“I have been speaking with the rest of the team, and they are embracing the new strategies. We also think these strategies need to be agency-based, a system approach.

How do we get there?” Maryann asked, feeling hopeful, and Rodis replied, “These types of changes are influenced by culture and mindsets; remember, it takes a village. And there are ways to get everyone’s buy in.”

In a previous article entitled, New Strategies for Substance Use Assessment: 5 Reasons Why, Maryann, a clinician on the HOPE ACT team met with Rodis, a consultant, to discuss Raj, a patient who was using K2, cocaine, and heroin and had been hospitalized multiple times.  By the end of their meeting, Maryann had learned a lot, and she felt empowered and ready to implement the tools for substance use assessment. At her present follow up meeting with Rodis, Maryann was eager to understand the role of her agency and the system plan for implementing these new strategies for completing a comprehensive and effective substance use assessment.

In the previous article mentioned above, the five reasons discussed were related to the perspectives of the patient and client, and the clinician and advocate. Rodis told Maryann, “It takes a village.” This is certainly true if any changes are to be meaningful and sustainable. The entire agency and the system of healthcare, as a whole, need to be involved.

Below are five additional and crucial reasons for new strategies to completing a comprehensive and effective substance use assessment. This time we view them from the perspective of the agency and the system.

Agency perspective

• To enhance communication

With the new strategies, Maryann and her team decided to “restart the clock” with Raj, who then had the opportunity to speak at length about his substance use and reveal that he has been attending a substance use treatment group, as part of a court mandate. The clinician who does not know what he or she is looking for does not know what he or she encounters. Enhancing communication starts with the patient and client and then the clinician and the team, and it continues with the agency and the outside treatment providers, and the system as a whole. The new strategies for completing a comprehensive and effective substance use assessment provide a framework that helps us think differently about substance use assessment, thereby enhancing communication.

• To enhance clinical outcomes

Enhancing clinical outcomes involves enhancing communication. It also involves knowing the right questions to ask: The When, The How, and The What, when working with patients and clients with substance use disorder. “We have not really addressed Raj’s substance use needs; we simply have been expecting him to stop using,” Maryann stated, referring to herself and the team. She was also alluding to the lack of infrastructure at her agency, and she vowed to start advocating for something better.

System perspective

• To decrease waste in healthcare

“He says he takes his medications, but he keeps going in and out of the hospital. The team does not know what to do,” Maryann said to Rodis. There are several factors why someone gets admitted to an inpatient psychiatric hospital. Substance use is only one of many reasons, though it was the main one for Raj. The HOPE ACT team has become frustrated, in turn reinforcing the cycle. The team needed to learn new strategies for substance use assessment, in order to acquire the tools, new perspectives, and a new way of working with Raj. This has proven to be the case with Maryann.

Having a system that encourages, promotes, and emphasizes new strategies for completing a comprehensive and effective substance use assessment will lead to beneficial outcomes for the patients and clients, for the clinicians and advocates or staff, and for the agency. Together, this will help decrease waste in healthcare.

• To halt the cycle of fragmented care

In the previous article, New Strategies for Substance Use Assessment: 5 Reasons Why, I mentioned how healthcare practice tends to be in a silo. This is particularly true when it comes to mental health and primary care, and sadly, even more so when it comes to integrating substance use treatment and mental health care. This cycle of fragmented care has an unfortunate ripple effect. It disempowers clinicians and prevents optimal care for patients and clients; it hinders proper communication and decreases the likelihood of adequate clinical outcomes, and it also increases waste. As you can see, it is all interconnected, but this cycle can stop.

• Educated expectations

“We have been expecting too much from Raj, much more than we have ever expected from Ron, who, at one point, stopped taking his Lithium, his Metformin, and his Insulin, just because he did not feel like it.” Maryann articulated these words to her team, advocating for Raj, educating her colleagues, and taking a stance against the stigma associated with substance use disorder. Educated expectations require that we first understand what it means to have a substance use disorder, that it is in fact a chronic illness, no different from other chronic physical health conditions, like hypertension or diabetes. Also, cycles of sobriety and relapse are expected as part of the chronic condition of substance use disorder.

Educated expectations force us to emphasize the harm reduction model, to stay away from the righting reflex, and to evoke and work on the ambivalence of our patients and clients, if we are to engage in meaningful changes. “These types of changes are influenced by culture and mindsets; remember, it takes a village. And there are ways to get everyone’s buy in.”

Rodis explained to Maryann that a system, which emphasizes the above type of culture and mindset, would surely reach the goal of effectively caring for patients and clients with substance use disorder. Learning and implementing the new strategies for substance use assessment will help do just that.

“I have been speaking with the rest of the team, and they are embracing the new strategies. We also think these strategies need to be agency-based, a system approach. How do we get there?” Maryann asked, feeling hopeful, and Rodis replied, “These types of changes are influenced by culture and mindsets; remember, it takes a village. And there are ways to get everyone’s buy in.”

Maryann learned the first five reasons for the new strategies of completing a comprehensive and effective substance use assessment:

(1) Better care for our clients and patients;

(2) Better use of our countertransference and biases for the benefits of our patients and clients;

(3) Promotion of integrated substance use treatment and mental health care;

(4) Improvement of our advocacy skills on behalf of patients and clients affected by substance use disorders; and

(5) Provide better education and the tools to decrease stigma against substance use disorders.

As Maryann continued to meet with Rodis, she learned five additional reasons for the new strategies related to completing a comprehensive and effective substance use assessment, outlined as:

(1) To enhance communication;

(2) To enhance clinical outcomes;

(3) To decrease waste in healthcare;

(4) To halt the cycle of fragmented care; and

(5) Educated expectations.

At least one of these ten reasons should resonate with you and motivate you to learn the new strategies for completing a comprehensive and effective substance use assessment. Like Maryann, you will be able to identify your biases and think of ways to practice in a more integrated way. And you will enhance your advocacy skills. You will also help lead your agency towards this effective way of thinking: enhancing communication, enhancing clinical outcomes, halting the cycle of fragmented care, and upholding educated expectations. Lastly, you will stop falling into the trap of unknowingly and unintentionally failing to provide the right care for your patients and clients.

References:

1. Davies, John Booth (1998-01-18). The Myth of Addiction. Psychology Press Ltd (2nd rev edition).

2. McLellan, A. T.; Lewis, D. C.; O’Brien, C. P.; Kleber, H. D. (2000-10-04). “Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation”. JAMA. 284 (13): 1689–1695.

3. Shoal GD, Giancola PR (November 2005). “The relation between social problems and substance use in adolescent boys: An investigation of potential moderators”. Exp Clin Psychopharmacol. 13 (4): 357–66.

4. Lo CC, Cheng TC (2007). “The impact of childhood maltreatment on young adults’ substance abuse”. Am J Drug Alcohol Abuse. 33 (1): 139–46.

5. Ohannessian, C.M., Hasselbrock, V.M. (1999). Predictors of substance abuse and affective diagnosis: Does having a family history of alcoholism make a difference?. Applied Developmental Science, 3, 239-247.