Individual and Systemic Approaches to Promote Equitable and Holistic Care of Patients with In-hospital Substance Use. Co-sponsored by ACLP's Bioethics and Addiction & Toxicology SIGs

Abstract:

Background:

At least 12% of hospitalized patients have a substance use disorder (SUD) (Suen 2021) and in-hospital substance use (IHSU) is reported by 40% of patients with SUD (Grewal 2015). CL psychiatrists are frequently tasked with addressing IHSU during consultations for SUD treatment, care-interfering behaviors, and capacity for patient-directed discharges. Patients with addiction and particularly those with IHSU are stigmatized in the hospital and are at high risk for adverse outcomes. Successful management of IHSU can help patients achieve better outcomes. Despite the impact of IHSU, there are few studies of IHSU and providers rarely have access to clear protocols or guidelines to manage these difficult situations (Martin 2023).

Approach:

This workshop combines traditional didactic and active learning formats to provide participants with the tools to effectively manage cases of IHSU. We first present a case accompanied by test questions that highlight common clinical and ethical challenges, with answers presented throughout the workshop. We then review the limited available literature on IHSU. Next, we explore the role of countertransference and implicit bias in working with patients with IHSU. We focus on how liaison skills can optimize patient care for marginalized groups and facilitate interdisciplinary cohesion. We will then discuss policy-making and how appropriate management of IHSU can address provider distress and promote both patient and institutional well-being. Lastly, participants will take a self-assessment.

Format:

15 minutes: Dr. Levinsohn will introduce the main themes of the workshop through a case presentation of IHSU, followed by multiple choice questions which will be answered throughout the talk.

10 minutes: Ms. Tyler-Mills will review the available literature on IHSU such as prevalence, patient and provider perspectives, and how to identify IHSU (Barnett 2021).

20 minutes: Dr. Fukui and Ms. Tyler-Mills will describe how SUDs and IHSU contribute to poorer outcomes mediated in part though social determinants of health and stigma. They will discuss the management of countertransference and biases. Participants will improve their liaison skills through a role-playing exercise.

20 minutes: Dr. Zwiebel will present how institutions can adopt policies and frameworks to provide legal, ethical, and clinically effective care for patients with IHSU and the teams who care for them. She will propose solutions for best practices at a systems level.

10 minutes: Participants will be prompted to answer additional questions to apply their knowledge.


References:

Barnett BS, et al. Addressing in-hospital illicit substance use. Lancet Psychiatry. 2021;8(1):17-18.

Grewal HK, et al. Illicit drug use in acute care settings. Drug Alcohol Rev. 2015 Sep;34(5):499-502.

Martin M, et al. In-hospital Substance Use Policies: An Opportunity to Advance Equity, Reduce Stigma, and Offer Evidence-based Addiction Care. J Addict Med. 2023 Jan-Feb 01;17(1):10-12.

Suen LW, et al. National Prevalence of Alcohol and Other Substance Use Disorders Among Emergency Department Visits and Hospitalizations: NHAMCS 2014-2018. J Gen Intern Med. 2022 Aug;37(10):2420-2428.

Content Contributors:

Diversity, Equity, and Inclusion: This workshop will focus on patients with substance use disorders, a population that is frequently marginalized and stigmatized. Due to systemic and individual biases these patients often struggle to obtain adequate medical care. In this workshop, we will demonstrate how implicit bias training can help providers improve their effectiveness in liaising with primary teams, and discuss ethical and clinical frameworks to promote equitable care to these marginalized patients on an individual and systemic level. Speakers come from diverse career stages, institutions, ethnicities, and geographic locations.