Unveiling the Mind: How Science Illuminates Mental Health and Substance Use

Can cutting-edge research in neuroscience shed new light on the brain's role in addiction and its potential to revolutionize treatment methods? 

Join us in a captivating conversation with Dr. Jenny Stewart and Dr. Robin Aupperle from Tulsa's Laureate Institute of Brain Research (LIBR), where they delve into their collaboration with Family & Children’s Services Women in Recovery (WIR). 

 This unique partnership seeks to enhance our comprehension of the early recovery process for women facing extended prison sentences for drug-related offenses. LIBR's research, conducted during the initial three months of the program, aims to unravel the intricate workings of the female brain influenced by trauma, mental health disorders, and addiction.

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Transcript

Rachel: 0:00

Hello, and welcome to OK State of Mind, a podcast by Family Children's Services based in Tulsa, Oklahoma. This podcast seeks to satisfy inquisitive minds, eager to delve into the realm of mental health and overall wellbeing. Join us on a journey to gain insights shared by mental health experts, draw inspiration from remarkable stories of resilience forged by those who've navigated challenging paths, and unveil the intricate science that underpins our thoughts and emotions, a sort of invisibilia, if you will. Through these explorations, we aim to illuminate the captivating whys behind our cognitive and emotional selves. Hopefully unraveling the complexities that shape our behaviors, feelings, and perspectives. Last episode, we spoke with Sonya McDonald, a graduate of the Women in Recovery Program from Family and Children's Services. She shared with us her experiences with addiction and incarceration and the obstacles she overcame to find happiness and success. You can hear Sonya's compelling story of hope in episode three of the OK State of Mind podcast. Today, we continue our conversation about addiction and female incarceration in a fascinating conversation with Dr. Jenny Stewart and Dr. Robin Aupperle from Tulsa's Laureate Institute of Brain Research, also known as LIBR, and their extraordinary collaboration with the Women in Recovery Program. Dr. Stewart earned a Bachelor of Science in Psychology from the University of California, San Diego, and her Master of Arts and Ph. D. in Clinical Psychology at the University of Illinois at Urbana, Champaign. She joined LIBR in 2018. She is a Principal Investigator and Director for Training and Mentoring. She is also an Associate Professor at the University of Tulsa. Dr. Stewart's current research focuses on understanding how the brain changes during recovery from addiction to methamphetamine and opioids.

Chris: 1:59

Dr. Aupperle earned her B. A. in Psychology at Oklahoma State University and her M. A. and Ph. D. in Clinical Psychology from the University of Kansas. She's a Principal Investigator at LIBR. and an Associate Professor at the University of Tulsa. She runs the Neurocognitive Aspects of Anxiety, Trauma, and Treatment Lab at LIBR. This lab conducts neuroscience research to inform understanding of psychotherapy interventions to identify strategies for enhancing mental health and well being.

Rachel: 2:31

LIBR is known for its cutting edge research in neuroscience and mental health. They have been actively involved in studying the neural mechanisms underlying addiction, mental health disorders, and related issues. Their research aims to better understand the brain's role in addiction and to develop more effective treatments. The Women in Recovery Program, also known as WIR, is an intensive outpatient alternative for eligible women facing long prison sentences for drug related offenses. The program averages 18 months and includes treatment for substance use disorder and trauma, mental health therapy, parenting, employment, and education supports, just to name a few. The partnership between LIBR and WIR involves gaining a better understanding of the process of early recovery. LIBR works with women during their first three months in the WIR program to learn more about how women's brains are functioning as a result of trauma, mental health disorders, and or addictions. Trauma informed substance use programs like WIR help address the underlying causes that can lead to addictions and criminal justice involvement. People struggling with addiction experience heightened stress, drug craving and urges, aversive bodily sensations, and negative emotions including depression, anxiety, pain, and suicidal thoughts when trying to quit drugs and stay abstinent. This partnership aims to understand how clinical symptoms, behavior, brain function, and physiology change during early recovery and predict who has success.

Chris: 4:05

For decades, Oklahoma incarcerated more women than any state or country in the world. Today, Oklahoma's female incarceration rate has dropped nationwide to third, but the state still incarcerates twice the national average. WIR is helping women find recovery and change their life trajectories through alternatives to incarceration.

Rachel: 4:26

And with that, I'm Rachel Roberts.

Chris: 4:29

And I'm Chris Posey.

Rachel: 4:30

And we want to welcome Dr. Jenny Stewart and Dr. Robin Aupperle to the OK State of Mind podcast. Thank you all for being here with us today.

Dr. Stewart: 4:38

Thanks for having us.

Dr. Aupperle: 4:40

Good to be here.

Rachel: 4:40

So can you all share more about the partnership between LIBR and WIR and how this project got started?

Dr. Aupperle: 4:47

At LIBR, the mission is to conduct research, specifically neuroscience research that can inform and improve mental health treatment. And so we're very interested in doing work that is not only enhancing scientific understanding, but really has direct implications for treatment. And so in order to do that, it's important to really collaborate with people who are providing that treatment and on the grounds working with people who are experiencing different mental health or substance use problems. And I remember an initial meeting with with Mimi with Women in Recovery and kind of a lot of people around the table talking about the program and us talking about our interests and just being struck by how, how much Women in Recovery is focused on providing empirically based treatments and also kind of pushing the envelope in terms of incorporating scientific information to provide the best treatment possible for the women that are in the program. And with that being our focus of collecting data, collecting information, collecting knowledge that can inform treatment it was kind of a natural, I think, fit in terms of that partnership. And so we started with a study in which it was part of this larger study called the Tulsa 1000, where we were looking at multiple levels of measurement including brain imaging, self report, interview based measures, behavioral tasks bio assays, trying to understand mental health and substance instance use particularly predicting outcomes for people, like so what factors may contribute to how well people do long term. And so as part of that, we partnered with Women in Recovery to try to understand factors that might contribute to outcomes within the Women in Recovery program itself. And so since then, based on some of the results from that, as well as based on other things in the literature, we've also done other pilot studies looking at different potential intervention approaches within Women in Recovery, and then also some other studies that have come from that, that Dr. Stewart has led as well.

Dr. Stewart: 6:43

One study we're doing right now is looking at the women from Women in Recovery whose drug of choice is opioids and looking at how their brain changes in the first four months during recovery. If someone can stay abstinent, if they're engaged in treatment, what parts of their brain recover early on to help them stay sober?

Chris: 7:02

So this is clearly a sophisticated area of research. Are you able to tell us a little more about the background of this research? What got each of you going this direction?

Dr. Aupperle: 7:11

My main story I like to tell is that when I went to get my PhD in Psychology, I was really motivated primarily in the clinical domain. So my goal was to be a clinician doing therapy, mainly for anxiety and depression. Just from experiences with friends and, and people struggling with depression and anxiety and really wanting to add to that treatment. And as I was going into graduate school, I was just like, well, the research thing you kind of have to do to get your PhD and I'll do it on the side just so I can get out and be a clinical psychologist. And then when I was in graduate school, I really fell in love with the research. And I think what, what happened, it was like my first year of graduate school. too long ago to talk about. It was one of the very first studies came out that was published reporting on the impact of cognitive behavioral therapy on the brain. And before then, a lot of the focus of brain imaging studies was more on medication and pharmacologic treatments. And even though now it seems pretty obvious that if you change the way people think, you change the way they behave, you change the way they feel, there's going to be changes in the brain because the brain is what's kind of creating all of those experiences. It wasn't necessarily an obvious conclusion at that point. And so the study started coming out showing very similar effects of psychotherapy as they do it for medication and so that kind of made a light bulb go off in my head in terms of being able to combine my passion for treatment with also all this cool scientific research of trying to understand exactly what's happening during therapy and what's effective and what's helpful for people in terms of the neurobiological mechanisms. And so that's where I started and really a lot of my work focuses on understanding depression, anxiety, and specifically trauma. So the experiences we've had in our lives and how they impact the brain. And then what we can do in treatment, specifically psychotherapy treatment to help people improve their lives going forward. And so I think what a lot of this with addiction wasn't and substance use wasn't my primary interest, but trauma was. And so it was really with women in recovery that I started down this road of being understood, being more interested in substance use just because trauma is so, prevalent for substance use populations in general, people who are struggling with substance use, but particularly for the women in Women in Recovery and the lives that they've led and the amount of trauma they've experienced as well as the amount of resilience they've experienced and then just how we can think about treatment going forward really kind of engaged my passion, I guess.

Dr. Stewart: 9:38

Yeah, and I was doing clinical psychology at the same time as Robin and had the same ideas, and then I had an uncle and then a cousin who died by suicide related to their heroin addiction, and this was in the early 2000s in mid 2010 and it really kind of upset me but at the same time I was scared to study it because people always said studying addiction, that's heavy stuff. That's heavier than anxiety, heavier than depression. And I found a lab in San Diego where I'm from, and Robin was there already. So we did postdoc research together with Dr. Martin Paulus, and he studied the brain in veterans with addiction, all different types of addiction. And so I started working with him and got really engaged. And my family I think were excited because they had so many questions that they wanted answered. And every time I saw them, they would be like, Oh, Jenny will tell us what's new. What are your finding? So we were looking at the brain changes when you're in an inpatient unit getting treatment and also looking at college students and what college students, you know, they might dabble in alcohol and drugs. They might use Adderall to study. What happens to their brains if they go on to develop a full blown addiction versus they don't. So that was a lot of what we were studying. So I hope that our research at LIBR and elsewhere in partnerships we have with people will actually make a positive impact, and I feel like it is with Women in Recovery. I hope we can continue to make an impact.

Rachel: 11:09

You both kind of touched on this changing the way people think and you can change the way people feel misunderstanding addiction. Do you feel that addiction is misunderstood generally by the public?

Dr. Stewart: 11:22

I would say yes. There have been some recent New York Times articles about addiction, particularly with fentanyl and opioids, and reading the comments section, I was shocked just to, to see the comments being like, well, having an addiction is like a moral failing. It's all the fault of the person, they should have done X, Y, and Z to turn things around. And when my family members were addicted to heroin, I was of the same mind when I was growing up. I was just like, why can't they get their act together? Why are they hurting their families? But I realized that, it's a, it's a brain disorder. It's like your brain is getting hijacked by these drugs. And a lot of the decisions you're making don't make sense. And they're focused on getting, more of the drug.

Dr. Aupperle: 12:06

I don't know if this really dovetails with what Dr. Stewart was saying, but I think it does, adds to it. The idea that, so I think a lot of times there's a reference to addicts and identifying people purely by their substance use and kind of the recognition that individuals who are struggling with substance use have, that's not their whole being, that's not everything that they are and that each individual is incredibly unique, even though the drugs themselves have very similar effects across people and it creates this cycle in terms of the brain disorder and the mechanisms that keep them in the addiction and it kind of hijacks a lot of their lives that individuals have all of their other unique characteristics and interests and experiences that contribute to who they are as people and sometimes I think because the substances can take over so much of their lives that sometimes it can be hard for other people to see that. And, and I think the other piece that we've already talked about a little bit, but just the recognition of how much prior experiences in one's life might contribute to substance use. And I alluded to it with some of our experiences and interviews we've done with women in Women in Recovery. And I know the clinician that Women in Recovery would know this even more than we do, but just seeing how much trauma and negative experiences and environmental experiences that have contributed to where they are today and how when you see some of the things in terms of how people's lives unfold, how much it sometimes makes sense why they turned to substances and then seeing how the substance use then just took over and it's almost like you can understand where these things came from, both from a neurobiological mechanism, but also just from what was contributing to that at the time. And then also just the incredible resilience that a lot of times you see, even though they, they have struggled with substance use and there's some things that aren't working for some of these women, especially just the fact that they're still here, given everything they've experienced is is amazing. And so recognizing that both resilience part and the risk part.

Chris: 14:05

All right, so it sounds like when we view addiction through this lens you both are describing, we realize that addiction is not the person, it's simply the result of neurochemical and neurobiological imbalances that, as Dr. Stewart said, hijack people's normal thought processes. So what challenges do you face when attempting to assess and manage addiction at a neurochemical level, particularly when you're dealing with someone who may be an active addiction?

Dr. Aupperle: 14:35

One thing that's hard is that, for substance use as well as other mental health disorders there's not necessarily great biological assessments that, on an individual level, that can inform treatment. So even though we know that drugs have this impact on dopamine as well as the opioid system and and interacting systems with that, and, we know there's a lot of these mechanisms happening, but at the individual level, being able to measure something that then will inform treatment isn't necessarily there unfortunately. It'd be nice to get to that point. So right now we're more at the group level where we're still just trying to understand what is substance use doing to the brain and the body and then what can we glean from that to inform treatment more broadly of, okay, substance use impacts the dopamine system, the opioid system, which has led to certain pharmacologic approaches like methadone that are replacement therapies. So it's led to that at the group level, but still there's not like an individual test that can say, Hey, do you need methadone or not? It's more that we know that this works for people in general. And so I would say the same thing in terms of trying to understand what therapies might be effective. What we're doing is mainly focused on brain imaging and trying to understand from a systems neuroscience approach, like the different circuits and brain networks that might be involved in some of the things that are underlying substance use with the idea of informing treatment more broadly for substance use, even though we can't necessarily say at an individual level what this person needs versus this person.

Dr. Stewart: 16:05

Yeah, and there's the directors of National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse, the Dr. Volkov and Dr. Koob, they've developed a three stage model of addiction that has to do with different neural circuits involved in the brain. The first stage is binge intoxication, and that has to do a lot with dopamine in the subcortical striatum region of your brain. And then the next stage has to do with withdrawal. So if you haven't had the drug in a while, then you have, withdrawal symptoms. So you'll feel irritable. You'll have a headache. You might have stomach problems. You might feel depression and anxiety. So the withdrawal negative affect stage really has to do with, it's not to have to do with the amygdala. So the fear center of your brain being over activated. And then the third stage is you get past that a bit, the negative affect, and then you become preoccupied with getting the drug again, because you're thinking, Oh, I felt so horrible. I just don't want to feel horrible like that ever again. That has to do with your prefrontal cortex. So, that's the planning, decision making part of your brain. And that prefrontal cortex area is shut down by the drug. So that contributes to, poor decision making, and going back to drug use. Even though you lost your job, you lost your family you lost things that most of us find meaningful. So those are the three sort of regions that we're focusing on at LIBR. Robin has really taken the lead on the reward striatum system, like trying to improve positive affect and reward in people struggling with addiction. And my work with opioid users is trying to see if the negative affect withdrawal system improves so people stop feeling horrible with prolonged abstinence.

Rachel: 17:50

Can you elaborate on the results you've been seeing and what exactly happens to a brain on meth?

Dr. Stewart: 17:56

There's a recent article that came out that looked across 45 studies that had at least two brain scans of people with different addictions. So it's not just meth, but there were several meth studies in there, and it looks like within the first seven months of abstinence, so after people start a treatment program, their structure of the prefrontal cortex goes back to normal, or what we consider normal, and their function of the prefrontal cortex, so their ability to make decisions, comes back online within a year. So that's really promising in terms of you can start making really good decisions again, as long as you just stay abstinent. The hard part is staying abstinent. Right? And studies we've done on meth with Dr. Paulus in the past, we saw that as well, that prefrontal cortex after a year seemed to be back online.

Rachel: 18:46

Are you seeing the same things across the board with other drug addictions, or does the brain on meth or opioids look different from the brain on any other drug?

Dr. Stewart: 18:55

I would say it's similar to opioids for sure. And then the verdict's still out on cannabis and we'll have to see how that goes. But there aren't that many longitudinal studies on cannabis yet.

Dr. Aupperle: 19:06

Some of the findings, particularly with Women in Recovery, so we did assessments related to brain imaging, but also cognitive testing. So assessment of executive function, attention, concentration, memory, and we know that substance use, and so we showed it in this population as well, that substance use is related to reduced performance on these types of cognitive tests, but not dramatically so. So it's a subtle difference compared to say individuals with depression, no substance use or healthy controls. But the interesting thing was that not necessarily lifetime substance use, but trauma experiences was more related to performance. And so, this idea that even within substance use population, some of the things that are observed in terms of both brain function as well as cognitive function may not just be due to the substance use, but also to the other co occurring symptoms and experiences that they've had. And that's in some ways kind of sucks for them that they have a lot of different things that are kind of impacting. But it's also a good thing just in terms of we know that there's good treatments for PTSD and people can process through some of that and their symptoms can improve. And so then just thinking about abstinence improves these functions and then treatments for co occurring symptoms and problems can also improve these functions, which means it's good news for the long term trajectory and ability to recover from these things.

Chris: 20:27

Have you been surprised by any of your findings?

Dr. Aupperle: 20:29

I don't know about surprise, but excited, maybe is more the better word. But I would say, so one of the exciting findings that we're working on writing up and publishing with Women in Recovery is that in functional MRI, we looked at how people respond when they're anticipating reward. So, in this specific instance, anticipating monetary reward. So, when they might get a dollar or five dollars. And, when people are anticipating reward, an area of the brain called the nucleus accumbens, or the ventral striatum is kind of our reward center of the brain. So you see that, that region activate pretty consistently across all humans in terms of anticipating reward. So what you actually see with substance use is a decreased or, blunting of response during that anticipation of reward. And the idea is that this potentially can relate to both reduced experiences of reward and experiences of positive emotion, but also that it may impact decision making and impulsivity. So the idea is that if our brain's not responding well to anticipating future rewards, then we're not going to be able to make the best decisions to reach those long term rewards. And so we might act more for the short term and the immediate dopaminergic release or immediate reward activation that you might get from substances. And so what we saw with Women in Recovery, we completed scanning early on in the intervention and then towards the end of the program, about a year later. And what we saw was from one point to another, we saw impulsivity improve. So people, reported being less impulsive, which is actually a pretty big deal because a lot of the interventions in the literature that are, say, shorter 30 day types of treatments don't necessarily see that improvement. So the fact that we're seeing improvement in impulsivity is awesome but then also that change in impulsivity related to the level of change in reward reactivity during anticipation rewards in the stratum. And so the idea is that the more people are starting to respond when they're anticipating rewards and responding to that positive aspect and rewarding aspect of their environment, the better they're able to make less impulsive decisions and better decision making. And so I think this is important for Women in Recovery and understanding of substance use and is also informed. We're starting a pilot study more on alcohol use disorder, so it's a separate study right now. But it's relevant, I think, for substance use more generally going forward, but with the idea of using psychotherapy that's really focused on trying to enhance people's experience of positive affect and reward while they're reducing their use of substances because the idea is that when we get a lot of dopamine or reward reactivity with the drug the brain stops responding to other things in our environment. And so, as we stop using the drug, the brain's wanting that, and not getting it. And so feeling, what would you refer to, anhedonia, or a loss of positive affect. And so, not just the negative withdrawal symptoms, but also the reduction in positive affect can lead people to try to go back to the substances. If you're not getting any pleasure or reward from other things in your life, you're going to turn back to that. And so the idea is if we can do things that really focus them in on how to enhance positive affect through savoring, reminiscing, focusing on all the little things in your environment that may improve positive affect during that crucial stage that maybe we can help people get past that point of recovery more effectively.

Dr. Stewart: 23:49

And we also at LIBR have float tanks. So it's like salt water pools and we have an open one and a closed one, but we did a pilot study with Women in Recovery participants where we had them sit in a zero gravity chair and float in the pool. So they switched, they did one and then the other. And we wanted to see if that would change their drug craving or their anxiety or their depression or their negative affect versus positive affect. And we were so pleasantly surprised because being in the salt water pool they said decreased their craving and increased their positive affect. So they felt so much happier after being in the pool for 45 minutes than in the zero gravity chair, which is our control condition. But that was cool because there are the float pools in multiple places in Tulsa, and Mimi from Women in Recovery is like, well, can we just bus people over and just float all day That would be awesome. That seems like a relatively easy intervention, to start, so we're going to do more float research too.

Dr. Aupperle: 24:46

And the cool thing is all these things that we're looking at all go back to the original study that we did with Women in Recovery where we're trying to understand factors that predict outcome, and really three factors came out of that. One was impulsivity that we kind of talked about in terms of relating to positive affect. One was trauma and it was actually individuals who report more trauma actually do better and with potentially the idea that people who are more aware and have insight into those experiences and are reporting them then are able to engage better with treatment. And then third was interoception which is the process of monitoring our internal bodily states. So being aware and being able to engage in strategies to regulate those internal bodily states. So like heart rate, stomach sensations

Dr. Stewart: 25:30

Breathing,

Dr. Aupperle: 25:30

Yeah. Yes. And so and so then the idea stems off of that, the, the more we can do to target those things in a more, in a targeted way potentially the better. So that led to positive affect interventions, the floating and then we're also working on a kind of structured psychosocial history assessment where we're, we call it the Tulsa Life Chart or the TLC. And it is a way of getting negative and positive experiences, traumatic experiences, substance use, social support hobbies, everything from an individual's birth till current, and then charting it in this interactive graphical ways and with the idea that women may have gleaned insight from that in terms of being able to connect the different things that have happened throughout their life potentially enhancing that awareness of trauma and then how these things are related to one another. And so I think it just shows this process of research and clinical collaboration where it's like we can glean things here and there, and then it leads us to these other studies that can try to pick away at okay, what can we do? What can we do to improve outcomes? And even if it's a little here, a little there, hopefully in the end it makes a difference.

Rachel: 26:35

In your time partnering with WIR, do you see cases of intergenerational addiction?

Dr. Stewart: 26:41

So we were doing a smaller Tulsa Life Chart project for recovery and our team interviewed a woman graduated from the WIR program and has remained abstinent, but she said that her daughter was currently going through the program, which was mind blowing that her daughter was doing really well. But I think they were both having a lot of the same struggles. And then you wonder the interaction between genetics and environment and how that plays out. It was pretty powerful.

Dr. Aupperle: 27:09

I know we see even from the TULSA Life Chart and then just from the information we gleaned from the clinicians at Women in Recovery and what the women have talked about that family and parenting and their relationships with their children, for the women who have children is incredibly important in treatment. And when we ask, say, within the Tulsa Life Chart, we asked what was the most powerful part of treatment for you a lot of the women would talk about the parenting classes or the realization of how their substance use was impacting their kids as being one of the primary motivators for them to actually be successful in the recovery process. And I think there's this intergenerational trauma, but not just trauma, but substance use and just the impact that these things have on individual's behavior and their family and everything that's happening and that impacts the kids. And then as they grow up, that impacts their decisions and their behavior. And it just kind of keeps going. But the power that they see in terms of breaking that, because I think when people are able to see, oh, wow, I'm just passing along this cycle to my kids and then seeing the way out of that it's amazing to see the light bulb go off of I can stop this cycle with my kids.

Chris: 28:17

So this is pretty exciting. It sounds like a lot of promising research is taking place at LIBR. Is there anything else that gives you hope?

Dr. Aupperle: 28:24

I think it's the women in particular that give me hope that when you talk to them, particularly the ones that have been successful and graduated from the program and looking back on their experience and just all the things that they've been able to overcome. And it's just astounding. And I think it's hard to interview these women and not feel hopeful

Dr. Stewart: 28:45

The Women in Recovery program gives me hope, on the job training, GED training, helping go to college, the mindfulness and yoga and the emotion regulation skill training. I'm just astounded at all of the hard work that the WIR team just puts into everything. And it makes me really proud to be able to say we get to, to to work with WIR, so great experience.

Dr. Aupperle: 29:12

And my hope would be that hopefully more people get access to a program like this. Because I think when I've had people in my family dealing with substance use for a long time as well that just don't have access to the same level of treatment. And that at least what is available hasn't worked for them. And so it'll give me hope if we see more resources going towards supporting these types of comprehensive, longer term programs that can be more effective.

Rachel: 29:38

Can you tell us how our listeners can find out more about your research?

Dr. Stewart: 29:43

Well, they can reach out to us on the LIBR website. I think our emails are on there. I've had other people email me from the community asking questions about certain, like, Oh, I want to know this about a certain drug. Can you, can you send me some research about that? And so I would send them some PDFs. NIDA and NIAAA have great info for, like, family members and caregivers so yeah, National Institute on Drug Abuse. They have plenty of, informative brochures and stuff about various substances and what they do to the brain and body, but again, I'm totally willing to help out and send resources.

Chris: 30:19

Thanks for tuning in. If you found value in what you heard today, there are a few ways you can support and stay connected to us. First, be sure to hit that subscribe button wherever you're listening to us. Subscribing ensures you never miss an episode. And, it's absolutely free. It also helps us continue bringing you quality content. Consider leaving us a review. Your reviews not only make our day, but they also help others discover the podcast and join our community. Share this episode with friends, family, and anyone who might find it interesting. Word of Mouth is a powerful way to grow our podcast family, and we truly appreciate your support. We're always eager to hear your thoughts, ideas, and suggestions for future episodes. Visit okstateofmind. com for all of our episodes. You can also email us at communications at fcsok. org with any episode ideas or questions. We'd love to connect with you. Thank you once again for accompanying us on the journey. Until next time.