Guest Editorial

Family Medicine Is Poised to Lead on Addiction Care

August 21, 2019 02:17 pm Flora Sadri-Azarbayejani, D.O., M.P.F.

Addiction is arguably the most stigmatized disease in the nation, and it does not discriminate; it impacts everyone -- youths, senior citizens, women, men, the impoverished and the wealthy. Those struggling with the disease of addiction deserve to get their lives back, and they require medical help to do so.

[headshot of Flora Sadri-Azarbayejani, D.O., M.P.F.]

Many cases of addiction start with cravings to self-medicate. Struggling with stress, financial troubles, unemployment, grief, social issues and other difficult life events can push people to utilize unhealthy coping strategies. For some, that might look like avoiding social interaction, engaging in risky behavior, consuming excess food or not eating enough. Getting closer to the issue, it may look like drinking too much alcohol, taking more than the prescribed amount of sleeping pills or trying an unknown substance at a party.

People who struggle with substance use are trying to cope. They are searching for a way to feel normal or to numb pain. Many do not know where to go or who to turn to for help.

Despite the stigma, people with addiction are incredibly resilient. I urge other physicians and medical professionals to truly listen to their patients' stories. The medical community has the tools to help people reclaim their lives. In recovery, people can regain access to job opportunities, housing, their children, education, important relationships, and even their dreams and aspirations. There is nothing more rewarding than being part of that journey of recovery and helping someone rediscover life. The satisfaction and catharsis are indescribable.

Why Family Medicine?

According to a 2012 study by the nonprofit Center on Addiction,(www.centeronaddiction.org) "40 million Americans age 12 and over meet the clinical criteria for addiction involving nicotine, alcohol or other drugs," and "another 80 million Americans fall into the category of risky substance users." The authors discovered that only 10% of those with addiction receive treatment, and fewer still receive screening and early intervention. Perhaps the worst finding is that "few receive anything that approximates evidence-based care."

Family medicine is intended to treat the whole patient. Physicians called to this field are often the first to discover a mental or behavioral health issue. Cooccurring diagnoses are common, and it is just as vital to find and recognize addiction as it is to identify depression, anxiety or any other disorder.

Substance use disorder is a chronic brain disease, and treatment requires long-term monitoring. Family physicians have an extraordinary opportunity to play a vital role in addiction treatment in either dedicated facilities or the traditional primary care setting. As more physicians in family medicine advance in addiction medicine and obtain waivers to provide medication-assisted treatment for addiction, their primary care skills enhance the treatment they can provide to addiction patients in any setting.

The integration of behavioral and primary care is essential to addiction treatment, and family medicine physicians within the addiction subspecialty can provide a holistic approach.

Just as you check patients for health markers -- blood pressure, heartbeat, breathing -- so, too, can you check external health factors such as housing, food accessibility and positive self-esteem. Caring for the whole person means aiming for recovery that leads to a stable job, steady income, access to food and the ability to afford housing. The ability to care for themselves and their families directly impacts patients' well-being, their stability in recovery and their traditional health markers.

A study published in PLOS ONE(journals.plos.org) found that "multidisciplinary and coordinated care delivery models are an effective strategy to implement opioid use disorder treatment and increase medication-assisted treatment access in primary care." Primary care and family medicine settings are perfect for early intervention, and growing research can predict the best avenues for treatment and prevention.

Building rapport with patients and cultivating that trust early in recovery is imperative to creating a lasting positive relationship. Significant medical intervention is needed for recovery -- monitoring, urine screening and candid conversations. Family medicine offices and addiction treatment centers are busy, and it can feel difficult to make the time necessary to treat these patients. But the reward is well worth it.

Barriers

Stigma surrounding addiction does not impact only patients. It extends well beyond to their family members, friends and even to the physicians who treat them. The patients seen at addiction treatment centers are the same patients seen in any other practice setting, but to admit to their struggle with addiction, a patient must first feel welcome to do so.

Unlike other chronic conditions such as cancer or diabetes, an unjust moral judgment is often attached to addiction diagnoses. The medications used to treat SUD are frequently misunderstood and met with apprehension or suspicion. Addiction medications work to stop craving and withdrawal. They do not produce a high or lead to continued addiction. Using medication for addiction is not the exchange of one opiate for another.

The medical education and research communities have work to do to make this information common knowledge. Medical education is just now advancing to meet the needs of the growing opioid epidemic. As research advances, findings need to be focused on reaching policy stakeholders and legislators who can address this.

Certification

Addiction medicine has been an official subspecialty since 2016. With the epidemic now upon us and certification requirements set to increase beginning in 2022,(www.theabpm.org) the time to certify is now. The American Society of Addiction Medicine offers specialized courses for exam preparation(elearning.asam.org) and networking connections to help meet the nearly 2,000-hour requirement.

In the future, certification will require a fellowship. This means that not only will the certification process be more difficult, it will also be significantly slowed if there are not enough certified addiction medicine physicians to provide those fellowships. Getting certified now means supporting the future.

Hope for the Future

Can we imagine a nation free from overdose, drug-related incarceration, license confiscation, family separation and addiction stigma? Advances in preventive measures, child education, medical school curricula and genetic research offer pathways to a future addiction-free nation and perhaps an addiction-free world.

The end of addiction relies on the physicians who help increase access to care and the voices that speak out against stigma. Punishment does not work, scorning those who relapse does not work, and ignoring the epidemic most certainly does not work.

Physicians have the opportunity and ability to serve as the biggest advocates for their patients. Addiction patients often become like extended family -- many send thank-you cards and gush about landing their dream job, repairing damaged relationships, getting their children back and otherwise turning their lives around. Take action and join this journey toward the end of addiction.

Flora Sadri-Azarbayejani, D.O., M.P.F., is a regional medical director for CleanSlate Outpatient Addiction Medicine,(www.cleanslatecenters.com) a national medical group that provides office-based outpatient medical and behavioral health treatment for the chronic disease of addiction, primarily alcohol and opioid use disorders.

Related AAFP News Coverage
Authors See Crucial Role for Primary Care in Opioid Epidemic
(7/10/2018)

Leader Voices: A Right Way to Treat Opioid Addiction
(2/9/2018)

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