Substance Use Disorder: Addiction Medicine Skills for Primary Care

Heidi Allespach, PhD: Clinicians must be prepared to recognize that addiction is a disease and it’s a very serious and fatal disease, which is often written off as a weakness or poor moral character, or something like that.  Only by recognizing it as a disease can they really help their patients through compassion, through empathy, but also through setting very strong boundaries.

Bernd Wollschlaeger, MD, FAAPM, FASAM: The evaluation of these patients by providers, physicians, physician assistants, nurse practitioners, and all those who work in a medical team, is a challenge and therefore we need to standardize the approach. We need to recognize that we’re dealing with a chronic illness that requires a team approach from multiple medical professionals.

It’s important that we have proper documentation through charts either actual or- in the future- virtual, that we all can feed into and retrieve information from. And the use of templates, so that we don’t forget what kind of tools we should approach and use in every single patient.  So what forms to use, what agreements to use, checklists that we could apply.  So a true standardized approach to chronic illness is needed, as we do with diabetes, with hypertension, with heart disease.

Heidi Allespach, PhD: One of the questions that we ask practitioners is to think about how past experiences with someone with a substance use disorder or addiction might affect their current feelings about the patient with addiction and how those feelings might then influence their treatment of the patient.  Often the responses include things like feeling anger, disgust, frustration.  And if someone is not self-aware of these feelings and their antecedents, it can tremendously affect the care they provide to these patients, and in turn, how the patients feel about themselves. Patients in the late stage of addiction are already feeling really bad about themselves and so the self-awareness is important in providing the best overall quality of care for patients with substance use disorders.

Bernd Wollschlaeger, MD, FAAPM, FASAM: We are in the very early phases of integrating addiction medicine into clinical science, into clinical medicine.  And I say that because in the past we were locking people up with mental illnesses, and addiction is considered to be a mental illness.  We locked up people, institutionalize people that suffered from addictions.  Nowadays, we have accepted it that addiction is a chronic illness.  We accept that it’s a treatable condition, but we still have to struggle even as physicians with stereotypes that we need to overcome. We’re making progress, in my opinion.

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