So this is super exciting for us to get this group together. We have an interprofessional panel really to discuss the nuts and bolts of addiction treatment. So why don't we go ahead and get started? One of the first things I want to say as I look around the table is that we do have somebody missing. Unfortunately, Lindsey Powell can't be with us today. She's our nurse who has helped us develop this course. Hopefully, we will hear from her soon at another time. But what I really want to do is open this discussion up to all of us and have us tell learners in a very practical way, what is your role in addiction treatment? And what clinical skills do you use the most? Liz, why don't we start with you? And then we'll go around. >> So I work in primary care. I'm a physician assistant and I utilize the skills of interviewing physical exam and diagnosing patients. >> Fantastic, Rob? >> So as an advanced practice nurse, I diagnose and use medicine and psychotherapy in my treatment of people with substance use disorders, as we refer people as appropriate. Earlier in my career as a nurse, I would do home visits as well to patients' homes. I've worked inpatient on inpatient units, doing everything from basic collecting of vitals and other assessments of patients while their in withdrawal and, yeah. >> So Liz, as you hear what Rob is doing, are there any differences between what a physician associate would do and what an advanced nurse practitioner might do? >> I think it's kind of setting dependent. So in the primary care setting that I work in, we do actually do screenings. We have people that are trained in SBIRT, which is Screening, Brief Intervention, and Referral to Treatment, to kind of help us identify people. Not only with substance use disorders where people are at risk. And in that setting, we have a team of licensed clinical social worker and addiction specialists that we can refer to. >> Fantastic, and both PAs and APRNs, you all prescribe medication? >> Yes. >> In Connecticut and in different states that that can vary a little bit or what were able to prescribe or not, but in Connecticut, yes. >> So state laws impact addiction treatment and different- >> Yeah, without a doubt. >> Yeah. >> And Shannon? >> Well, as an addiction psychiatrist, I've worked in a detox setting and a residential rehab doing evaluations and management of detoxification from different substances. And I have worked in a primary care setting, teaching and consulting with regard to general mental health and psychiatric comorbidity and substance use disorders. And I have a private practice so in that setting, do pharmacotherapy and psychotherapy both for general mental health and substance use disorders. >> So you work in both primary care and in mental health settings? >> Yeah. >> Thank you. Robert? >> Yes. >> [LAUGH] >> Tell us what you do [LAUGH]. >> I am the non-clinician at the table and I come from the public health world. What I do is really look at the epidemiology of substance use and addiction, people who are in and out of treatment. Try to understand and work with clinical practitioners to improve their ability to keep people in treatment, to get people to want to go to treatment in the first place and to try to figure out what the barriers are that prevent people from getting access to the treatment they might need and might benefit from. >> So a lot of prevention- >> Well, it's both prevention and care. Some of the work we do involves evaluating programs of care as well as programs of prevention. So for instance, we do a lot of work with looking at the benefits of treatment for opioid use disorder in different settings. Some of the work we're doing now is in prisons in the community in different parts of the world even. And it all depends on what group of people were interacting with. If we're interacting with people who are in treatment, we want to find out what's preventing them from getting the care they need. And if it's people entering, we want to find out what is associated with keeping them there and having them reduce their risk of relapse. >> So you look at health care systems and try and see what works and try and make it better. >> Both the systems and the individuals- >> And the individuals. >> Most of the time you can't do one without the other in public health. >> And Jeanette? >> Yeah, so I'm an addiction medicine specialist and a primary care provider and I spend time clinically in two different settings. One is a primary care clinic embedded within addiction treatment. And another setting is a addiction treatment clinic embedded within primary care. And similar to Liz is I think a lot of the same skill sets in both of those settings. But they're adapted differently depending on sort of how we're engaging the patients in those particular settings. And then spend time, some of them share on teaching and trying to evaluate curricula around addiction treatment and prevention. >> So you work in academic addiction medicine? >> Yes. >> So one question that comes up a lot is what's the difference between addiction psychiatry and addiction medicine? >> [LAUGH] >> Can one of you maybe speak to that? Good question, certainly for, I mean, the most obvious part to me is with addiction psychiatry, spending a lot of time on the evaluation of the psychiatric comorbidity. Because there are such high rates of mental illness that are hand in hand with the substance use disorder and really needing to tease those apart and treat both simultaneously. But I think addiction medicine does a good job at that as well and knowing that you have to sort of collaborate and that way that it's not something that's overlooked. But I don't know. Can you say anything about- >> Yeah, I know, I totally agree. I think addiction medicine, many of us have trained in family medicine, internal medicine, preventive medicine, maybe even emergency medicine, obstetrics, gynecology. So recognizing that patients in any field may experience complications of their substance use and present two different providers. But if we don't really have some degree of skills to diagnose, assess, evaluate and either treat on-site or refer to treatment, it's a huge missed opportunity. The other thing, as Shannon was saying, recognizing that interplay between mental illness at substance use disorder and being able to treat both simultaneously is vital. It happens a lot on the medicine side as well with serious chronic infections and acute infections related to substance use disorders as well as other acute and chronic medical conditions. So I think it's almost like a Venn diagram where we have some skill sets that are very similar. I think amongst everybody in the table and then sort of specific things that lie outside a little bit. >> because there's a lot of overlap. >> Yeah. >> People with addiction have a lot of other things going on. >> Right, right, and as Robert said, may not access treatment for that particular issue, right? So you have to be able to capture them when they access treatment. Otherwise, we're missing an opportunity. So I think you're speaking to the fact that we need people to know about addictions no matter what field of healthcare they're in. Because people come in lots of different doors.
