Addiction Psychiatry Service
Addiction Psychiatry Service is a team-based approach to delivering inpatient addiction services to people with substance use disorders who have been medically admitted to the hospital. It works to build trust with patients through a team-based approach, and relies upon community partnerships to link patients to the resources they need upon discharge. How does this build trustworthiness? This approach demonstrates compassion and empathy from a patient’s first encounter with the team, enabling patients to engage in treatment with a team they can trust.
How It Works
The Addiction Psychiatry Consult Team is highly specialized in the treatment and management of substance use disorders. The team is comprised of an addiction psychiatrist, a psychologist, an advance practice provider, an addiction fellow, licensed clinical social workers, a pharmacist and a peer support specialist. The addiction psychiatry consult team starts with a thorough evaluation of substance use, psychiatric co-morbidities, psychosocial factors, and biomedical complications. The team considers:
- What stage of substance use is the patient in? – Acute intoxication, acute withdrawals, sobriety.
- What are the acute concerns of the patient? – Current physical, emotional, and behavioral symptoms.
- What are the medical complications of the patient? – Addressing the goals and obstacles of the primary medical team in treatment of the patient.
- What are the aftercare needs of the patient? – The recovery environment and motivation for recovery.
Working with the patient, subsequent visits are spent developing the patient’s readiness to change and tailoring the patient’s recovery treatment plan on discharge. Throughout our encounters we foster an assurance of clinical abilities, medical ethics (autonomy, justice, beneficence, and non-maleficence) and character.
Historically, acute care hospital settings have done a poor job of identifying and treating substance use disorders. Individuals with substance use disorders are a stigmatized population who often lack trust in the medical model. The Addictions Team is building trust by engaging patients during acute hospitalization to provide an opportunity for patients to obtain a substance use disorder diagnosis, participate in initial treatment and become linked and engaged with on-going outpatient treatment. We have developed a unique team comprised of a psychiatrist, social workers and a peer recovery navigator who all provide different expertise to engage patients and start building trust from the first encounter. The focus of this team is to stabilize the patient and link them directly to an outpatient provider so they can continue their recovery at time of discharge.
Since its inception, the Addictions Team has also built trust with many community partners to ensure patients have access to the resources immediately when discharged from Parkland. Most notably, the Addictions Team has built trust and a partnership with the local mental health authority’s substance abuse department, OSAR, to link unfunded patients to treatment. OSAR is now on-site at Parkland to meet and engage patients in person and bridge the gap in services that has historically led to relapse post discharge.
Furthermore, this team has expanded its service into the Parkland Behavioral Health Center. Many of the patients treated in the inpatient setting are medically complex and may not have access to sufficient outpatient substance use treatment. By building trust and engaging patients early, this team is now able to see those patients routinely in the outpatient setting. This has only strengthened the rapport built with patients and allowed the treatment team to see patient’s live in their recovery.
The Addictions Team has developed a system of care that engages patients who historically mistrust the medical system by building trust, linking to resources, and promoting recovery from admission.
Skills and Competencies
The team should be able to evaluate and treat for effects of acute intoxication and withdrawals and how it could complicate the primary medical management of a patient. Other needed competencies include:
- Recognize and treat underlying psychiatric disorders (Dual Diagnosis).
- Safety evaluation, including harm to self or others, preventing medical comorbidity and overdose.
- Interventions by the social workers, peer navigator, psychotherapist and pharmacist, including motivational interview to move patients through levels of change, relapse prevention and psychoeducation.
- Knowledge about recovery environments and referral ability to local partners as well as within the hospital system.
Patients with substance use disorders (SUD) have growing rates of acute hospitalizations, longer lengths of stay, hospital readmission, and medical costs. These patients are more likely to utilize emergency room services, have higher number of acute hospital admissions, and are more likely to readmit with untreated acute and chronic medical conditions. Acute hospitalization provides a unique opportunity to diagnose and initiate engagement in substance use treatment.
At Parkland, we noticed a high number of medically admitted patients needing varying degrees of substance use treatment. In an effort to address this uniquely vulnerable patient population, our Consult Liaison Psychiatry Team created an Addictions Psychiatry Consult Team to provide specialized care to the SUD population. The Addictions Team treats patients who have been medically admitted to the hospital, who also have a co-occurring substance use disorder. The goal of this team is to engage patients in substance use treatment while in the hospital to hopefully engage the patient in long-term treatment and recovery. This team was also awarded the United Way Community Impact Grant with VIP services to provide care to our specialized population.
We believe this practice is building trust because it actively seeks to provide care to patients that our community dismisses and is trained to mistrust. It shows compassion and empathy from the first encounter with this team. This allows for patients to engage in treatment with a team they can trust; trust will help them acutely, trust they will provide a connection to care and trust them. This team uniquely gets to see patients in both the inpatient and outpatient settings. They build trust on the inpatient side and foster trust with ongoing medication management, individual therapy, group therapy and peer engagement on the outpatient side.
The consult service has expanded within Parkland with primary providers consulting us increasingly by name.
The practice is based on American Society of Addiction Medicine criteria as well as screening brief interventions and referral to treatment (SBIRT) principles, both of which can be scaled down to different levels of care. SBIRT can be implemented and has supportive evidence in multiple different settings including primary care. The members of the team also can be scaled down to include a provider, social worker and a peer navigator. The practice can be used at more than one setting where nursing infrastructure can be provided. We plan to expand the practice through the Parkland system using the hub and spoke model.