Ensuring High Quality Addiction Care for All: The Fix Q&A with the President of the American Board of Addiction Medicine

By John Lavitt 12/04/15

Dr. Patrick Gerard O’Connor on the growth of addiction medicine specialists, medication-assisted treatment, and bringing his knowledge to the White House.

Dr. Patrick Gerard O’Connor

As President of the American Board of Addiction Medicine, Dr. Patrick Gerard O’Connor is a national expert on medication-assisted therapy and evidence-based practices. As the Section Chief of General Medicine at the Yale Medical School of Medicine, Dr. O’Connor has focused his scholarly work on the interface between primary care and substance abuse. His publications include studies on the management of opioid withdrawal in primary care settings, opioid maintenance in primary care, and the use of Naltrexone for treating alcohol dependence in primary care patients. Dr. O’Connor recently co-chaired a national symposium with Recovery Czar Michael Botticelli entitled, “Medicine Responds to Addiction” at the White House.

Addiction medicine is opening the door by allowing physicians from any field and not just psychiatry to specialize in addiction.

At the start of your medical career, you received SBIRT training. SBIRT is an acronym for Screening Brief Intervention & Referral to Treatment. Can you describe this training? Do all doctors receive it? If not, should all doctors be required to have SBIRT Training today?

Before I came to Yale, I did SBIRT training during my residency, and I have been involved in SBIRT training during my time at Yale. SBIRT training is an acronym for Screening Brief Intervention & Referral to Treatment. SBIRT is a comprehensive public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders.

We emphasize the importance of SBIRT training here at Yale, and we have had that training program in place for a number of years. The training program has been done in collaboration with colleagues in other departments. For example, we have worked very closely with the Emergency Medicine Department. We have tried to also provide training in SBIRT for some of the major residency programs like internal medicine, pediatrics, OBGYN and emergency medicine as I just mentioned. The idea is to try to get all residents and medical students to have this training. 

The training itself involves a variety of curricular pieces, including case studies, training videos, slide sets for the faculty to use, along with training manuals and modules for SBIRT. We have a basic presentation that gives the nuts and bolts of SBIRT. Then we have a series of activities where the residents try to learn and practice SBIRT techniques so they hopefully can later apply it to their clinical settings. 

In regards to your question of whether all doctors receive this training, unfortunately, the answer is no. There are a lot of institutions across the country where SBIRT training is not available. In fact, it’s certainly more the case that it’s not available than it is available. From my perspective, all doctors should have SBIRT training as part of their basic learning procedures, both in medical school and in residency programs. It’s a very straightforward skill that builds upon the foundational interviewing techniques that physicians learn to provide for a whole variety of conditions that their patients have. Why not use those same type of skills and apply them in their care of patients with substance abuse disorders? 

SBIRT training involves basic skills around raising a subject with a patient, providing feedback about alcohol and drug use, trying to come up with strategies to help enhance the motivation to change when people are ready to change, then coming up with a plan. Not coming up with a plan on their own, but assisting people in the process of coming up with a plan that will help them make that change. It’s pretty darn important stuff, and it should be available much more than it is now. 

You are the current president of the American Board of Addiction Medicine (ABAM). Can you tell us about ABAM, and what it has been able to accomplish?

Certainly. The American Board of Addiction Medicine was created back in 2007 to help certify and maintain the certifications of physicians in the field of addiction medicine. What we are trying to do through this process is to assure that high quality addiction care is accessible to everybody. ABAM is what we are currently calling an independent board and that means a board that is not part of the much larger American Board of Medical Specialties (ABMS). One of the primary goals of the organization is to move addiction medicine from being an independent specialty to being part of ABMS. We think that we are pretty close to doing that now. We have certified over 3,000 physicians in the field. We expect to see those numbers continuing to grow as we move forward. 

It’s important to note that ABAM is overseen by a board of directors, and those directors are professionals that represent eight different medical specialties. We are really trying to bring addiction medicine to all of medicine. The specialties on the board include psychiatry, internal medicine, OBGYN, family medicine, emergency medicine, pediatrics, preventive medicine, and surgery. The makeup of our board really makes the point that we view addiction medicine as a multi-specialty field. Physicians from all kinds of backgrounds are needed and can participate as addiction medicine specialists. 

Another big part behind the question of why the American Board of Addiction Medicine has come into being is to support the development of training programs in the field. Just like we had zero diplomats back in 2007 to represent addiction medicine, we also had zero fellowship programs. Now we are up to 37 of those programs in major medical centers throughout the country. We anticipate that number is going to continue to grow over the next several years. The goal is to have an addiction medicine program at every major medical school in the country in the not-too-distant future. We are well on our way toward achieving that goal.

For many patients, abstinence represents an ideal to be recommended, but the harm reduction approach can help as well.

Do you believe the Affordable Care Act has changed the landscape of addiction medicine and the treatment industry in the United States? Are these changes for the better?

I would say that certainly the letter and spirit of the Affordable Care Act in terms of putting in basic insurance reforms to ensure that everyone has access to affordable healthcare, including healthcare-related substance abuse and substance abuse disorders is changing the landscape. No doubt that’s what the Affordable Care Act put into place as part of its mandate. I think we are just beginning to see that happen in very positive ways, but we still have a ways to go. The entire healthcare field has to get reoriented to seeing substance use and substance abuse disorders the same way that they see other diseases and illnesses and problems that people present with. 

Historically, as you know, there’s been a real problem in that regard from everyone’s perspective, including physicians, nurses, and the healthcare field in general as a whole. But the problem goes beyond the healthcare field to include employers, insurance companies, families and beyond. I think the Affordable Care Act is going to help shift that perspective. Although these changes are just beginning to occur, there’s no doubt that they are for the better. Still, there’s a lot of growth that needs to happen, but I believe that I am seeing the start of what will have a truly positive impact on our overall healthcare system. 

You recently co-chaired a White House Symposium on “Medicine Responds To Addiction” with Recovery Czar Michael Botticelli. At the symposium, you stated, “Today, we are at a critical turning point when it comes to addiction prevention, treatment, and recovery… There is now an extensive body of science concerning the epidemiology of addiction, the consequences of risky substance use and substance-use disorders, and the effective approaches to prevention and treatment. The time has now come to advance patient care by fully integrating this science into medical practice.” 

How can the science be integrated into the medical practice? If more education is needed for physicians, how should this education be delivered? Beyond changing medical school curriculums, how can doctors already in long-term practice be included? 

These are all great and important questions. There’s no doubt that we have the evidence and we have the science behind addiction medicine. A lot of us have been concerned that the uptake of that knowledge into general medical practice has been slower than it should be. In terms of how the science can be integrated into medical practice, it needs to be integrated at every touch point in terms of how we deliver care to patients. 

For example, medical schools have really been behind the eight ball on this issue. They simply have not given addiction-related training and information that same space in their curriculums as the traditional emphasis that the management of other diseases and conditions have received. I can’t tell you how much time I spent in medical school, like students currently spend in medical school, studying cardiology for example. There’s no doubt that cardiology is important. But you could argue that the health problem of addiction is just as important, yet it gets short shrift in terms of how it’s taught to our youngest trainees. From day one integrated all the way through the curriculum until graduation, there needs to be training about addiction medicine for all of our medical students. 

Of course, such training in addiction medicine needs to continue once people go on to residency as well, and not just in the primary care disciplines. It needs to be done in all disciplines. For example, how many cases of trauma on a surgical service are related to problems of alcohol and drug use? Too numerous to count. Yet, when patients are treated in those settings, their bones might be put back together, but more often than not, no effort is made to do something specific about what caused those bones to be broken in the first place. Every specialist and every specialty need to take ownership of this issue.

With a number of specialties, we now have certification and the maintenance of certification in addiction. One of the very promising discussions we had at the White House summit was with the diverse number of specialty boards represented that expressed a commitment to integrating content about addiction medicine into their certifications and recertification exams. If physicians know that they will be tested on these topics when they take their exams, it clearly will help motivate a sufficient emphasis on addiction-oriented topics and the learning of this information. This will impact doctors in long-term practice. They are going to need to participate in that process in order to maintain their board certification. 

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Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.