Even providers need help overcoming addiction stigma

The instructor is explaining what addiction is to a group of health care providers at the Veterans Administration Connecticut Healthcare System campus in West Haven. But while the instructor talks, all of the physicians, nurses, administrators, psychologists, chaplains, social workers, and others assembled in the conference room are holding their breath.

Fifty seconds into the discussion, the participants in this mini-residency on substance use disorders are not really focused on the topic anymore. But once they resume normal breathing, it’s an opening to talk about what addiction can feel like, said Brent A. Moore, Ph.D., research psychologist at VA Connecticut Healthcare System and a research scientist at VA Yale University School of Medicine’s Department of Psychiatry.

“That’s kind of what addiction is like a lot of times,” Moore said. “After a use of something, people feel normal, they don’t feel necessarily high. And the worst part is that in another few hours, they’re holding their breath again. They often do a lot of drastic things to be able to breathe.”

You would think that health care providers would already understand.But Moore and his colleagues say stigma surrounding substance use disorder can keep providers from asking the right questions of patients and failing to identify people who need treatment.

“We’re getting better at getting people into treatment,” Moore said. “That being said, of all the folks that have any substance use disorder, let alone opioid use disorder, the majority don’t seek treatment so we still need to make it more acceptable. We need to find ways to get through stigma.”

Research shows that people who feel more stigmatized are less likely to seek treatment and to remain in treatment. Stigma can adversely affect how providers respond to their individual patients, suggesting training like Moore’s mini residency on addiction can improve treatment engagement and success.

Improved training for health professionals in the diagnosis, treatment, and prevention of substance use disorders is among the initiatives outlined in the Comprehensive Addiction Resources Emergency (CARE) Act, H.R. 2569.

The legislation would authorize $100 billion in funding directly to states, U.S. territories, counties and cities, tribal nations and other public/nonprofit entities over 10 years to address the opioid crisis. Funding recipients would be required, with some exceptions, to offer behavioral therapies in addition to medication-assisted therapies.

In June, American Psychological Association Chief Executive Officer Arthur C. Evans Jr., Ph.D., testified in favor of the CARE Act before the U.S. House Committee on Oversight and Reform. Evans called attention to the need for a “whole person” approach — including nonpharmacological pain treatment — to address the opioid epidemic.

Evans told the Congressional panel that psychologists are on the front lines providing clinical services and conducting research in addition to providing education to address the opioid crisis.

Psychologists are developing methods to identify patients most at risk of developing an opioid use disorder if they prescribed opioids and are conducting the

behavioral interventions that are preferred alternatives to opioids for treating pain, he said.

“We also strongly support the CARE Act’s substantial investment in the education and training of psychologists and other substance use and mental health service providers,” Evans stated in his testimony. “There is a dire shortage of professionals in this area, and a need for greater expertise among the existing health care provider workforce.”

The CARE Act includes provisions for the development and dissemination of “curricula and resource materials relating to evidence-based practices for the screening, prevention, and treatment of substance use disorders, including information about combating stigma, prescribing best practices, alternative pain therapies, and all drugs approved by the Food and Drug Administration for the treatment of substance use disorders.”

Moore’s work examines ways to make addiction treatment more accessible, inviting and effective to a broad range of individuals, especially among patients who come into primary care settings.

Moore said providers are often hesitant or uncomfortable bringing up or discussing an opioid or other substance use disorder. As a result, patients sometimes may not get referrals and the type of treatment they need. Conversely, providers can end up giving a patient the impression that they don’t have a real problem or saying negative things, he said.

“You need to get people to have a better understanding of what addiction is to have empathy enough to interact,” Moore said.

Over the past year, 75 health care professionals have taken the two-day addiction mini-residency at the West Haven VA campus, said Moore, who is hoping to scale up the program.

Participants have responded that after completing the program, they felt more confident and capable in interacting with people with substance use disorders and that they better understood the circumstances of addiction.

“You start to see people as people,” Moore said.