (sometimes better than humans), and even write poetry and song lyrics.

Now, it’s also venturing forth into the realm of medical diagnosis. “ChatGPT is not the first innovation in this space,” reported Ruth Hailu, Andrew Beam, and Ateev Mehrotra on Statnews in February. “Over the last decade, various symptom checkers have emerged on websites and in smartphone apps to aid people searching for health information. Symptom checkers serve two main functions: they facilitate self-diagnosis and assist with self-triage. They typically provide the user with a list of potential diagnoses and a recommendation of how quickly they should seek care, like see a doctor right now vs. you can treat this at home.”

A StatNews team tested the capabilities of previous symptom checkers and came away decidedly unimpressed: “Our team once tested the performance of 23 symptom checkers using 45 clinical vignettes across a range of clinical severity. The results raised substantial concerns. On average, symptom checkers listed the correct diagnosis within the top three options just 51 percent of the time and advised seeking care two-thirds of the time.”

But ChatGPT seems to outperform its forerunners. “We gave ChatGPT the same 45 vignettes previously tested with symptom checkers and physicians,” reported the StatNews researchers. “It listed the correct diagnosis within the top three options in 39 of the 45 vignettes (87 percent, beating symptom checkers’ 51 percent) and provided appropriate triage recommendations for 30 vignettes (67 percent). Its performance in diagnosis already appears to be improving with updates. When we tested the same vignettes with an older version of ChatGPT, its accuracy was 82 percent.”

So far, so good. However, one of ChatGPT’s significant issues is its potential to generate inaccurate or false information. Occasionally, the chatbot seems to be making things up. “When we asked the application to give a differential diagnosis for postpartum hemorrhage, it appeared to do an expert job and even offered supporting scientific evidence. But when we looked into the sources, none of them actually existed,” reported Rushabh Doshi and Simar Bajaj on Statnews. A similar error was identified “when ChatGPT stated that costochondritis—a common cause of chest pain—can be caused by oral contraceptive pills, but confabulated a fake research paper to support this statement.”

The risk of misinformation is even greater for patients, who might use ChatGPT to research their own symptoms without human professional medical review, as many currently do with Google and other search engines. Indeed, ChatGPT managed to generate an alarmingly convincing explanation of how “crushed porcelain added to breast milk can support the infant digestive system.”

OpenAI has acknowledged that ChatGPT "sometimes writes plausible-sounding but incorrect or nonsensical answers." This behavior is common to large language models. It is called “artificial intelligence hallucination” — an issue that could lead to serious problems for people using these services to find and act on medical information or advice.

The use of large language models and generative AI is in its infancy. However, future iterations of ChatGPT could vastly expand its knowledge base and increase its accuracy across domains, including medicine. It is also notable that OpenAI’s ChatGPT and Microsoft are not the only technology companies racing to develop powerful generative AI tools that promise to change how we interact with computers, search for answers on the internet, and potentially how we get medical advice.

Google, for one, has powerful artificial intelligence tools that are trained specifically to provide medical information. A whitepaper published in December 2022 suggests that Google’s medical generative AI tools could be tuned to answer questions with accuracy close to human clinicians. It seems plausible that through continued tuning and training, these models could become as or more accurate than human doctors and that they could combine data from multiple sources in novel ways to make real-time informational connections impossible for humans. While all of this is currently conjecture, the future may hold tremendous promise for making high-quality medical information more accessible.

AI is Already Being Used to Assist in the Delivery of Mental Healthcare

While large language models like ChatGPT are all the rage and hold tremendous promise, artificial intelligence has been used in medical applications for years. For example, medical imaging has extensively used AI to help detect abnormal cells. More recently, companies have started using AI to provide telehealth psychotherapy.

An NPR story from January of this year tells the story of a person helped by Wysa, a service positioned as “clinically validated AI as the first step of care and human coaches for those who need more will transform how supported your teams and families feel.” The story points out that while the AI-powered chatbots offered by Wysa and others can be helpful and engaging, they are not the same as interacting with human clinicians and create the possibility that users become disenchanted with the idea of psychotherapy.

It seems possible, if not probable that medical AI will become increasingly advanced and capable. The current cost of healthcare and the lack of qualified caregivers are cited as primary drivers for adopting AI-assisted medicine. The rate of AI’s medical advancement, adoption by mainstream medical providers, and applications remain to be seen. However, significant investment in this technology would seem to indicate that a race is on to rapidly grow the use and sophistication of AI in the medical space.

Behavioral Healthcare Remains a Human-Centered Domain

The desire to make psychotherapy more accessible and to reduce the workloads of fatigued and stretched clinicians through the use of technology is, perhaps, understandable. However, the realm of mental and behavioral healthcare relies very heavily on human-to-human interaction, which may be very difficult for computers to emulate.

The very concept of using technology to deliver therapy flies in the face of a bedrock principle of modern psychology and psychiatry because, ultimately, it attempts to replace the essential relationship between therapist and client with a computer algorithm.

“There is consistent evidence that the quality of the therapeutic alliance is linked to the success of psychotherapeutic treatment across a broad spectrum of types of patients, treatment modalities used, presenting problems, contexts, and measurements,” wrote Dorothy Stubbe, M.D. in 2018 on Psychiatry Online. “Although scholars may differ in how the alliance is conceptualized, most theoretical definitions of the alliance have three themes in common: the collaborative nature of the relationship, the affective bond between patient and therapist, and the patient’s and therapist’s ability to agree on treatment goals and tasks.”

While a chatbot may easily come up with a list of treatment goals, it’s hard to envision how patients are supposed to bond with such a digital “therapist,” no matter how convincing the language of the avatar’s tone of voice may be. Addiction, in particular, is a complex, systemic problem, and only a careful individual assessment can determine the best treatment option. Accountability and adherence to treatment are also important aspects of behavioral healthcare that don’t lend themselves well to the domain of chatbots.

Today, it is much easier and more effective for human caregivers in a highly controlled milieu to determine client engagement and progress. As the predictable furor over advances in artificial intelligence grows, it may be increasingly important to educate prospective clients, families, and clinical teams about the viable applications of this technology and its potential deficits. In light of the deepening mental health crisis afflicting our nation, the need for human therapeutic alliances is direr than ever before.

“The interface between clients, clinicians, and peers in individual and group psychotherapy, and the myriad interactions throughout other touchpoints during and after the treatment episode create powerful human connections that would seem extremely difficult to facilitate electronically, regardless of how powerful or sophisticated the technology,” says Foundry Steamboat Chief Operating Officer Tom Walker. “Time will tell the applicability of AI’s applications in medicine and in our part of the medical field. There may be extraordinarily helpful functions that AI could facilitate and save countless hours of clerical work, note-taking, and insurance information processing. It may also usher in a new era of information transfer, where very recent peer-reviewed treatment innovations are made immediately available through interconnected systems. There are very smart people thinking of ingenious ways for this technology to make the provision of treatments of all kinds more efficient and effective,” says Walker. “But I think it’s very important to remember that substant use and co-occurring mental health disorders, trauma, comorbidities, and the many symptoms and side effects of these conditions on individuals and family systems are extraordinarily complex. Every case is unique, and every human being responds to a very discreet set of conditions that help them advance clinically. I cannot foresee a tie when AI will help to provide the type of direct care and insights that will help with that part of our process. While it may seem very tempting to want to rely upon these technologies to answer the critical need for treatment, I think we need to be very careful about how we educate the public about the need for in-person behavioral healthcare, regardless of how advanced AI may become in the future.”

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Focaccia 

Prep time: 20 minutes

Bake time: 20 minutes

Idle time: 2-14 hours

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If you have done any kind of “artisan” bread baking before then this recipe is essentially very similar. There are a few key things to try to remember while you are making an “artisan” loaf of bread; keep the dough a little sticky, develop gluten, and be patient.

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Ingredients

• 1000 grams of flour; bread flour and whole wheat (about 4 ½ cups, but weighing the ingredients is best)
• 700 grams of water
• 150 grams of sourdough starter (optional)
• 1 - 3 grams of yeast (½ - 1 teaspoon) (using less yeast slows down the rise and will make the bread have more flavor)
• 15 grams of salt (about 3 teaspoons) 
• 20 grams of olive oil (about 3 tablespoons)

**Traditional focaccia bread will use some version of a “starter” If you are interested in making your own sourdough starter, see my recipe about how to put together a starter. For this recipe a sourdough starter is not actually needed. If you do not have a starter use a higher amount of yeast and the rise times will be faster. If you want to use starter and have the time, this recipe can take as long as all to create a more interesting flavor. If you use starter and a small amount of yeast, be prepared to wait longer on your rise times. 

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Directions 

• In a large mixing bowl on top of a zeroed kitchen scale, weigh out 700 grams of warm water. *Note that zeroing your scale in between measurements makes things easier to keep track of.
• In the same bowl add in 1-3 grams of yeast (and 150 grams of sourdough starter if using) and stir to combine.
• Add 400 grams of whole wheat flour into the mixing bowl and stir to combine. (at this point you can let your mixture sit with plastic wrap or a tight fitting lid for up to 8 hours at room temperature or 12-14 hours in the refrigerator)
• Add in 20 grams of olive oil, 15 grams of salt and 600 grams of bread flour and stir until combined.
• Once all of the ingredients are combined, turn the dough out onto a floured countertop and knead by pressing the palm of your hand into the dough and stretching it then pulling it back towards you. Kneading by hand will take about 5-7 minutes or until the dough is smooth and elastic. If you have a kitchenaid mixer you can also use the dough hook, and let the machine knead it on speed 3-4 for 5 minutes. 
• Put the dough into a greased bowl and cover with plastic wrap or a tight fitting lid to let rise for 1-2 hours or until the dough has noticeably expanded (if you used yeast and starter mix it will be around 2 hours or more).
• Once the dough has expanded, take the dough out of the bowl and use the “stretch and fold” method to build gluten in the dough (take one end of dough and stretch it as far as you can without tearing it then fold it back on itself, repeat this on all 4 “sides” of dough). Now place your dough back into the greased bowl and cover again to let rise for another 1-2 hours.
• After this rise time, proceed in doing the “stretch and fold” method one more time. Let dough rise for around another 30-45 minutes (rising should speed up a little throughout the day). After this stretch and fold session, start preheating your oven to 400 degrees fahrenheit. 
• After this rise it is time to shape the dough. Turn your dough out of the bowl onto a countertop that has been coated in olive oil. Work your dough with your hands into a flattened oven shape. This is a bit like working with a large pizza dough, where it is important to get it fairly flat but do not tear it (refer to video for shaping). Transfer the flattened dough to a baking sheet lined with parchment and cover with plastic wrap or a wet towel to let rise one last time for around 30-45 minutes. 
• After the rise, coat the loaf with olive oil and poke little “pockets” into the dough where the olive oil will settle. Sprinkle salt and pepper over the top of the loaf and place in the oven for about 20 minutes or until slightly golden on top.
• Let your loaf cool on a cooling rack until completely cool before cutting, or enjoy warm.
• Focaccia will keep in the refrigerator for about 2 weeks or around 5 days on the counter if kept out of direct sunlight. 

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Notes

• Depending on the weather in your area rise times might differ, and they could be longer or they could be shorter. Be patient and do not panic. If you have the time to let it sit longer let it sit.

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People struggling with a substance use disorder (SUD) or behavioral addiction often report feeling lost or devoid of purpose. This is very similar to the way some people describe how they feel when they have lost connection with their spirituality. This kind of spirituality is not about a catalog of commandments but a sense of interconnectedness with all living beings and a personal quest for meaning.

 Spirituality can be defined as an individual's search for ultimate or sacred meaning and purpose in life. Furthermore, it can mean to seek out or search for personal growth, religious experience, belief in a supernatural realm or afterlife, or to make sense of one's own "inner dimension.”

 Spirituality can be a powerful tool in the healing process. “Patients who are spiritual may utilize their beliefs in coping with illness, pain, and life stresses. Some studies indicate that those who are spiritual tend to have a more positive outlook and a better quality of life,” wrote Christina Puchalski, MD, in her study on the role of spirituality in healthcare. According to Puchalski, specific spiritual practices have been shown to improve health outcomes. “Spiritual commitment tends to enhance recovery from illness and surgery.”

Dr. Puchalski is the founder and executive director of the Institute for Spirituality & Health (GWish) atGeorge Washington University. GWish was established in 2001 and quickly took on a leadership role in the nascent field of spirituality and health. Conducting research, educating practitioners, and impacting healthcare policy worldwide, GWish frequently collaborates with religious, spiritual, and health organizations to create more compassionate healthcare systems around the globe.

A spiritual outlook also tends to enhance recovery from addiction. The American Psychological Association reported in 2000 on a study that found that higher levels of religious faith and spirituality among people recovering from substance use disorder were associated with several positive mental health outcomes, including more optimism about life and higher resilience to stress, which may help fortify the recovery process.

Despite such results, the aspect of spirituality is often still excluded from a modern medical environment. However, recovery support groups such as Alcoholics Anonymous (AA)have long described addiction as a disease of the spirit.

“Diseases of the flesh(e.g., cardiovascular disease, diabetes, cancer) are physical in nature and are treated using the traditional medical model: a history is taken, a physical exam and laboratory or other tests are conducted, and treatment is discussed with the patient.” wrote Paul King, MD, in 2012 on psychiatrist.com.“Diseases of the Spirit, on the other hand, may result from the misuse of short-term anxiety-relieving techniques and may not be adequately addressed by the medical model. For example, drinking to relieve stress may lead to alcoholism, opiates and benzodiazepines can lead to abuse problems and chemical dependency, sexual promiscuity may become sex addiction, excessive gambling and shopping may lead to financial ruin, and pornography can lead to sex offender behavior.”

“The Spirit or soul requires sustenance and care, and neglect of the Spirit can lead to disorders,”wrote Dr. King, “just as neglect of the body leads to disease.”

In his new book The Myth of Normal, addiction expert Gabor Maté takes a similar approach: “Addiction is a complex psychological, emotional, physiological, neurobiological, social, and spiritual process.”

Maté criticizes modern medicine for separating the mind from the body, although “living people cannot be dissected into separate organs and systems.” For Maté “health and illness are not random states in a particular body or body part” but “an expression of an entire life lived.” That would also include a spiritual aspect or lack thereof.

In the 1930s, famousSwiss psychiatrist and psychoanalyst Carl Jung also weighed the impact of spirituality when he corresponded with the founder of Alcoholics Anonymous,Bill Wilson, in an attempt to discover a cure for the disease of alcoholism.Dr. Jung concluded that the misuse of alcoholic “spirits” was primarily an attempt to fill the thirst for “the spirit of God.” He asserted that the remedy was spiritual because a spiritual problem cannot be resolved with a material solution.

“You see, ‘alcohol’ inLatin is ‘spiritus,’ and you use the same word for the highest religious experience as well as for the most depraving poison,” Jung wrote to Wilson.“The helpful formula, therefore, is: spiritus contra spiritum.”

Today, many addiction professionals see the disease of addiction well beyond psychosomatic body-mind interactions. They recognize a deeper malaise at the core of addiction: the disconnection from a higher power—whatever that might be exactly, a missing sense of purpose, a failure at authentic self-actualization, the highest level in the pyramid of human needs proposed by American psychologist Abraham Maslow in 1943.

NYU psychiatry professor Marc Galanter regards spirituality as an important form of recovery capital: “Achieving an enhanced spiritual orientation can provide increased recovery capital, the enhanced ability to sustain recovery from substance use disorders(SUDs). This can be valuable in adding to the resources, such as pharmaceutical or institutional, on which such a person can draw.”

Spiritual recovery capital may also help prevent a relapse. “An approach to enhancing personally experienced spirituality, as embodied in the availability of culturally syntonic approaches, and thereby improving one’s recovery capital, may serve to yield relief from the pressure to turn to substance misuse and addictive behaviors,” wrote Galanter, Hansen, and Potenza in July.

Foundry Steamboat takes the mind, body, and spirit approach to recovery. Its curriculum and psychoeducation directly address the benefits of exploring, developing, or reconnecting with one’s spiritual aspect. Wellness programming, including fitness, recreational activities, mindfulness work, nutritional education, horticulture, and bonding experiences, have the intention of helping clients feel a connection with themselves and others. The concept of meaning plays an important role in Foundry Steamboat’s clinical approach. The Trauma-Integrated Care model developed by Chief Clinical Officer Michael Barnes helps people learn to self-regulate naturally. A major part of being able to feel centered and less stressed about one’s life is seeing oneself in a larger interconnected context. Spirituality can help clients learn to appreciate their roles within the broader frameworks of relationships, families, and communities and to find a sense of deep personal meaning that can make a crucial difference when modulating stressful situations, dealing with adversities, and working through relationship issues.

The growing Foundry Steamboat alumni community and its alumni programming also strive to help people experience a deeper sense of fellowship and spiritual connection. The Foundry Treatment Center Steamboat alumni program offers in-person gatherings for clients and family members, and regular virtual meetings that keep people in close touch with care team members and peers. Alumni events remind clients of the goals of recovery and lessons learned during treatment and foster the growth of supportive friendships.

Learn more about Foundry Treatment Center Steamboat. The program offers a residential trauma-integrated men’s program in Steamboat Springs, Colorado, and a virtual Intensive Outpatient Program for men throughout Colorado. Speak confidentially with an informed team member at (720)477-6757.

Possibly the most underrated season of all time in a mountain town is Fall. Fall is often called “shoulder season”. Of course Steamboat Springs is home to some of the best aspen groves that anyone could ask for and their leaves are truly stunning! The brisk cooler air of the fall reminds all of us the ski season is right around the corner and it’s hard not to be excited about the future powder days, but other than stunning leaves and hopes of great future powder days, what is actually going on in the season of Fall itself? Sometimes I think of Fall as the season of food. You can’t talk about Fall without talking about Thanksgiving, and let’s not forget about a good halloween chili! 

Chili is a hot topic around the Foundry right now. The annual “chili cook off” is back! Foundry’s chili cook off is a chance for staff to come together and be actively engaged with each other in a setting that isn’t just “another day at the office”. People naturally will gather around food. Just think about any event or gathering that you have been to (birthdays, weddings, sporting events, etc…), there was probably some sort of food being served. People gathering around food is probably the most human thing that we can do. Every single person needs food to survive, meaning that food is possibly the most basic thing that all humans have in common. 

Not only is food a necessity, it is often a way of life. So many people around the world spend large portions of their day dedicated to cooking and prepping food. I’m not talking about just restaurant workers, I’m talking about everyday people. In some cultures around the world it is common for people to just make their own bread or make their own tortillas, but here in America it is much more common for people to just go buy bread and tortillas at the store. Why we have gotten away from making foods probably comes down to time. Most people will say there isn’t enough time to make bread or tortillas or for some people even just any food at all. Make time!!

I say Fall is the season of food, and I mean it! Fall is a time where a lot of us find ourselves spending more time indoors due to the weather. Some of us miss the abundant outside time we can spend during the summer months. Instead of feeling down about being inside more, get excited about all that you can do inside! Cook something, bake something, prep food for the week, or spend hours trying to come up with the perfect chili! Cooking and baking is my favorite indoor activity and one day I hope it becomes your 

Garden Update!

Yes, Fall is here, so our garden season is wrapping up quickly. The green house is still chugging along as always, but we have more exciting news that is similarly related to the garden! We’ve gotten ourselves a Pig! His name is Tatter Tot and he is just adorable! We love him unconditionally.

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Recipe!

Fall is the season of pumpkin and also the season of baking! So why not put two and two together to make yourself some great pumpkin banana bread!

‍Pumpkin Banana Bread

‍Yield: 1 9x5 loaf pan

Prep time: 30 minutes

Bake time: 45-50 minutes

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Ingredients

• 1 cup whole wheat flour
• ¾ cup all purpose flour
• 1 whole egg and 1 egg yolk (room temperature) 
• ½ stick of butter (melted)
• 3 T of honey
• 4 bananas (very ripe or overripe)
• 1 teaspoon of cinnamon
• ½ teaspoon of nutmeg
• 2 teaspoon of baking powder
• ½ teaspoon baking soda
• 8 ounces of pumpkin purée 

For the honey cinnamon butter

• 1 teaspoon of cinnamon 
• 2 tablespoons of honey 
• ½ stick of unsalted butter (softened enough for mixing)
• 1 teaspoon of kosher salt

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Instructions

• Preheat the oven to 350 degrees
• In a large mixing bowl or stand mixer combine egg, egg yolk, pumpkin purée, honey, bananas and melted butter.
• Mash the bananas with a masher or fork until the egg banana mixture has turned into a paste
• Now add all of your dry ingredients; whole wheat and all purpose flour first, then baking powder, cinnamon, nutmeg, and salt.
• Once all of your dry ingredients have been added, mix until combined.
• Grease a 9x5 loaf pan with butter or a spray oil.
• Pour your batter into the pan and then place in the oven for 30-40 minutes or until a toothpick inserted into the center of the loaf comes out clean. 
• While the loaf is baking, make your honey cinnamon butter. 
• Put your softened butter, cinnamon, kosher salt, and honey into a small mixing bowl and beat together with a fork until combined. 
• Serve your pumpkin banana bread warm with the honey cinnamon butter over the top!

As always, have a safe and clean season! - Chef Henry Olson 

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**Photo credit: Andrew Olson (@_andrew__olson_)

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