Practically Speaking: Behind the Episode: The Big Bears
The confidence to effectively treat comorbid substance use disorders and mental illness has always eluded me. I can competently explain the rationale for treating both concurrently and I happily collaborate with providers who can address significant substance use concerns. But the task of becoming familiar with effective treatments (such as medication-assisted treatment) feels overwhelming to me. This is unfortunate because the need for such expertise clearly exists.
Listen to the full discussion here: The Big Bears: Medication-Assisted Treatment of Substance Use Disorders with Comorbidities
A recent study (Bennett et al, 2022) highlighted the prevalence of opioid use disorder in service members and veterans:
● Injuries sustained during service have resulted in many service members presenting for treatment of chronic pain.
● Pain management has frequently occurred through the prescription of opioids. In 2008, more than 1 in 10 service members were legally or illegally using opioids.
● The U.S. Army reported that 25‐35% of soldiers prescribed opioids met DSM-IV criteria for substance dependence while awaiting medical discharge.
● Between 2012–2018, 2,421 veterans died from an alcohol-involved overdose. The vast majority of these deaths also involved opioids.
It’s common knowledge that substance use disorders often occur comorbidly with mental illness. Furthermore, this substance use can often be conceptualized as a way of coping with psychiatric symptoms (such as depressed mood or anxiety) and/or significant life stressors. Therefore, a concurrent approach to treatment is highly recommended.
Unfortunately, many barriers exist to effective treatment, including stigma, concerns about career impact, and logistical challenges, such as access to care. Complicating the situation further, withdrawal from physiological dependence on opioids or alcohol is outright dangerous and requires medical intervention.
Medication-assisted treatment (MAT) is a highly effective option for these clients. MAT represents a multi-faceted approach to addiction recovery by combining medications with counseling and behavioral therapies. In this approach, medications are used to reduce cravings and withdrawal symptoms in clients with opioid (Suboxone) or alcohol (Naltrexone or Acamprosate) abuse disorder. As the client’s substance use decreases and their ability to engage with behavioral treatments increase, psychological treatments can be initiated for comorbid concerns such as PTSD or depression.
On this episode of CDP’s Practical for Your Practice Podcast, Drs. Lefkowitz and Ermold get an introduction to MAT from a practicing clinician. Our guest, Catherine Perri, gives us the beginner’s education that we both need. Using examples from her work at Ripple Ranch Recovery, Catherine explains what MAT is, addresses the stigma associated with dual diagnoses, and describes the goal of utilizing MAT in conjunction with evidence-based psychotherapies to treat “the whole person.” Listen in to this important conversation here.
Also save the date for P4P’s upcoming “Live” episode in which we want to hear from YOU our listeners! On Aug 13, 2024 1000-1200 Eastern, you can be part of the conversation and the podcast! Have a question for our hosts? Reactions to previous episodes? Want to share your “What is your why?” origin story? Give us a call! 301-715-8592, code 4878058925#. And if you can’t call us at that time, you are welcome to leave us a voice-mail message at speakpipe.com/cdpp4p or send us an email at cdp-podcast-ggg@usuhs.edu. The episode will not be broadcast live, but will be recorded and edited before release, so don’t let that deter you!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Lefkowitz earned her M.A. and Psy.D. in clinical psychology at Widener University, with a concentration in cognitive-behavioral therapy.
References:
Bennett AS, Guarino H, Britton PC, O'Brien-Mazza D, Cook SH, Taveras F, Cortez J,
Elliott L. U.S. Military veterans and the opioid overdose crisis: a review of risk factors and prevention efforts. Ann Med. 2022 Dec;54(1):1826-1838. doi:
10.1080/07853890.2022.2092896. PMID: 35792749; PMCID: PMC9262363.
The confidence to effectively treat comorbid substance use disorders and mental illness has always eluded me. I can competently explain the rationale for treating both concurrently and I happily collaborate with providers who can address significant substance use concerns. But the task of becoming familiar with effective treatments (such as medication-assisted treatment) feels overwhelming to me. This is unfortunate because the need for such expertise clearly exists.
Listen to the full discussion here: The Big Bears: Medication-Assisted Treatment of Substance Use Disorders with Comorbidities
A recent study (Bennett et al, 2022) highlighted the prevalence of opioid use disorder in service members and veterans:
● Injuries sustained during service have resulted in many service members presenting for treatment of chronic pain.
● Pain management has frequently occurred through the prescription of opioids. In 2008, more than 1 in 10 service members were legally or illegally using opioids.
● The U.S. Army reported that 25‐35% of soldiers prescribed opioids met DSM-IV criteria for substance dependence while awaiting medical discharge.
● Between 2012–2018, 2,421 veterans died from an alcohol-involved overdose. The vast majority of these deaths also involved opioids.
It’s common knowledge that substance use disorders often occur comorbidly with mental illness. Furthermore, this substance use can often be conceptualized as a way of coping with psychiatric symptoms (such as depressed mood or anxiety) and/or significant life stressors. Therefore, a concurrent approach to treatment is highly recommended.
Unfortunately, many barriers exist to effective treatment, including stigma, concerns about career impact, and logistical challenges, such as access to care. Complicating the situation further, withdrawal from physiological dependence on opioids or alcohol is outright dangerous and requires medical intervention.
Medication-assisted treatment (MAT) is a highly effective option for these clients. MAT represents a multi-faceted approach to addiction recovery by combining medications with counseling and behavioral therapies. In this approach, medications are used to reduce cravings and withdrawal symptoms in clients with opioid (Suboxone) or alcohol (Naltrexone or Acamprosate) abuse disorder. As the client’s substance use decreases and their ability to engage with behavioral treatments increase, psychological treatments can be initiated for comorbid concerns such as PTSD or depression.
On this episode of CDP’s Practical for Your Practice Podcast, Drs. Lefkowitz and Ermold get an introduction to MAT from a practicing clinician. Our guest, Catherine Perri, gives us the beginner’s education that we both need. Using examples from her work at Ripple Ranch Recovery, Catherine explains what MAT is, addresses the stigma associated with dual diagnoses, and describes the goal of utilizing MAT in conjunction with evidence-based psychotherapies to treat “the whole person.” Listen in to this important conversation here.
Also save the date for P4P’s upcoming “Live” episode in which we want to hear from YOU our listeners! On Aug 13, 2024 1000-1200 Eastern, you can be part of the conversation and the podcast! Have a question for our hosts? Reactions to previous episodes? Want to share your “What is your why?” origin story? Give us a call! 301-715-8592, code 4878058925#. And if you can’t call us at that time, you are welcome to leave us a voice-mail message at speakpipe.com/cdpp4p or send us an email at cdp-podcast-ggg@usuhs.edu. The episode will not be broadcast live, but will be recorded and edited before release, so don’t let that deter you!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Lefkowitz earned her M.A. and Psy.D. in clinical psychology at Widener University, with a concentration in cognitive-behavioral therapy.
References:
Bennett AS, Guarino H, Britton PC, O'Brien-Mazza D, Cook SH, Taveras F, Cortez J,
Elliott L. U.S. Military veterans and the opioid overdose crisis: a review of risk factors and prevention efforts. Ann Med. 2022 Dec;54(1):1826-1838. doi:
10.1080/07853890.2022.2092896. PMID: 35792749; PMCID: PMC9262363.