‘There are no wrong doors’: Improving care for addicts
Founded in 2017, the Yale Program in Addiction Medicine is focused on preventing, treating and reducing harm for people with or at risk of developing unhealthy substance use or addiction. David Fiellin, Ph.D., Professor of Medicine, Emergency Medicine, and Public Health at the Yale School of Medicine, serves as his program director and works at the intersection of primary his care, the general health care setting, and addiction. He was also recently named editor-in-chief of the Journal of Addiction Medicine.
Fielin sat down with Yale News to talk about the program, his new editorial role, and his hopes for the field in the years to come.
What sparked your interest in addiction medicine research?
David Feelin: It was a combination of three factors: patient numbers, opportunities to improve science, and a rapidly evolving medical field. I have always wanted to work with underserved people. Then, when I joined the National Clinician Scholars Program here at Yale University, I received high-quality training in clinical epidemiology and health services research. At the same time, I was working on a project evaluating research into the treatment of alcohol withdrawal and realized that the science of addiction medicine did not utilize many state-of-the-art methodological techniques. It is clear that the field is changing rapidly, with treatments becoming more readily available in common medical settings.My mentor at Yale University is at the forefront of these changes I felt like I was in the right place at the right time.
What are the challenges in evaluating and treating drug use and addiction?
Feelin’: One of the greatest challenges is the understanding among patients, families, and non-professional health care professionals of the core concepts of addiction treatment, genetic predisposition, neuroscience, and the rationale for the treatments we offer. I think there is a lack of understanding about Unfortunately, I think it leads to misunderstandings at best and stigma at worst.
For example, consider the state of Opioid Use Disorder. That’s what basic neuroscience has been understood from his late 60’s to his mid-70’s. And there are effective drugs that address the underlying neurobiology. However, most clinicians, families, and patients seek non-medication-based treatments because of the weakness of willpower that has historically been thought to be the underlying cause of this disorder. Unlike other medical conditions where people are encouraged to use life-saving treatments, addicts are often discouraged or stigmatized from taking life-saving medications.
What is the mission of the Yale Program in Addiction Medicine?
Feelin’: The program’s mission is to expand access to and improve the effectiveness of prevention, treatment and harm reduction services for people with unhealthy drug use and addiction.
At Yale University, we are fortunate to have expertise in addiction and related fields in various departments and schools. However, it turns out that faculty and students are often unaware of what their peers are doing across campus. When the program was established, we created a convening structure for individuals around the campus of Yale University who were substantially involved, bringing together physicians and faculty members from medical schools, public health schools, nursing schools, law schools, and more. endeavored to function as Medication for use, harm reduction, addiction.
What are your goals as program director?
Feelin’: My primary focus has been to build our work on four core pillars: clinical services, teaching, research, and policy. Following our recent strategic planning process, we want to add community engagement to our pillars.
Clinically, our primary focus is to advance the concept that there should be no wrong door for those who need help coping with substance use. The first is to ensure that patients who join our healthcare system through any portal receive quality care and referrals for unhealthy substance use and addiction.
On the educational front, we offer subspecialty training through our Addiction Medicine Fellowships. In addition, Jeanette Tetrault, Srinivas Muvvala, and others created an addiction medicine thread that goes through medical students, education that doctors associate students with, and APRN. [Advanced Practice Registered Nurses] students receive. And we are dedicated to increasing the number of underrepresented people in the addiction health care profession.
For research, we continue to develop and evaluate the most effective treatments, especially for alcohol, opioid, and tobacco use disorders, and the most effective strategies for their implementation in the general health care setting.
In terms of policy, we are actively engaged in local, state, national and international efforts to implement the most effective evidence-based policies against substance use and addiction. For example, for the Opioid Reconciliation Fund, which is distributed to states through settlement agreements with pharmaceutical companies and other entities involved in opioid distribution, we are working with national agencies to ensure the maximum return on investment. It also addresses the ways in which stigma is expressed in legal and regulatory practices. Our legal representatives have confirmed that some of these practices violate the Americans with Disabilities Act and are working with us to address that discrimination.
Which community groups does this program currently partner with?
Feelin’: We work very closely together and many of our clinical services are provided through community organizations such as Yale New Haven Hospital, Cornell Scott Hill Health Center and Fair Haven Community Health Center. We also work with the APT Foundation and community organizations focused on harm reduction, such as the New Haven Harm Reduction Task Force and the Connecticut Harm Reduction Alliance.
What are you looking forward to in your role as editor-in-chief of the Journal of Addiction Medicine?
Feelin’: To continue to advance the field to produce the best possible science to guide the treatment of patients and those at risk. We also want to help put this science into practice and improve public discourse and policy on substance use and addiction.
What are your hopes for the field of addiction medicine in the years to come?
Feelin’: This is a critical time for addiction treatment. We hope that the field will begin to more accurately reflect the diversity of the patient population we see. Medical professional students and trainees are drawn to the field in record numbers. I am very happy to hear that. I think that bodes very well for this area. And I hope that prejudice will decrease. We didn’t talk about cancer diagnoses in the last century, and before effective treatments, people were wary of talking about depression and other mental health diagnoses. It is a condition that is both clinically and environmentally contributory, has evidence-based treatments that are as effective as in other areas of medicine, and warrants an important clinical role for addiction medicine professionals. I hope individuals start to realize that they can. Care, Public Health, and Policy.