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Supporting the Addiction Workforce: Q and A with Dr. J. Craig Allen

January 10, 2017 | Addiction Treatment | Comments
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J. Craig Allen, MD, is a addiction psychiatrist and a member of the National Council Medical Director Institute. He is the medical director of Rushford, an addiction and mental health treatment organization in Connecticut that provides services for children, teens and adults and is part of the Hartford Healthcare system. 

The Department of Health and Human Services recently released a report that projects a significant shortage of behavioral health practitioners over the next decade. How will this impact care and communities across the country? What do you see as solutions?

With today’s challenges in accessing evidence-based care, it is frightening to think of a future with an even greater deficit in well-trained providers. The passage of the 21st Century Cures Act and the release of the Surgeon General’s report on Alcohol, Drugs and Health signify a real investment in substance use disorder treatment. I anticipate there will be a paradigm shift where, like 50 years ago with smoking, there is an all hands on deck response to this societal killer.

The improved integration of substance use expertise within primary care will go a long way towards addressing the projected shortage. When used consistently, screening, brief intervention and referral to treatment (SBIRT) reduces and prevents risky alcohol and drug use from progressing to a more serious and complicated illness requiring higher levels of care and more specialized providers. Health care providers also have an increased understanding of addiction as a chronic disease and an appreciation of the various paths to recovery, yet underutilize roles like recovery coaches and peer support specialists.

Where is the gap in the behavioral health workforce?

A strengthened workforce is going to be essential in reducing the burden of addictions and incorporating addiction treatment into mental health treatment is not as big of a leap as one might imagine. In a typical community mental health center, case management, multilevel provider treatment teams and a recovery-oriented system of care mirrors the most effective addiction treatment model. There are high rates of substance use disorder in people with mental illnesses and even higher rates of mental health problems among people with substance use disorders. Treating either disease alone — instead of  concurrently — leads to poorer outcomes. Although definitive educational training around addictions is necessary, we also need to better understand the role of non-traditional staff, like recovery coaches and peer support specialists. Trained peer specialists should be an essential part of the treatment team. Peer specialists can improve engagement, enhance quality of care and provide hope — all while reducing reliance on other clinicians.

How do you engage primary care clinicians in addiction treatment?

Even as Connecticut’s largest provider of addiction and co-occurring services for 40 years, when Rushford merged into the Hartford system we were an unknown entity. We have a number of avenues that allowed us to engage and strengthen relationships with primary care clinicians. Grants from SAMHSA and the Conrad Hilton Foundation for SBIRT training and behavioral health integration moved us into closer contact with primary care providers. We partnered with Hartford Healthcare’s chief medical officer to improve safety and quality by establishing a campaign promoting naloxone’s use in emergency departments and physician offices. We collaborated with the medical risk management program to create a series of educational videos for the system’s 5,000 physicians. We were asked to cofacilitate a systemwide opioid management committee which included hospitalists, emergency department physicians and specialists in pain management and surgical. Since then, we have helped update the alcohol detox protocol with the hospitalist, worked with obstetrics and fetal medicine on their program addressing neonatal abstinence syndrome, provided presentations and collaborated with women’s health, bariatric surgery and transplant, as well as engaged in a pilot project with the Connecticut chapter of the American Academy of Pediatrics focused on identifying adolescents at high-risk for developing substance use disorders. One of our addiction medicine fellows led a series of lectures for the dental community on pain management and we were pleased when a group of doctors from our flagship hospital initiated an Addiction Interest Group and asked one of our senior physicians to act as an advisor.

We have forged a strong relationship with Hartford Healthcare’s community relations department, which has led to numerous television, radio, print and social media opportunities. Community engagement is so important because it advances the understanding and acceptance of substance use disorder as a biologically based chronic disease where prevention, intervention and treatment allows people to lead productive and rewarding lives in recovery.

What specific training or programs are helpful to prepare the workforce to address addictions? Are there informal ways to cross-train and educate providers that have been effective?

The year-long American Board of Addiction Medicine fellowship in addiction medicine, like the one we offer at Rushford, is the gold standard for developing substance use disorder expertise and preparing for the addiction medicine boards. However, there are other pathways for physicians to get practical training. At Rushford, we have had residents shadow our practitioners or do month-long rotations in the same tract as the psychiatric residents meeting the addiction component of their training. Some community physicians who have taken the buprenorphine training course for the treatment of opioid disorders work closely with the clinicians in our psychosocial programs.

There are also numerous educational opportunities offered in person and online. For a focus on opioid use disorders and pain, the Provider’s Clinical Support System for Opioid Therapies (PCSS-O) offers free, continuing education programs on the safe and effective treatment of opioid use disorders. PCSS-O also has a Colleague Support Program that allows providers access to mentors from across the country. The American Society of Addiction Medicine is an excellent source of cutting edge, practical information for professionals who care for those at risk for or living with substance use disorders. The International Nurses Society on Addictions is a professional organization for nurses committed to the prevention, intervention, treatment and management of addictive disorders. And, you can always find information from federal agencies, like the National Institute on Drug Abuse (NIDA) and the SAMHSA.

How do you think the workforce shortage will affect the care you provide and your community? What solutions do you think will help? Let us know below or tweet us using the hashtag #BH365.

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