The Importance of Family Engagement in Addiction Treatment
In this panel discussion, Dr. Sarah Bagley and Alicia Ventura, MPH share how to increase awareness and understanding of substance abuse disorders, what goes on during recovery month and the importance of family engagement in addiction treatment.
Featured Speaker:
Alicia Ventura, MPH is the Director of Special Projects and Research for BMC's OBAT team. Her focus is on expanding the capacity-building arm of BMC's OBAT Program to educate healthcare providers at the local, state and national level about how to provide high-quality, evidence-based care to people who use drugs. She is responsible for overseeing all research and evaluation related to BMC's OBAT Program, ensuring results are disseminated widely and that any gaps and areas of need are identified and addressed. Alicia also currently serves as Public Health Clinical Research Advocate on the advisory board team for Families for Sensible Drug Policy, a global coalition of families, professionals, and organizations representing the voice of the family impacted by substance use. She has published in numerous peer-reviewed journals on topics including: reproductive health, HIV, consequences of alcohol and other drug use. Alicia received her Master's in Community Public Health at New York University and has over 15 years of experience working in the healthcare system overseeing implementation of large NIH-funded research studies, and managing the development, implementation, and evaluation of clinical and public health programs related to addiction, behavioral health, women's health and reproductive healthcare. She is a fierce advocate for people who use drugs and their families and is committed to social justice and harm reduction as guiding principles.
Sarah Bagley, MD | Alicia Ventura, MPH
Dr. Sarah Bagley is a primary care physician at Boston Medical Center. A graduate of the Georgetown University School of Medicine, the Combined Internal Medicine and Pediatrics Residency at Brown University, and the Boston University Addiction Medicine Fellowship, her particular research interests are in the treatment of opioid use disorders in the adolescent and young adult population and the involvement of the family in addiction care. She sees patients in both General Internal Medicine and the Adolescent Center. She is the Medical Director of the CATALYST Clinic – a clinical program to provide integrated medical and behavioral health care for adolescents and young adults who use substances – and an Attending on the inpatient Addiction Consult Service.Alicia Ventura, MPH is the Director of Special Projects and Research for BMC's OBAT team. Her focus is on expanding the capacity-building arm of BMC's OBAT Program to educate healthcare providers at the local, state and national level about how to provide high-quality, evidence-based care to people who use drugs. She is responsible for overseeing all research and evaluation related to BMC's OBAT Program, ensuring results are disseminated widely and that any gaps and areas of need are identified and addressed. Alicia also currently serves as Public Health Clinical Research Advocate on the advisory board team for Families for Sensible Drug Policy, a global coalition of families, professionals, and organizations representing the voice of the family impacted by substance use. She has published in numerous peer-reviewed journals on topics including: reproductive health, HIV, consequences of alcohol and other drug use. Alicia received her Master's in Community Public Health at New York University and has over 15 years of experience working in the healthcare system overseeing implementation of large NIH-funded research studies, and managing the development, implementation, and evaluation of clinical and public health programs related to addiction, behavioral health, women's health and reproductive healthcare. She is a fierce advocate for people who use drugs and their families and is committed to social justice and harm reduction as guiding principles.
Transcription:
Melanie Cole (Host): Every year the Substance Abuse and Mental Health Services Administration sponsors Recovery Month to increase awareness and understanding of mental and substance use disorders and celebrate the people who recover. Here to tell us about that today, in this panel discussion are my guests Dr. Sarah Bagley, she’s a Primary Care Physician and an Addiction Specialist and Alicia Ventura, she’s on the Advisory for Families for Sensible Drug Policy and she’s the Director of the Special Projects and Research Office Based Addiction Treatment, and they are both at Boston Medical Center. Ladies, thank you so much for joining us and Dr. Bagley, I’d like to start with you. Tell us a little bit about the link between substance abuse and mental health, because often those dealing with one or the other can be subject to the other one. Tell us about that link that you’ve seen.
Sarah Bagley, MD (Guest): So, I think that we know that there is a strong link between substance use and underlying or cooccurring mental illness. My work, I take care of primarily adolescents and young adults who have substance use disorders and I think that pretty consistently what we see is that many of these youth are coming with maybe a primary complaint around their substance use, but that as we get to know them, we find that they also have underlying anxiety, they have underlying depression, they may have a history of trauma. And that as we realize that it is really important that we also address their cooccurring mental health disorders because if we don’t also treat those; it’s going to be very hard for those youth to lead those fulfilling lives that we are trying to help them lead.
Host: So, than Alicia, tell us a little bit about drug addiction. Is that considered in itself, a mental illness or are they really two separate things that just happen to go hand in hand many times?
Alicia Ventura MPH (Guest): We typically do not talk about substance use disorder as a mental illness. We think of it more as a health condition. But as Dr. Bagley mentioned, there is a lot of overlap between the two. And it’s relatively new that people have started treating both mental health and substance use disorder concurrently. Prior there was sort of this idea that you can only treat one or the other. But really, people have learned that it’s more beneficial for the patient to treat them at the same time.
Host: Alicia, when we were speaking off the air, you mentioned that you have a vested interest in this topic. Please tell us a little bit why.
Alicia: So, I am what we would refer to as an affected family member which means that I have someone in my family who has a substance use disorder. And I also kind of act as a family member to someone I grew up with who has a substance use disorder. And that’s sort of given me this inside perspective to the treatment system and some of the gaps that exist. A lot of what goes on at home for the family is not always recognized and there’s a lot of this acute care when people are in crisis and then they are discharged home and the family has to provide basically life sustaining care in the home. And often that’s not recognized by treatment facilities or providers and Dr. Bagley and I have both been very vested in trying to make that more a part of primary care and really all care that’s provided.
Host: Then Dr. Bagley, along those lines, if a person is being treated for substance abuse, where does that leave them with their mental health issues which could be a lifelong issue? How do these things go together in treatment? Tell us a little bit about what’s involved in treatment.
Dr. Bagley: It’s a really important point, because I think that as Alicia noted, we think about substance use disorders as a health condition and oftentimes as a chronic health condition which can be similar to as how we think about mental health disorders and so, now in the setting where I practice, and where a lot of use at Boston Medical Center are taking care of patients is actually based in primary care. And so, what that means is that patients can come to us and we can offer them regular primary medical care services but we are also able to offer them treatment for their substance use disorder which might include a medication like buprenorphine or naltrexone and then also we can offer them a consult with a psychiatrist or potentially therapy with a social worker or a psychologist and so in that way, we are able to offer this integrated care that both addresses their substance use disorder but then also their mental health disorder. And because it’s being offered in a medical home, that is sort of ongoing care.
So, as Alicia noted too, a lot of times, the treatment system for addiction has been set up so that people are sort of in and out of a lot of different programs and I think that what we’ve seen is really a shift in the way that we think about this. Because if we’re considering it a chronic illness, we really do need to provide sort of a continuum of care in a place that really is a medical home for patients who have substance use disorder. And in that way can provide that ongoing care.
Host: That’s a great point that you brought up about ongoing care. Alicia, can you expand for us on what Dr. Bagley said about how people should go about finding a program? Do mental health patients have more trouble in treatment? Is it harder to keep them in treatment? What do you want, and we’re going to get into family members being involved in a minute; but what would you like people to know about keeping their loved ones in treatment? Is it more difficult when they suffer from both?
Alicia: I would say it’s difficult for me to speak for all family members, right? I can really only speak to my own experience. My family member actually does have both a mental health disorder as well as a substance use disorder. And it certainly is very challenging. Mostly because it’s difficult to find programs that specialize in both. And I think that it’s difficult to weed out sometimes what is being cause by the substance as opposed to what’s being caused by the mental illness.
And there’s also a lot of difficulty with follow up care and where is the best place to put someone. I think in general; we just need more services. The state has recently invested quite a bit in mental health facilities and specifically facilities that are able to treat both substance use disorder and mental health. So, hopefully that will create more opportunities for people to receive the care they need.
Dr. Bagley: That’s a great point Alicia, because I think if you think about it, as Alicia sort is setting up as from like the patient’s perspective; it’s really not helpful for an individual who may have an opioid use disorder and also have depression go to a program or go to a treatment center and say you know I need help addressing my opioid addiction and I also need help addressing my depression, and to be told well, we are really good at addressing this one thing, your depression, but we can’t really help you with your opioid addiction or we are really not set up. You might have to go somewhere else to do that.
And from the patient’s perspective, that doesn’t make any sense at all. It’s going to make their life more complicated. It means that they are going to have to tell their story twice. They are going to have to develop sort of relationships in two different settings and potentially be given two different treatment plans that may or may not be sort of complimentary to each other. And so I think the importance of trying to create programs and systems of care where from the patient’s perspective, he or she can go to a program and to be able to receive a sort of comprehensive assessment, diagnosis and then treatment plan and have all of his or her needs met there, hopefully with family involvement is just so much – it’s so important. The care is better. It’s more efficient and it’s truly, truly patient centered.
Host: What a great way to look at it and such important points Dr. Bagley. Alicia, tell us about families. Please reiterate for us the importance of family engagement in addiction treatment and how families can get involved. What do you want families to know about how involved they should be and how suborn they should be if they are trying to get a loved one the help that they need? What do family members, what are we supposed to do?
Alicia: That is a very complicated question. Family members have been very much pushed to the periphery when we’re talking about addiction. And we haven’t spent enough time educating family members about what they can do and empowering them to help their loved ones. If you think about it, so I did this math and say someone is receiving one hour of treatment a week, which is pretty generous; 99% of their time is spent outside of the healthcare system. And the family is the most basic social unit of our society and a lot of times, families are given misinformation. And because they don’t have an opportunity to get that education, often they will go to their primary health care provider or some other person that they deem a specialist and they will ask them what to do. And that person or physician will have no idea what the family should do, because it’s just not something that they are well educated in or that anybody is like super well educated in.
And so, families play an incredibly important role if you just think about the support that they are able to provide and often families are ridiculed and told that they are enabling someone’s substance use if they provide them with love and resources and that is so not true. We know that kicking someone out to the street, those sorts of things are not helpful. A substance use disorder however you want to define it or conceptualize it; we know that it is compulsive use despite negative consequences. So, adding negative consequences is not going to help this person with their substance use.
And so families can provide this really unparalleled support, and some are totally capable of doing that and I think a lot of times, all that we really need to do is to give families that information and empower them and teach them how to be these supports and not stigmatize them and push them away and give them false information that’s going to eventually harm their loved one.
Dr. Bagley: Those are great points Alicia. I think that what’s being highlighted is the importance of sort of different levels of care that even family members need. And so, some of that might mean actually family members on their own should be able to access services that support them because there can be a lot of stress and potentially anxiety that goes along with supporting someone who has a substance use disorder. But that also families need readily accessible information to find out about options for treatment, what different kinds of treatment mean, what’s the most appropriate treatment, what’s evidence-based treatment and that that can be really hard for families to access unless they already have a family member who is ready to enter treatment which may or may not be true.
And then we also need to think about once someone is engaged in treatment, how do we create a system that also integrates families into it. So, it’s a complicated issue and right now, I think Alicia highlighted we are not actually doing a very good job on sort of any level in terms of figuring out how to involve family members and support family members and really leverage the relationship, the expertise that families have when it comes to caring for their loved one with a substance use disorder.
Alicia: Yeah, I totally agree, and I think Dr. Bagley raises a great point which is that family members in and of themselves, are more likely to develop chronic mental health and health conditions than their peers who are not experiencing addiction in the family. So, they really do need their own services. And I also think we need to teach family members about how they can be supportive across this continuum of care. So, things like and Dr. Bagley has done research on this, having Narcan or naloxone in the home so that if their loved one is to overdose in the home, they are able to reverse that overdose. And teaching families sort of a harm reduction model where of course abstinence is the goal because it is the least – it comes along with the least amount of harm; but not everybody is going to get there or wants to get there. So, how do families intervene along this continuum of care where there’s risks at each point?
Host: Such great points and so important for listeners to hear. Dr. Bagley, as we wrap up, please tell us what you would like listeners to take away from this segment about concurrent substance abuse and mental health disorders and the hope and care that is out there if you or a loved one suffer from these.
Dr. Bagley: So, I think the word you just used Melanie, is really important is hope – is that we know that there is hope. We know that people can recover. We know that people can get better. And that treatment does exist that is effective for both substance use disorders and mental health disorders. And we know that families can be valuable partners as we continue to try to figure out the best ways to address addiction. I would want to add too that recovery is a lifelong process and that we also want to make sure in this month that we continue to support people who still continue to use drugs who are not yet in recovery and that it’s really important we think about how systems of care to best support them as well.
Host: Alicia, last word to you. Tell listeners what you’d like them to know about recovery month and hopeful advice for those suffering from both mental health issues and substance abuse and for those that love them.
Alicia: I guess the takeaway is that recovery is self-defined and it’s also possible and we need to support people across this continuum of substance use no matter where they are and what their goals are. Our focus needs to be on supporting them, meeting them where they are at and reducing the risk that exists for them in the place that they are. And empowering both people who use substances and their families to come together and create a support system that is eventually going to help the person regardless of where they are at. So, I think empowerment is really what I want people to take away from this is that they are not helpless. There are treatments. There are interventions. There are supports and there are people working very hard who care very much about them.
Host: Beautifully put. Thank you so much ladies, and I can hear the passion in your voice. Thank you for all that you are doing and thank you for joining us. That wraps up this episode of Boston MedTalks with Boston Medical Center. Head on over to our website at www.bmcaddiction.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, if you know somebody with addiction or substance use disorder or mental illness; please share this podcast with them, share it with friends and family of those and other loved ones because that is how we all learn together from the experts at Boston Medical Center. And don’t miss all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.
Melanie Cole (Host): Every year the Substance Abuse and Mental Health Services Administration sponsors Recovery Month to increase awareness and understanding of mental and substance use disorders and celebrate the people who recover. Here to tell us about that today, in this panel discussion are my guests Dr. Sarah Bagley, she’s a Primary Care Physician and an Addiction Specialist and Alicia Ventura, she’s on the Advisory for Families for Sensible Drug Policy and she’s the Director of the Special Projects and Research Office Based Addiction Treatment, and they are both at Boston Medical Center. Ladies, thank you so much for joining us and Dr. Bagley, I’d like to start with you. Tell us a little bit about the link between substance abuse and mental health, because often those dealing with one or the other can be subject to the other one. Tell us about that link that you’ve seen.
Sarah Bagley, MD (Guest): So, I think that we know that there is a strong link between substance use and underlying or cooccurring mental illness. My work, I take care of primarily adolescents and young adults who have substance use disorders and I think that pretty consistently what we see is that many of these youth are coming with maybe a primary complaint around their substance use, but that as we get to know them, we find that they also have underlying anxiety, they have underlying depression, they may have a history of trauma. And that as we realize that it is really important that we also address their cooccurring mental health disorders because if we don’t also treat those; it’s going to be very hard for those youth to lead those fulfilling lives that we are trying to help them lead.
Host: So, than Alicia, tell us a little bit about drug addiction. Is that considered in itself, a mental illness or are they really two separate things that just happen to go hand in hand many times?
Alicia Ventura MPH (Guest): We typically do not talk about substance use disorder as a mental illness. We think of it more as a health condition. But as Dr. Bagley mentioned, there is a lot of overlap between the two. And it’s relatively new that people have started treating both mental health and substance use disorder concurrently. Prior there was sort of this idea that you can only treat one or the other. But really, people have learned that it’s more beneficial for the patient to treat them at the same time.
Host: Alicia, when we were speaking off the air, you mentioned that you have a vested interest in this topic. Please tell us a little bit why.
Alicia: So, I am what we would refer to as an affected family member which means that I have someone in my family who has a substance use disorder. And I also kind of act as a family member to someone I grew up with who has a substance use disorder. And that’s sort of given me this inside perspective to the treatment system and some of the gaps that exist. A lot of what goes on at home for the family is not always recognized and there’s a lot of this acute care when people are in crisis and then they are discharged home and the family has to provide basically life sustaining care in the home. And often that’s not recognized by treatment facilities or providers and Dr. Bagley and I have both been very vested in trying to make that more a part of primary care and really all care that’s provided.
Host: Then Dr. Bagley, along those lines, if a person is being treated for substance abuse, where does that leave them with their mental health issues which could be a lifelong issue? How do these things go together in treatment? Tell us a little bit about what’s involved in treatment.
Dr. Bagley: It’s a really important point, because I think that as Alicia noted, we think about substance use disorders as a health condition and oftentimes as a chronic health condition which can be similar to as how we think about mental health disorders and so, now in the setting where I practice, and where a lot of use at Boston Medical Center are taking care of patients is actually based in primary care. And so, what that means is that patients can come to us and we can offer them regular primary medical care services but we are also able to offer them treatment for their substance use disorder which might include a medication like buprenorphine or naltrexone and then also we can offer them a consult with a psychiatrist or potentially therapy with a social worker or a psychologist and so in that way, we are able to offer this integrated care that both addresses their substance use disorder but then also their mental health disorder. And because it’s being offered in a medical home, that is sort of ongoing care.
So, as Alicia noted too, a lot of times, the treatment system for addiction has been set up so that people are sort of in and out of a lot of different programs and I think that what we’ve seen is really a shift in the way that we think about this. Because if we’re considering it a chronic illness, we really do need to provide sort of a continuum of care in a place that really is a medical home for patients who have substance use disorder. And in that way can provide that ongoing care.
Host: That’s a great point that you brought up about ongoing care. Alicia, can you expand for us on what Dr. Bagley said about how people should go about finding a program? Do mental health patients have more trouble in treatment? Is it harder to keep them in treatment? What do you want, and we’re going to get into family members being involved in a minute; but what would you like people to know about keeping their loved ones in treatment? Is it more difficult when they suffer from both?
Alicia: I would say it’s difficult for me to speak for all family members, right? I can really only speak to my own experience. My family member actually does have both a mental health disorder as well as a substance use disorder. And it certainly is very challenging. Mostly because it’s difficult to find programs that specialize in both. And I think that it’s difficult to weed out sometimes what is being cause by the substance as opposed to what’s being caused by the mental illness.
And there’s also a lot of difficulty with follow up care and where is the best place to put someone. I think in general; we just need more services. The state has recently invested quite a bit in mental health facilities and specifically facilities that are able to treat both substance use disorder and mental health. So, hopefully that will create more opportunities for people to receive the care they need.
Dr. Bagley: That’s a great point Alicia, because I think if you think about it, as Alicia sort is setting up as from like the patient’s perspective; it’s really not helpful for an individual who may have an opioid use disorder and also have depression go to a program or go to a treatment center and say you know I need help addressing my opioid addiction and I also need help addressing my depression, and to be told well, we are really good at addressing this one thing, your depression, but we can’t really help you with your opioid addiction or we are really not set up. You might have to go somewhere else to do that.
And from the patient’s perspective, that doesn’t make any sense at all. It’s going to make their life more complicated. It means that they are going to have to tell their story twice. They are going to have to develop sort of relationships in two different settings and potentially be given two different treatment plans that may or may not be sort of complimentary to each other. And so I think the importance of trying to create programs and systems of care where from the patient’s perspective, he or she can go to a program and to be able to receive a sort of comprehensive assessment, diagnosis and then treatment plan and have all of his or her needs met there, hopefully with family involvement is just so much – it’s so important. The care is better. It’s more efficient and it’s truly, truly patient centered.
Host: What a great way to look at it and such important points Dr. Bagley. Alicia, tell us about families. Please reiterate for us the importance of family engagement in addiction treatment and how families can get involved. What do you want families to know about how involved they should be and how suborn they should be if they are trying to get a loved one the help that they need? What do family members, what are we supposed to do?
Alicia: That is a very complicated question. Family members have been very much pushed to the periphery when we’re talking about addiction. And we haven’t spent enough time educating family members about what they can do and empowering them to help their loved ones. If you think about it, so I did this math and say someone is receiving one hour of treatment a week, which is pretty generous; 99% of their time is spent outside of the healthcare system. And the family is the most basic social unit of our society and a lot of times, families are given misinformation. And because they don’t have an opportunity to get that education, often they will go to their primary health care provider or some other person that they deem a specialist and they will ask them what to do. And that person or physician will have no idea what the family should do, because it’s just not something that they are well educated in or that anybody is like super well educated in.
And so, families play an incredibly important role if you just think about the support that they are able to provide and often families are ridiculed and told that they are enabling someone’s substance use if they provide them with love and resources and that is so not true. We know that kicking someone out to the street, those sorts of things are not helpful. A substance use disorder however you want to define it or conceptualize it; we know that it is compulsive use despite negative consequences. So, adding negative consequences is not going to help this person with their substance use.
And so families can provide this really unparalleled support, and some are totally capable of doing that and I think a lot of times, all that we really need to do is to give families that information and empower them and teach them how to be these supports and not stigmatize them and push them away and give them false information that’s going to eventually harm their loved one.
Dr. Bagley: Those are great points Alicia. I think that what’s being highlighted is the importance of sort of different levels of care that even family members need. And so, some of that might mean actually family members on their own should be able to access services that support them because there can be a lot of stress and potentially anxiety that goes along with supporting someone who has a substance use disorder. But that also families need readily accessible information to find out about options for treatment, what different kinds of treatment mean, what’s the most appropriate treatment, what’s evidence-based treatment and that that can be really hard for families to access unless they already have a family member who is ready to enter treatment which may or may not be true.
And then we also need to think about once someone is engaged in treatment, how do we create a system that also integrates families into it. So, it’s a complicated issue and right now, I think Alicia highlighted we are not actually doing a very good job on sort of any level in terms of figuring out how to involve family members and support family members and really leverage the relationship, the expertise that families have when it comes to caring for their loved one with a substance use disorder.
Alicia: Yeah, I totally agree, and I think Dr. Bagley raises a great point which is that family members in and of themselves, are more likely to develop chronic mental health and health conditions than their peers who are not experiencing addiction in the family. So, they really do need their own services. And I also think we need to teach family members about how they can be supportive across this continuum of care. So, things like and Dr. Bagley has done research on this, having Narcan or naloxone in the home so that if their loved one is to overdose in the home, they are able to reverse that overdose. And teaching families sort of a harm reduction model where of course abstinence is the goal because it is the least – it comes along with the least amount of harm; but not everybody is going to get there or wants to get there. So, how do families intervene along this continuum of care where there’s risks at each point?
Host: Such great points and so important for listeners to hear. Dr. Bagley, as we wrap up, please tell us what you would like listeners to take away from this segment about concurrent substance abuse and mental health disorders and the hope and care that is out there if you or a loved one suffer from these.
Dr. Bagley: So, I think the word you just used Melanie, is really important is hope – is that we know that there is hope. We know that people can recover. We know that people can get better. And that treatment does exist that is effective for both substance use disorders and mental health disorders. And we know that families can be valuable partners as we continue to try to figure out the best ways to address addiction. I would want to add too that recovery is a lifelong process and that we also want to make sure in this month that we continue to support people who still continue to use drugs who are not yet in recovery and that it’s really important we think about how systems of care to best support them as well.
Host: Alicia, last word to you. Tell listeners what you’d like them to know about recovery month and hopeful advice for those suffering from both mental health issues and substance abuse and for those that love them.
Alicia: I guess the takeaway is that recovery is self-defined and it’s also possible and we need to support people across this continuum of substance use no matter where they are and what their goals are. Our focus needs to be on supporting them, meeting them where they are at and reducing the risk that exists for them in the place that they are. And empowering both people who use substances and their families to come together and create a support system that is eventually going to help the person regardless of where they are at. So, I think empowerment is really what I want people to take away from this is that they are not helpless. There are treatments. There are interventions. There are supports and there are people working very hard who care very much about them.
Host: Beautifully put. Thank you so much ladies, and I can hear the passion in your voice. Thank you for all that you are doing and thank you for joining us. That wraps up this episode of Boston MedTalks with Boston Medical Center. Head on over to our website at www.bmcaddiction.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, if you know somebody with addiction or substance use disorder or mental illness; please share this podcast with them, share it with friends and family of those and other loved ones because that is how we all learn together from the experts at Boston Medical Center. And don’t miss all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.