The opioid crisis shows exactly why we need better integrated health care in this country.
Pill bottles are universal. Orange plastic, white child-proof cap. Inside, a mountain of uniform pills, all one color and shape—unassuming, candy-like pellets hiding palliative properties, masking addictive qualities. Opiate prescriptions are written daily—for end-of-life care, following cancer treatments, for chronic pain, for those recovering from surgery, or even after wisdom tooth extractions. But one of these innocent prescriptions can lead to more sinister uses.
Therein lies the stark juxtaposition: for all the uniformity of pills, those who’ve succumbed to opioid addiction are the opposite—they are all different. They represent all ages, ethnicities, and socioeconomic backgrounds. They’re not just a statistic. They’re children, parents, athletes, retirees, teachers, executives, students, workers, neighbors, community members, friends. This addiction isn’t bound by political affiliation or geographic location.
It’s a mass-produced crisis that lacks any fail-safes or contingency plans.
The crisis isn’t new. And we still haven’t found the answer to what will create lasting change. What’s missing is a comprehensive solution, a combined effort of both doctors and mental health professionals to increase prevention and access to effective treatment.
The opioid crisis was declared a nationwide public health emergency on Oct. 27, 2017. In 2018, there were 68,557 drug overdose deaths in the United States—a decrease from the previous year, yet approximately 2.1 million Americans still have an opioid use disorder, leaving the epidemic far from solved.
国产偷拍视频The opioid epidemic was first seen as a social issue rather than a health crisis. The social issue is not so much the people suffering from a substance use disorder—rather, it’s the stigma surrounding the issue that prevents people from accessing help and doctors from taking the necessary steps to treat it.
国产偷拍视频Not addressing what led to the opioid epidemic— doctors’ overreliance on prescriptions and America’s need for quick-fix solutions—is doing an injustice to the crisis. Just as time and effort is needed to prevent a relapse for an individual, the same is required to conquer the epidemic once and for all.
“A 2019 report from the Urban Institute reports that only one in five individuals in the U.S. with an opioid use disorder receives treatment,” says Michele Nealon, Psy.D., the president of The Chicago School of Professional Psychology. “Institutions are called to not only examine the etiology and impact of the opioid epidemic, but to prepare a workforce with the skills required to effectively respond. We need to teach students to apply evidence-based practices in the prevention and treatment of opioid use disorders to support a culture of health and recovery.”
So why does the crisis persist? And what needs to change to ensure that it can finally be put to rest?
国产偷拍视频It may come down to basics—to looking at patients as people, to breaking down the silos that exist, and taking a more integrated approach to health care.
Treatment for substance use disorders
Substance use disorder in the 1970s was viewed as a social problem. Besides detoxification in hospitals it was primarily treated in programs that were separated from mainstream health care facilities, leading to programs in more than 14,000 locations around the U.S.
This has trickled into the education received at medical schools across the country. There is little to no training in medical school about how to diagnose or treat mental illness, let alone substance use disorders. Mostly, students are just taught to manage symptoms. As a result, general practitioners are often ill-equipped to recognize or treat patients struggling with addiction—or to even recognize risk factors in the first place to prevent such issues from occurring.
国产偷拍视频“I think there are things that are risk factors that many clinicians aren’t aware of. If you’re aware of those, you can prevent some of the substance abuse problems,” says Gregory Canillas, Ph.D., an associate professor in the Forensic Psychology graduate program at The Chicago School. “It links to deeper issues. It’s not just that people get a prescription and all of the sudden get addicted to medication. The root usually has to do with trauma.”
Add to that the overwhelming number of patients that general practitioners see each year: Kaiser Permanente, one of the nation’s largest physician networks, reported an average of 1,751 patients per physician a year. With so many patients to tend to, doctors typically only spend 13 to 16 minutes with each patient. Doctors, strapped for time and acting with best intentions, are battling a system that doesn’t allow them the time needed to do a comprehensive job.
“Psychologists do initial assessments in an hour and a half. We ask all these questions of people before we come up with a diagnosis,” Dr. Canillas explains. “Medical doctors, they don’t have time to see patients for more than 15 minutes. So they hear symptoms and come up with a plan really quickly, and can’t necessarily connect all the things patients may say. They don’t have time to think holistically, or think of ways to treat physical issues other than with medication.”
Say a patient comes in complaining of chronic back pain. He also recently lost his job and his family has a history of depression. Some doctors, after spending 13 to 16 minutes with the patient, would prescribe an opioid. The patient leaves, without seeing their doctor for another year—the pain goes away, yet the refills keep coming.
“It is important to note that while many patients are living with serious pain, they need health care providers that are responsible in their prescribing practices and are also able to help their patients understand the potential risks and explore alternative strategies for managing their pain,” Dr. Nealon says.
国产偷拍视频Treatment for opioid addiction exists: medication-assisted treatment (MAT) involves the use of medications that relieve withdrawal symptoms and psychological cravings, and counseling and behavioral therapies. In order to receive or administer one of the medications used for MAT, the patient is required to be in therapy or counseling, and the physician—if operating outside of an Opioid Treatment Program (OTP)—must acquire a special license and work in a “qualified practice setting.” The licensure process requires eight hours of training. As of 2018, only about 5 percent of the nation’s doctors are licensed to prescribe the medications involved in MAT.
“For one of the major and clinically effective treatment plans, a doctor has to have a special license to prescribe those medications with no restrictions,” says Sandra Siegel, Psy.D., faculty in the Counseling Psychology Department, who has worked with people suffering from addiction for 40 years. “Yet there are no limitations on doctors prescribing opioids.”
If a doctor isn’t trained to recognize risk factors or treat addiction—they may not take that next step of getting that special license and cannot prescribe the medicines that will actually help with addiction. And patients often leave offices with a script for another pill. But that doesn’t address the root issue of addiction or help a patient recover. It just enables the cycle to continue.
What are the risk factors for opioid addiction?
According to the Center on Addiction, risk factors can include genetic disposition, psychological factors, and environmental influences (exposure to physical, sexual, or emotional abuse or trauma, substance use in family or among peers, access to addictive substances).
The root of the problem is most commonly trauma. Substance abuse often co-occurs with a mental illness—40 percent of those with a substance use disorder have also been diagnosed with a mental illness. When this issue isn’t addressed, recovery can be even harder.
“I treat people individually and I always look at them holistically: what brought them to start using. That, to me, is the way to treat individuals,” Dr. Siegel says. “But the greater problem is, why are Americans so reliant on pills?”
One of the reasons why the opioid crisis spiraled out of control is due to people self-medicating, trying to quickly fix real problems.
“We’re used to taking medication. We feel like we should never feel uncomfortable,” Dr. Siegel says. “So there’s a pill for everything, absolutely everything—if you’re depressed, if you’re anxious, whatever it is, there’s a pill for it and we take it.”
国产偷拍视频Mental health isn’t a quick fix. Neither is addiction. Recovery can take a lifetime—something Dr. Siegel herself has seen with some clients.
Just treating someone with medication won’t get at the root cause. Neither will jumping right to treating any psychological problems—which is why an integrated approach is needed to solve the crisis.
“Self-actualization is at the top of Maslow’s Hierarchy of Needs,” Dr. Canillas says. “What psychology students do sometimes is try to get clients to that place right away. But a lot of clients that I’ve seen, particularly clients who are lower-income ethnic minorities, don’t have access to mental health services. If they’re unemployed, their focus is on eating and paying rent. They’re not focused on family origin issues.”
Dr. Canillas once worked with a student whose client was unemployed and asked her for help on a resume. The student refused, saying it was the case manager’s job. Dr. Canillas saw it from another perspective: the client was worried about fundamental needs and needed a job. The resume needed to come first. Once the client stopped coming, the student recognized that the resume was the basic need. The student called her client back and offered to help with her resume.
“Once the client got the job, the client was able to look at the reason why she had the issues that she had, which also could be linked to why she was unemployed. The psychological component is important obviously, and it is the root of the problem—but you need to look at other things like unemployment, whether people are connected with social support, all of those things help people stay on the right path and make treatment effective. That’s part of seeing people holistically. You can’t just treat clients psychologically, you have to treat the whole person and the whole problem.”
An integrated approach
国产偷拍视频If doctors are educated on addiction and risk factors, they can help identify those who may be more prone to addiction or those who are already suffering from substance abuse. They are also more likely to take the steps needed to obtain the license to prescribe the life-changing drugs involved in medication-assisted treatment.
国产偷拍视频Dr. Canillas, who has conducted training for medical professionals on treating psychological issues, emphasizes this education aspect.
“The medical professionals I’ve seen were uninformed about the connection between psychological issues and physical health issues. So we would spend some time talking about that. I called it the holistic interview: integrating mental health and health care assessment. That kind of training is so important and helps.”
国产偷拍视频In our current system, no bridge exists between doctors—who may be the first line of defense in recognizing risk factors or first signs of addiction—and professionals who can provide or point patients to resources that can help them. In the end, more education can lead to more risk assessment and greater access to resources, which can in turn create a holistic approach to patient care that equally combines both psychological and physical components.
The Chicago School recognizes the importance of this in training future health professionals.
国产偷拍视频“Our expert faculty have built modules on opioids and other substance use disorders into the curriculum preparing our students to effectively utilize harm-reduction strategies, evidence-based treatment practices including medication-assisted treatment,” Dr. Nealon explains. “Students, faculty, staff, and alumni can all engage in the important work of helping to build and support a culture of recovery, so that after individuals have successfully completed treatment for their opioid use disorder, they can live active, productive, fulfilling lives by fully embracing recovery.”
If a doctor gives medication or a mental health professional goes straight to treating psychological needs, they’re failing the patient by not setting a proper foundation. A holistic approach can only be achieved with that partnership between doctors and mental health professionals—a true integrated answer to the opioid crisis.
This mass-produced crisis needs a whole-person unified solution.
Learn more about The Chicago School
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