For Dr. Meldon Kahan, medical director of the Substance Use Service at Women’s College Hospital (WCH), the traditional model of treating addiction – waiting for months to go into a treatment program far away from one’s home – just doesn’t work. It’s not the right solution for these patients.
“Most addiction treatment takes place in institutions that are far away from health care centres, that have long waiting lists and that use primarily psychosocial counselling. This presents tremendous barriers to addicted patients, and it’s a serious problem,” says Dr. Kahan.
“In most cases, when patients want help for their addiction, it’s usually because they’re in crisis. They often go to emergency departments, because they want and need help immediately. However, this doesn’t help them deal with their addiction in the long term.”
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So, WCH developed a Substance Use Service that uses a completely different model of care, and it’s one of the few hospital-based addictions programs in Ontario.
“One of the things that makes our service unique is that our team is inter-professional and inter-departmental – we work in a shared care model integrating addictions services and family medicine together with psychiatry and social work, and we offer a combination of counselling and medication,” explains Dr. Sheryl Spithoff, WCH family physician who specializes in addictions.
The interdisciplinary team at WCH meets weekly to go over referrals and they often consult one another to make decisions.
“We view addiction as both a biomedical and psychological illness, and one that needs to be primarily treated in a health care setting,” says Dr. Kahan, adding that in the long term patients should be cared for by their family doctor.
Family doctors can follow the patient for years, encourage counselling and detect relapse; they can treat the patient’s physical health at the same time as the addiction, and patients trust them because they’ve established a long term relationship with them.
The service also works on rapid access, and the team is available as soon as possible to see the patients in crisis.
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Dr. Kahan says that hospital-based interventions that combine medication and counselling and offer immediate access are very effective, and his experience confirms this.
The team is currently conducting a randomized trial. Participants are recruited from withdrawal management centres and are randomly assigned to receive either immediate or delayed intervention. Immediate intervention means that hospital staff bring the patient to WCH within a day or two of being referred by a detox centre; the delayed intervention is more traditional in that patients are given the phone number for the Substance Use Service and it’s up to them to make the call.
“What we’re finding is that there’s tremendous need for addiction services, and our initial impression is that the immediate intervention works a lot better, in terms of meeting patients where they are at and decreasing barriers to service,” says Dr. Kahan.
The Substance Use Service is available to men and women, and offers a wide variety of services including help with alcohol and all drug addictions, smoking cessation, and addictions in pregnancy. The service accepts self-referrals as well as referrals from physicians, community agencies and health care workers. It is more accessible than traditional addiction treatment programs for several reasons: because it’s offered in a non-threatening ambulatory hospital setting, because of the ease of referral and because it is less structured so the treatment can be individualized, which helps to retain patients in the program.
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“We’re not looking at just the substance use in isolation but looking at the whole person – at chronic pain management, mental health, trauma and substance use. We treat all of these together by combining medication with psychotherapy and case management,” says Dr. Inbal Gafni, addictions psychiatrist, WCH.
One example of this work is the Seeking Safety treatment group, a 10-week group therapy piloted for women with symptoms of post-traumatic stress disorder (PTSD) and substance use, which often go hand-in-hand.
“People need a lot of tools to be able to cope with addiction, and we’re able to give them a toolbox of resources to do that,” says Dr. Gafni.