Helping patients with substance use disorders manage their other health problems can assist them in their recovery, says Sharone Abramowitz, MD, co-chair of the recent California Society of Addiction Medicine conference. She notes addiction medicine professionals often ignore patients’ other chronic health conditions.
“We don’t want to forget the rest of health when treating substance use disorders,” says Dr. Abramowitz, a psychiatrist and psychotherapist in private practice and Director of Behavioral and Addiction Medicine for the Primary Care Medicine Training Program at Alameda Health System. “It’s not just about relapse prevention – we also want to focus on things that improve health.”
People addicted to drugs or alcohol may be out of touch with their bodies, she says. “Often there’s been a lot of damage to their health through substance abuse. We may have to help them deal with diet, exercise, medication management and access to other physical health resources they may need. They can be driven back to using if they are struggling with poor health control.”
This holistic approach is not common in the addiction medicine field, she observes. “Often in substance abuse treatment, we are very focused on helping the person maintain recovery and prevent relapse, with 12-step work and medications that can help in the substance abuse recovery process and co-morbid mental health recovery processes.”
In primary care, however, there has been a growing recognition that most patients with chronic conditions, including substance use disorders, “need a different kind of health system than one that focuses on acute health management.” The chronic care model supports patients in better self-managing their chronic conditions and their overall health. “We need to partner with patients and be very empathic, and understand the barriers that keep them from better self-managing their issues,” Dr. Abramowitz says. “This model is very well elaborated for chronic conditions such as diabetes, but it is also needed for substance use disorders.”
For patients with alcohol use disorders, self-management could include 12-step work and making sure they know how to take naltrexone. It also should include a broader look at their health, she notes. “Over 50 percent of people in substance use treatment are still smoking, and many have unhealthy diets—just take a look at the food they tend to serve at 12-step meetings as an example.”
Recovery counselors can help patients by doing something as simple as asking when was the last time they saw a doctor. “If the patient hasn’t seen their primary care doctor in awhile, the counselor can ask what the barriers are. They can ask if they’re taking regular walks. It’s a matter of putting a patient’s whole health on your radar when you work in recovery.”
Professionals working with patients with a substance use disorder can collaborate with them to draw up a self-management ‘action plan’ to improve their whole health. “It needs to address the barriers in their life, and has to be realistic—based on something very doable that can help patients succeed,” says Dr. Abramowitz, who co-authored a paper, “Helping Patients Help Themselves: How to Implement Self-Management Support,” for the California Healthcare Foundation.
Generally, she first waits until a patient is stable in their recovery before expanding the plan to cover their overall health. “We make the plan very specific and concrete. For instance, the person will state how many 12-step meetings they will attend a week, and with whom. I’ll ask about what they are doing around exercise and then collaborate with them on creating a simple exercise plan, if they feel ready. Perhaps they will come up with walking three days a week for half an hour, and naming the specific days and times they will do it. Then I’ll check in with the patient to see how it’s going.”
She finds that patients whose plan includes ways to improve their overall health do better in their recovery work. “When they’re exercising and eating better and starting to go to the doctor, it seems to help them stay on track with their other recovery work – one feeds the other,” she says. “We need to be conscious of the patient’s whole health and how it’s intersecting with the recovery process.”
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