Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: Qualitative study in primary care
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Although very common, excessive drinking by people who also use other drugs is rarely studied by scientists. The purpose of this study was to find out patient’s and clinicians’ opinions about addressing this issue. All of them took part in a study called PINTA – Psychosocial interventions for problem alcohol use among problem drug users.
Doctors reported obstacles to addressing heavy drinking and overlooking and underestimating this problem in this population.
Patients revealed that their drinking was rarely spoken about and feared that their methadone would be withheld.
Read the full article in the latest issue of the Drugs and Alcohol Today: http://www.emeraldinsight.com/loi/dat
See also my previous posts about the PINTA study:
What is the future of addiction medicine? What is the future addiction specialist going to look like? Nobody knows what the future is going to look like, but the delegates of the 25th CSAM annual conference imagined answers to these questions in Banff, Alberta at the Banff Centre on Tunnel Mountain. As a first comer to the conference, I had a lot to learn and a lot to write down. Read more below.
Seven high-profile experts explored trends at home and abroad and the scientific topics impacting the future of addiction treatment delivery in their keynote plenaries.
November 5th, the national conference of the Association for Medical Education and Research in Addiction – AMERSA 39th – took place in Washington, DC. With 75% of the 225 delegates being new to the conference, the conference dynamics enlivened. As a rather small association with only 1 FTE, it is doing great in attracting so many new delegates. To see what lectures they got to hear, read my notes from the Keynote speeches below.
There is no room for prosecutors in the delivery room
Dr Paltrow questioned who gets the rights when it comes to pregnant drug users. While the laws in many US states try to protect the unborn child, in reality it is the judge, the county and the attorney who gets the rights. Is this the protection of the unborn or of the system? Dr Paltrow’s mother smoked during pregnancy:
“Maybe if my mom wasn’t smoking throughout her pregnancy, I might have been a for-profit lawyer.”
To reduce the stigmatisation of pregnant women with substance use disorders, make sure to “use the word use” – not Abuse, neither drug-dependent newborn. If you are asked to drug test when you shouldn’t, it is a moral obligation to do civil disobedience. The medical education should include teaching the risks that clinicians carry when they report pregnant women who use drugs.
What is appropriate counselling?
Betty Ford Award Plenary Session at the AMERSA 39th Annual National Conference
“No matter what is the dimension of drinking, the diversity is there.”
If you enjoyed reading about this year’s conference, you may like to read my notes from the previous year, 38th meeting in San Francisco, CA, November 4th, 2014.
Many doctors see addiction as a disease of body only. If overdone, this view can lead to medicalization of addiction. Some may argue that the latest research proves addiction as a chronic brain disease. This view is supported by brain scans of people who used drugs compared to people who didn’t. The scans show a loss of dopamine neurons after heavy methamphetamine use. Although brain’s plasticity allows it to recover, we don’t know how much of this loss is permanent.
While brain researchers may not mean to reduce addiction to a purely medical condition, its psychological, social and spiritual facets get sometimes overlooked. Not only medical students do not get enough education on addiction, what they get is often focused on the biological aspect.
To bridge this gap, in June 2014, a group of eight medical doctors (five doctors in training and three staff) from Canada went on a three day journey to a remote First Nations (i.e. American Indian) community to hear stories of recovery and participate in traditional healing techniques. After the trip, the Director of their addiction training programme (www.addictionmedicinefellowship.org), analysed the group’s experiences using qualitative research techniques and presented* the narratives at conference of the Association for Medical Education and Research in Substance Abuse.
People from the First Nations reservation shared their experience with the power of spiritual recovery tools – sweat lodges (see Figure 1), community round ups, connection to heritage, family support, and elder-guided self-reflection: “…learning came through creating bonds of friendship with people at Alkali Lake. It was through these bonds that the human face…emerge[d] and the real learning started to happen.”
|Figure 1. Sweat lodge (photocredit: fellowship archive)|
First Nations communities are over-represented among people with substance use disorders in Canada. Having little sense of cultural competency, clinicians can become discouraged when faced with the suffering and despair of those with substance use disorders: “…the most valuable lesson [of the field trip] was in deepening the understanding that the most effective way of being an addiction physician is by humbling ourselves, relinquishing our titles as doctors and getting to know the person behind the addiction.”
The Director encouraged programmes to “find a local community that has tackled the programme and go out to do a field trip and learn from the community members.”
*Text first published at a registration-restricted website: https://www.mariecuriealumni.eu/news/doctors-sweat-discover-traditions-first-nations
Story based on a poster presented at the AMERSA conference November 5th, 2014: Lighting the ember of hope: Integrating field experience and narrative techniques into Addiction Medicine Fellowship training. By Launette Rieb (a,b), MD, MSc, CCFP, FCFP, dip. ABAM; Nitasha Puria (b), MD, CCFP; Marcia Thomson (a), MSc; and Evan Wood (a,c) MD, PhD, ABIM, FRCPC, dip. ABAM
a)St. Paul’s Hospital Goldcorp Addiction Medicine Fellowship, Vancouver, B.C., Canada. b)Department of Family Practice, and c)Division of HIV/AIDS, Faculty of Medicine, University of British Columbia, Canada
Association’s for Medical Education and Research in Substance Abuse mission is to improve health and well-being through interdisciplinary leadership in substance use education, research, clinical care and policy. Text taken from www.amersa.org
Clinical addiction medicine training is a multidisciplinary addiction medicine fellowship that strives for excellence in clinical training, scholarship, research and advocacy and involves medical education to trainees from Psychiatry, Internal Medicine, Family Medicine and Nursing. For more details, click here.