Volume 4, Issue 2

What If?? An Idea to Promote the Integration of Physicians Into the Treatment of Addiction
Louise Haynes, MSW
Medical University of South Carolina

Have you ever heard the term “goomer” (Get Out of My Emergency Room)? That was the 1970s term for a person who would later be called a “frequent flyer” – someone who was seen repeatedly in hospital emergency departments. This person often had a mental illness, substance abuse or both. “Goomers” were reviled by medical residents working in emergency rooms because they required lots of time and attention, and visit after visit, they never seemed to get any better.

For many physicians, exposure and training in the treatment of addiction has consisted of caring for the down-and-out emergency room patient who barely survived from crisis to crisis. Physicians-in-training rarely, if ever, saw substance abusing patients get better, and their knowledge of what we know as recovery was non-existent. Is that still true today? Probably. Could it change? Perhaps.

What if medical education included an immersion experience through which physicians’ training required them to participate in a treatment program that included interactions with patients, families and staff in a recovery-oriented culture? Could this experience balance out the necessary grind of medical training often found by working in the emergency department?

Such a program already exists. Financed by philanthropy, the Betty Ford Institute’s Summer Institute for Medical Students is designed to give students a one-week experiential opportunity to learn about addiction and recovery through integration into the daily life of the patients and participation in the Center’s family program.

“In the area of addictive disease, awareness and sensitivity to the issues surrounding it begins with an adjustment in attitude. It has long been said the best way to help those not addicted understand the recovery process is to let them see it happen. This concept is equally true in the Summer Institute for Medical Students, where students learn side by side with alcoholics/addicts or with recovering family members working their own recovery... Being a part of a process that fosters change strongly reinforces the belief that both the alcoholics/addicts and their families can and do recover.”

According to Joseph Skrajewski, Director of Medical Education for the Betty Ford Center, 112 medical students are chosen annually from a much larger group of applicants from all over the world. Since 1985, more than 2,000 medical students from many of the nation’s leading universities have participated in the Center’s weeklong immersion program to learn about addiction, treatment and recovery. Although there is not currently an evaluation component to measure the long-term impact of this initiative, there is a 10-item pre/post questionnaire which is used to assess attitudinal changes among the participants relative to the Center’s rather traditional treatment philosophy, the results of which are presented below.

 

Survey Statement

%“true”
before

%“true”
after

1

I feel comfortable assessing a patient for addiction

15%

87%

2

Addiction in NOT due to a lack of willpower or choice

95%

98%

3

As a physician, I am comfortable talking to addicts
about their addiction/behavior

35%

95%

4

I am comfortable talking to family members about problems
they have due to a loved one’s addiction

43%

92%

5

I understand that addiction is a brain disease

48%

100%

6

I know the 12-Steps and how they are used in treatment and for long-term recovery

 4%

90%

7

I understand the roles of a Sponsor in a patient recovery program

27%

94%

8

Patients who are mandated to go to treatment do as well as those who choose to enter a program

55%

75%

9

I recognize what medications are most likely to “trigger” a relapse for recovering adults

 9%

73%

10

I know what community resources are available for patient referral, regarding treatment and 12-Step programs

15%

93%

 
While the survey results demonstrate significant changes in the desired direction, it could be argued that medical students who enroll in the immersion program are likely to have some knowledge or life experience that motivates them to seek a greater understanding of addiction. So, the Betty Ford Center experience builds on an existing openness to a greater understanding of recovery.

It would be interesting to conduct follow-up interviews with medical students who had participated in the program to understand how this training experience influenced their career paths, future professional decisions and patient care. Did the positive attitude changes toward addiction and recovery persist, or did later experiences erase the lessons learned during the one-week immersion program at Betty Ford?

The Betty Ford Center’s sister organization, Hazelden, has a similar program that focuses on medical residents, and there are likely similar medical education programs in other treatment programs across the country.

So, what if more of the nation’s best treatment programs offered scholarships to support a training program for medical students or residents and those programs used the best science available to provide evidence-based treatment to support recovery? 

And, what if we evaluated those medical education experiences and continued to refine and enhance the most salient aspects of the experience? Could a positive experience that allowed physicians-in-training to interact with patients, families and staff make a significant impact in breaking down the barriers that impede the integration of physicians into holistic medical care of those affected by addiction? What do you think?




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