Changing the Culture of Addiction Treatment

Addiction is a complex and prevalent problem that exempts no race, culture, or creed. Despite decades of research dedicated to finding the cause of addiction — genetic, neurologic, psychosocial — we are still at a loss for treating people battling with ending their substance abuse. Historically, society has criminalized those discovered to be abusing drugs and alcohol. Moreover, healthcare professionals (HCPs) charged with caring for the sick are admittedly biased in their encounters with addicts [1–3]. This affects their level of engagement and approach to providing care [4,5]. These biases can be further compounded by race — giving biased compassion for white middle class Americans versus scorn and haste to poor persons of color [6,7]. This divide fractures the opportunity for the utilization of services, in that compassion offers the opportunity to communicate and educate, while haste offers a few brochures and the door. Looking beyond race for a moment in order to take a new approach in addressing this need, the intersection of bias and education offers a unique space to reduce barriers to utilization of services.

Decades of research have always prominently pointed to education as a social determinant of health outcomes [8–11]. Persons of color are less likely to know and understand health disorders. Cultural differences also influence stigmas and misunderstandings, especially in mental health disorders. This creates an intimidating environment for the patient, which only adds to the shame that persons with addiction already feel when seeking help. When persons with addiction are approached by HCPs with disdain and rejection, no matter how subtly, they may reject the care offered by these providers.

One way to begin changing the dynamic of the patient-HCP interaction is changing the language in the exam room. Medical jargon can be confusing to the patient. Additionally, some terminology may have a different impact in scientific versus lay context. For example, the term substitution or replacement therapy can have different reactions in the same conversation. The HCP perspective of this term is “I am offering this as the best treatment option to help you overcome”. The patient perspective is “You’re just swapping one addiction for another”. These interactions lead to misinterpretations that create an unsupportive environment for the patient.

One recommendation to begin to change the culture of addiction treatment is to teach HCPs and medical staff to empathize with patients. Dr. Epstein, a family physician based in Rochester, NY, conducted a year-long program in mindful practice to promote and address compassion and other issues centered around quality of care. At the program conclusion, participants (physicians) improved their own well being, as well as becoming more empathic and attuned to their patients’ psychosocial needs. Adopting the practice of mindfulness can allow health care practitioners to improve their patient care and create a more supportive environment [12]. Additionally, HCPs and medical staff that interact with patients could take a psychology course to gain better training in non-biased interactions.

In conclusion, patients feel uniquely vulnerable during an HCP visit. Asserting views might require disagreeing, which can lead to fear of negative consequences that might impact future care [13]. Suffering with addiction only magnifies this vulnerability. Integrating psychology methods will help physicians adapt their communication strategies to address such concerns as well as other limitations.

References:

1. Howard MO, Chung SS. Nurses’ attitudes toward substance misusers. I. Surveys. Subst Use Misuse. 2000;35(3):347–365. http://www.ncbi.nlm.nih.gov/pubmed/10714451.

2. Happell B, Taylor C. Negative attitudes towards clients with drug and alcohol related problems: finding the elusive solution. Aust N Z J Ment Health Nurs. 2001;10(2):87–96. http://www.ncbi.nlm.nih.gov/pubmed/11421976.

3. Crothers CE, Dorrian J. Determinants of Nurses’ Attitudes toward the Care of Patients with Alcohol Problems. ISRN Nurs. 2011;2011:821514. doi:10.5402/2011/821514.

4. Brener L, von Hippel W, Kippax S. Prejudice among health care workers toward injecting drug users with hepatitis C: Does greater contact lead to less prejudice? Int J Drug Policy. 2007;18(5):381–387. doi:10.1016/j.drugpo.2007.01.006.

5. van Boekel LC, Brouwers EPM, van Weeghel J, Garretsen HFL. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug Alcohol Depend. 2013;131(1–2):23–35. doi:10.1016/j.drugalcdep.2013.02.018.

6. Cherry M. Drug Abuse and Our Biased Compassion | The Huffington Post. http://www.huffingtonpost.com/myisha-cherry/our-biased-compassion_b_4739361.html. Published 2014.

7. Lopez G. When a drug epidemic’s victims are white. http://www.vox.com/identities/2017/4/4/15098746/opioid-heroin-epidemic-race. Published April 2017.

8. Goldman D, Smith JP. The increasing value of education to health. Soc Sci Med. 2011;72(10):1728–1737. doi:10.1016/j.socscimed.2011.02.047.

9. Olshansky SJ, Antonucci T, Berkman L, et al. Differences In Life Expectancy Due To Race And Educational Differences Are Widening, And Many May Not Catch Up. Health Aff. 2012;31(8):1803–1813. doi:10.1377/hlthaff.2011.0746.

10. Montez JK, Berkman LF. Trends in the Educational Gradient of Mortality Among US Adults Aged 45 to 84 Years: Bringing Regional Context Into the Explanation. Am J Public Health. 2014;104(1):e82-e90. doi:10.2105/AJPH.2013.301526.

11. Zimmerman EB, Woolf SH, Haley A. Understanding the Relationship Between Education and Health: A Review of the Evidence and an Examination of Community Perspectives. 2015. https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/zimmerman.html.

12. Epstein R. Attending: Medicine, Mindfulness, and Humanity. 1st ed. New York: Scribner; 2017.

13. Weir K. Improving patient-physician communication. American Psychology Association Monitor on Psychology. http://www.apa.org/monitor/2012/11/patient-physician.aspx. Published 2012.

Dr. Ayana Martin received a PhD in Molecular Medicine and Translational Science. She co-founded EncepHeal Therapeutics to help address a very serious problem for those struggling with substance abuse that currently has no targeted solution. She and her startup team are passionate about promoting areas of healthcare that are poised for significant advancement but are currently undervalued and underfunded.