Being an Addictions Counselor on a Liver Transplant Team
Keith Narr is a lifelong learner and career-changer. He also educates and changes other people's lives. As of January 2022, he is one of the few licensed alcohol and drug counselors in Minnesota who is fully embedded in a liver transplant team. That means he works full-time with patients in the liver organ transplant pipeline at M Health Fairview who have been diagnosed with alcohol or substance use disorder.
“I am dedicated 100% to the liver transplant team,” Keith says. “The University of Minnesota has been doing liver transplants since 1964, and we've had substance use disorder treatment programs here for just about as long. But there's never been a dedicated counselor.”
The University of Minnesota Medical Center Transplantation Division, he explains, uses an integrated model of care. Once a patient is connected with the department, they are assigned a social worker, a nurse, and other specialists like Keith who “keep the wheels turning” as they make their way through the stages of evaluation, recommendation, pre-transplant, transplant, and post-transplant.
“It's absolutely fascinating,” Keith says. “I love it.”
A Drive to Learn, Improve, and Help
Keith got his first bachelor’s degree in engineering from the University of Minnesota back in 1979. He then worked in telecommunications for 33 years, where he volunteered in his company’s employee assistance program helping colleagues who were struggling with different issues, including substance use.
Having gotten sober himself in 2000, he was interested in guiding others outside of his company on their journey to sobriety. He earned his second bachelor’s degree in addiction studies and became a licensed alcohol and drug counselor (LADC). In 2020, he returned to the U of M as a graduate student to pursue a Master of Professional Studies in Addictions Counseling.
“I have always been a big believer in the University of Minnesota,” Keith says. “I’ve taken continuing education on campus for different things over the years. When Ronn Olson (who was interning with him in Burnsville) started talking about the master's program, it really piqued my interest. I really enjoy learning, and here I am almost 65 years old in the master's program.”
“There's so much to learn in this field,” he continues. “I've got a lot of practical experience and a lot of learned experience, but it's a great program and the teachers are all doctorate level practitioners” who work with a variety of populations.
There are “just tons of things to learn from each other and the program.”
Breaking New Ground
In 2021, he and Ronn Olson gave a presentation on substance use disorder assessment at the request of the liver transplant team. Afterward, the Chief of the Transplantation Division in the Medical School, Dr. Andrew Adams, expressed an interest in having a counselor work exclusively with the liver transplant team.
“We never quit quitting. I always have a hope that they learned something here, (that) they were able to put together a little bit of something that counts, a little bit of sobriety.”
Although Keith was thrilled about the opportunity, this was new territory for him. Liver transplant patients are much different than the clients he was used to.
“Many of them are within months of dying" he says. "Some of them go for months or years with good management, and that's where the University of Minnesota Medical Center doctors and specialists work like crazy. Because even though we call it liver transplant, if somebody improves physically enough, they can continue on with their ‘factory’ liver.”
They can improve if they stop drinking alcoholically, for example, and start making other lifestyle changes. “Maybe your physical life improves and then the biological, sociological parts get better,” he says.
This is why it’s so important to get patients connected quickly to the people and resources they need, like social workers, registered nurses, hepatologists, and dietitians.
“We sometimes use the phrase in treatment that left untreated, your chronic disease wants you dead, so sometimes in the case of alcohol, the phrase is you drink, you die. It's all urgent, but this is really urgent.”
Keith is always looking for ways to improve treatment for his clients. His next goal is to hold virtual meetings twice a week for his liver transplant substance use group. This low-intensity outpatient treatment will be a huge benefit to patients who may have several medical appointments a day, may be immunocompromised, and likely have little energy.
“We never quit quitting,” he says. “I always have a hope that they learned something here, (that) they were able to put together a little bit of something that counts, a little bit of sobriety.”
Pro Tips for Students
- Be open to working places that you either never thought about, or if you thought about it, you didn't think you wanted to go there. This was advice that was given to me when I got my undergraduate degree. So during the internship, for example, go into someplace that you think isn’t where you want to work, with a population that you're not necessarily interested in. That might be a low risk way of broadening your horizons.
- Network with everybody you meet, because that's how we get our patients into places that are good for them. No one counselor can know all the resources, but one counselor can network with a whole bunch of other counselors, and somebody will know the resources that will be good for a patient.