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Substance Abuse Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wsub20
A Physician-Centered Approach to Addiction Identification and Treatment Misses the Opportunity for Interdisciplinary Solutions a
a
Adam J. Gordon MD MPH & Lauren M. Broyles PhD RN a
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (VAPHS) and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Accepted author version posted online: 28 Feb 2014.Published online: 12 May 2014.
To cite this article: Adam J. Gordon MD MPH & Lauren M. Broyles PhD RN (2014) A Physician-Centered Approach to Addiction Identification and Treatment Misses the Opportunity for Interdisciplinary Solutions, Substance Abuse, 35:2, 108-109, DOI: 10.1080/08897077.2014.898976 To link to this article: http://dx.doi.org/10.1080/08897077.2014.898976
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
SUBSTANCE ABUSE, 35: 108–109, 2014 C Taylor & Francis Group, LLC Copyright ISSN: 0889-7077 print / 1547-0164 online DOI: 10.1080/08897077.2014.898976
A Physician-Centered Approach to Addiction Identification and Treatment Misses the Opportunity for Interdisciplinary Solutions
Downloaded by [Northeastern University] at 16:23 27 October 2014
Adam J. Gordon, MD, MPH and Lauren M. Broyles, PhD, RN In a recent editorial, Wood and colleagues(1) argued that “many in the medical community fail to diagnose alcohol and other drug disorders in part because of the failure to educate physicians about addiction medicine.” The burden of alcohol and other drug unhealthy use and diagnosed disorders is indeed enormous. However, focusing on physician education, and, specifically, training physician specialists in addiction medicine, is a myopic view and potentially deleterious to the expansion of treatment. Patients with alcohol and drug use disorders and those with unhealthy use not meeting diagnostic criteria—a large patient sample oddly often overlooked—typically present for medical care.(2) A single professional group (physicians) cannot and ought not bear the bulk of responsibility for addressing unhealthy alcohol and drug use. All health care providers can and should be trained to screen, assess, treat, or refer their patients. Recognizing this critical educational gap among generalist clinicians, the United States has funded the development and implementation of addiction curricula for nonspecialists, physicians-in-training, and recently, other health care professional students/trainees.(3) The Institute of Medicine recognizes that patients with alcohol and other drug use and disorders do not routinely receive highquality care from health care providers and would benefit from comprehensive, interdisciplinary approaches to treatment.(4) Interdisciplinary collaboration is essential in our clinical, research, and educational responses for preventing, identifying, and treating addictions.(5) The US Department of Veterans Affairs concurs with this sentiment and recently reorganized its postgraduate addiction fellowship program from a physician-only trainee model to one where equal numbers of physicians and other health care professionals are trained to work in interdisciplinary research and clinical care teams. Seven fellowship programs were awarded funding, with the total capacity to train 28 interprofessional scholars at any one time. This interdisciplinary approach is proactive and consistent with how systems- and team-based care is occurring for all chronic medical disorders.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (VAPHS) and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Correspondence should be addressed to Adam J. Gordon, MD, MPH, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C, Building 30, Pittsburgh, PA 15240, USA. E-mail: [email protected]
Wood and colleagues’ foci on pharmacologic treatment as the sole evidence-based intervention and the provision of alcohol and other drug use care by either physicians or “unskilled laypersons” as the only choices for addiction services overlooks the range of nonpharmacologic approaches available as primary or adjunct therapies, which are often delivered by other health care professionals (e.g., nurses, social workers, psychologists, counselors, public health professionals). Patient-centric collaborative models of care (medical homes) will be incentivized by the Affordable Care Act and will require an expanded, interdisciplinary workforce to provide a range of covered treatments for alcohol and other drug use and disorders as well as prevention and early intervention services. Only referring patients to a specialty addiction physician minimizes the opportunity for all health care providers to effectively address alcohol and other drug use. Focusing educational efforts on training addiction physician specialists without interdisciplinary training has the potential to underaddress alcohol and other drug use as well as silo and fracture an already tenuous network of care. Substance Abuse journal serves as the official journal of Association for Medical Education and Research in Substance Abuse (AMERSA), likely the most prominent organization that advocates for an interdisciplinary approach to addiction issues. In this issue, we present abstracts from the 2013 annual meeting of AMERSA.(6) Additionally, Dr. Deborah Finnell advocates that the nursing profession is well poised to address screening, brief intervention, and referral to treatment in practice.(7) With the advent of patient-centered medical homes, nurses may be in the best position to address prevention, social, and treatment adherence concerns of patients, including providing a patient-centric approach to alcohol and other drug use and disorders. Another highlight of this issue includes Dr. Erik Gunderson’s original research, “A Survey of Synthetic Cannabinoid Consumption by Current Cannabis Users.”(8) In the context of medical harms associated with marijuana use and the increasing legalization of medical and recreational use of marijuana, it is unknown whether more medical—and societal harm—occurs with synthetic marijuana use.(9,10) Certainly, the work contained this issue, which originated from scholars representing various professional backgrounds, demonstrates that all disciplines play a role in identifying and addressing unhealthy alcohol and other drug use. Interdisciplinary approaches to research, education, and policy have the promise of improving care for vulnerable patients with unhealthy alcohol and other drug use and associated disorders.
EDITORIALS
ACKNOWLEDGEMENTS This material is the result of work supported with resources and the use of facilities at the VAPHS, Pittsburgh, PA. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
FUNDING Dr. Broyles is currently supported by a Career Development Award (CDA 10-014) from the Health Services Research & Development service of the U.S. Department of Veterans Affairs.
Downloaded by [Northeastern University] at 16:23 27 October 2014
REFERENCES [1] Wood E, Samet JH, Volkow ND. Physician education in addiction medicine. JAMA. 2013;310:1673–1674. [2] Institute of Medicine. Improving the Quality of Healthcare for Mental and Substance-Use Conditions: The Quality Chasm Series. Washington, DC: The National Academies Press; 2005.
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[3] Gordon AJ, Alford DP. Screening, brief intervention, and referral to treatment (SBIRT) curricular innovations: addressing a training gap. Subst Abus. 2012;33:227–230. [4] Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2006. [5] Broyles LM, Gordon AJ. SBIRT implementation: moving beyond the interdisciplinary rhetoric. Subst Abus. 2010;31:221–223. [6] Abstracts from the 2013 AMERSA national meeting. Subst Abus. 2014;35:194–216. [7] Finnell DF, Nowzari S, Reimann B, Fischer L, Pace E, Goplerud E. Screening, brief intervention, and referral to treatment (SBIRT) as an integral part of nursing practice. Subst Abus. 2014;35: 114–118. [8] Gunderson EW, Haughey HM, Ait-Daoud N, Joshi AS, Hart CL. A survey of synthetic cannabinoid consumption by current cannabis users. Subst Abus. 2014;35:184–189. [9] Gunderson EW. Synthetic cannabinoids: a new frontier of designer drugs. Ann Intern Med. 2013;159:563–564. [10] Gordon AJ, Conley JW, Gordon JM. Medical consequences of marijuana use: a review of current literature. Curr Psychiatry Rep. 2013;15:419.
Substance Abuse Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wsub20
A Physician-Centered Approach to Addiction Identification and Treatment Misses the Opportunity for Interdisciplinary Solutions a
a
Adam J. Gordon MD MPH & Lauren M. Broyles PhD RN a
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (VAPHS) and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Accepted author version posted online: 28 Feb 2014.Published online: 12 May 2014.
To cite this article: Adam J. Gordon MD MPH & Lauren M. Broyles PhD RN (2014) A Physician-Centered Approach to Addiction Identification and Treatment Misses the Opportunity for Interdisciplinary Solutions, Substance Abuse, 35:2, 108-109, DOI: 10.1080/08897077.2014.898976 To link to this article: http://dx.doi.org/10.1080/08897077.2014.898976
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
SUBSTANCE ABUSE, 35: 108–109, 2014 C Taylor & Francis Group, LLC Copyright ISSN: 0889-7077 print / 1547-0164 online DOI: 10.1080/08897077.2014.898976
A Physician-Centered Approach to Addiction Identification and Treatment Misses the Opportunity for Interdisciplinary Solutions
Downloaded by [Northeastern University] at 16:23 27 October 2014
Adam J. Gordon, MD, MPH and Lauren M. Broyles, PhD, RN In a recent editorial, Wood and colleagues(1) argued that “many in the medical community fail to diagnose alcohol and other drug disorders in part because of the failure to educate physicians about addiction medicine.” The burden of alcohol and other drug unhealthy use and diagnosed disorders is indeed enormous. However, focusing on physician education, and, specifically, training physician specialists in addiction medicine, is a myopic view and potentially deleterious to the expansion of treatment. Patients with alcohol and drug use disorders and those with unhealthy use not meeting diagnostic criteria—a large patient sample oddly often overlooked—typically present for medical care.(2) A single professional group (physicians) cannot and ought not bear the bulk of responsibility for addressing unhealthy alcohol and drug use. All health care providers can and should be trained to screen, assess, treat, or refer their patients. Recognizing this critical educational gap among generalist clinicians, the United States has funded the development and implementation of addiction curricula for nonspecialists, physicians-in-training, and recently, other health care professional students/trainees.(3) The Institute of Medicine recognizes that patients with alcohol and other drug use and disorders do not routinely receive highquality care from health care providers and would benefit from comprehensive, interdisciplinary approaches to treatment.(4) Interdisciplinary collaboration is essential in our clinical, research, and educational responses for preventing, identifying, and treating addictions.(5) The US Department of Veterans Affairs concurs with this sentiment and recently reorganized its postgraduate addiction fellowship program from a physician-only trainee model to one where equal numbers of physicians and other health care professionals are trained to work in interdisciplinary research and clinical care teams. Seven fellowship programs were awarded funding, with the total capacity to train 28 interprofessional scholars at any one time. This interdisciplinary approach is proactive and consistent with how systems- and team-based care is occurring for all chronic medical disorders.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (VAPHS) and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Correspondence should be addressed to Adam J. Gordon, MD, MPH, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C, Building 30, Pittsburgh, PA 15240, USA. E-mail: [email protected]
Wood and colleagues’ foci on pharmacologic treatment as the sole evidence-based intervention and the provision of alcohol and other drug use care by either physicians or “unskilled laypersons” as the only choices for addiction services overlooks the range of nonpharmacologic approaches available as primary or adjunct therapies, which are often delivered by other health care professionals (e.g., nurses, social workers, psychologists, counselors, public health professionals). Patient-centric collaborative models of care (medical homes) will be incentivized by the Affordable Care Act and will require an expanded, interdisciplinary workforce to provide a range of covered treatments for alcohol and other drug use and disorders as well as prevention and early intervention services. Only referring patients to a specialty addiction physician minimizes the opportunity for all health care providers to effectively address alcohol and other drug use. Focusing educational efforts on training addiction physician specialists without interdisciplinary training has the potential to underaddress alcohol and other drug use as well as silo and fracture an already tenuous network of care. Substance Abuse journal serves as the official journal of Association for Medical Education and Research in Substance Abuse (AMERSA), likely the most prominent organization that advocates for an interdisciplinary approach to addiction issues. In this issue, we present abstracts from the 2013 annual meeting of AMERSA.(6) Additionally, Dr. Deborah Finnell advocates that the nursing profession is well poised to address screening, brief intervention, and referral to treatment in practice.(7) With the advent of patient-centered medical homes, nurses may be in the best position to address prevention, social, and treatment adherence concerns of patients, including providing a patient-centric approach to alcohol and other drug use and disorders. Another highlight of this issue includes Dr. Erik Gunderson’s original research, “A Survey of Synthetic Cannabinoid Consumption by Current Cannabis Users.”(8) In the context of medical harms associated with marijuana use and the increasing legalization of medical and recreational use of marijuana, it is unknown whether more medical—and societal harm—occurs with synthetic marijuana use.(9,10) Certainly, the work contained this issue, which originated from scholars representing various professional backgrounds, demonstrates that all disciplines play a role in identifying and addressing unhealthy alcohol and other drug use. Interdisciplinary approaches to research, education, and policy have the promise of improving care for vulnerable patients with unhealthy alcohol and other drug use and associated disorders.
EDITORIALS
ACKNOWLEDGEMENTS This material is the result of work supported with resources and the use of facilities at the VAPHS, Pittsburgh, PA. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
FUNDING Dr. Broyles is currently supported by a Career Development Award (CDA 10-014) from the Health Services Research & Development service of the U.S. Department of Veterans Affairs.
Downloaded by [Northeastern University] at 16:23 27 October 2014
REFERENCES [1] Wood E, Samet JH, Volkow ND. Physician education in addiction medicine. JAMA. 2013;310:1673–1674. [2] Institute of Medicine. Improving the Quality of Healthcare for Mental and Substance-Use Conditions: The Quality Chasm Series. Washington, DC: The National Academies Press; 2005.
109
[3] Gordon AJ, Alford DP. Screening, brief intervention, and referral to treatment (SBIRT) curricular innovations: addressing a training gap. Subst Abus. 2012;33:227–230. [4] Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2006. [5] Broyles LM, Gordon AJ. SBIRT implementation: moving beyond the interdisciplinary rhetoric. Subst Abus. 2010;31:221–223. [6] Abstracts from the 2013 AMERSA national meeting. Subst Abus. 2014;35:194–216. [7] Finnell DF, Nowzari S, Reimann B, Fischer L, Pace E, Goplerud E. Screening, brief intervention, and referral to treatment (SBIRT) as an integral part of nursing practice. Subst Abus. 2014;35: 114–118. [8] Gunderson EW, Haughey HM, Ait-Daoud N, Joshi AS, Hart CL. A survey of synthetic cannabinoid consumption by current cannabis users. Subst Abus. 2014;35:184–189. [9] Gunderson EW. Synthetic cannabinoids: a new frontier of designer drugs. Ann Intern Med. 2013;159:563–564. [10] Gordon AJ, Conley JW, Gordon JM. Medical consequences of marijuana use: a review of current literature. Curr Psychiatry Rep. 2013;15:419.
