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Richard Saitz, M.D., MPH

Dr. Richard SaitzRichard Saitz, M.D., MPH, is a professor
of medicine and epidemiology at Boston University, and also primary care physician and director of the Clinical Addiction Research and Education (CARE) Unit in the Section of General Internal Medicine at Boston Medical Center. Dr. Saitz recently won the RSA Distinguished Researcher Award at the Research Society on Alcoholism's annual meeting in June 2012 in San Francisco, California.


Writer Sherry Wasilow interviewed Dr. Saitz from his office at Boston University.


SW: How did you begin your work in the field of alcohol studies?

RS: I trained as a resident physician in the late 80s at Boston City Hospital, which was an urban, public hospital. We saw many patients living with the consequences of alcoholism—like liver disease, seizures, internal bleeding, and pancreatitis. I learned how to take care of those medical conditions, but not their cause.

At that time, my colleagues were excited about advances in heart-disease treatment and were always citing the latest research as a basis for their care. I thought it surprising that we were ignoring the cause of some of the most common illnesses we saw, and were not basing our treatment on high-quality research. It was then I decided I wanted to address caring for the health consequences of alcoholism, and base that care on well-done, applicable research studies.

SW: How did this decision lead you to your current research focus?

RS: I started with studying a common problem in hospitalized medical patients: alcohol withdrawal. Standard treatment at the time – medication every six hours for three days regardless of what was going on with the patient – made no sense to me … it gave too much medication to some and not enough to others. My first study found that giving medication according to symptoms gave the right amount and took less time. It is now standard practice for managing alcohol withdrawal.

Soon I became interested in people who either had problems from drinking without a diagnosis of alcoholism, or were drinking so much they were putting themselves at risk for harm. There are many more such people in the population than there are people with alcoholism. Many of them are seeing physicians but are not receiving advice or care for their alcohol-related health risks; they have never seen alcohol-treatment specialists, let alone entered a treatment program. Those realizations shaped the next two decades of my research.

I began studying questionnaires that could identify risky alcohol use but were brief enough to be used in general healthcare settings. Then I studied whether brief counselling could work for people identified by those questions in terms of decreasing or preventing consequences, and whether that sort of clinical practice could be put into place in primary-care settings by primary-care physicians. At the same time, I didn't forget about those with more severe problems. It seemed that people with alcoholism were never taken care of in the regular health system. They were always sent elsewhere, so there were separate records, and to practitioners who were not part of the health system in any meaningful way. This led to very fragmented and poor care when found, even if the specialists they saw were superb. To address this seemingly obvious problem, colleagues and I designed ways to integrate medical, alcoholism, and mental-health care into medical settings, similar to how clinicians care for health problems such as asthma, diabetes, and depression. We tested these methods well before health reform made them popular, finding some successes and some challenges, but I still think it is the best and safest way to deliver care.

Dr. Spaitz quote

The last key characteristic of my research has been to demand, seek, and be true to what research studies tell us we should do in clinical practice with patients. Many people would be surprised to hear that much health care is not based on evidence, particularly with alcoholism. One recent concern has been to make sure we base our care on research, improve its quality, and get the evidence we need if there isn't any. One example of a practice that has been disseminated far in advance and even contrary to research evidence is called Screening, Brief Intervention, Referral and Treatment (SBIRT) (http://www.samhsa.gov/prevention/sbirt/). The concept makes sense, and early identification and brief counselling interventions make sense, and also work in some circumstances. But practice and dissemination has gone way beyond the evidence, which risks harming patients, wasting resources, or both. We need to discuss the actual scientific findings, however unpopular discussion may be.

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