Less Aspiration and More Implementation: How to Successfully Integrate Addiction Care into My Consultation-Liaison Practice

Abstract: Substance use disorders (SUD) are widespread and undertreated; their prevalence is largely unchanged in recent decades. Consultation-liaison (C-L) psychiatrists will continue to regularly encounter patients using non-prescribed substances. As examples, opioid related hospitalizations have more than doubled in the past two decades¹ and 50% of US counties lack sufficient prescribers for opioid use disorder (OUD) medications². A “disease of despair,” only 10% patients with alcohol-related liver disease (ALD) receive a face-to-face SUD treatment visit and < 1% receive alcohol use disorder medications³.

Challenges within addiction education and training complicate this already-difficult scenario. Addiction education, from medical school through residency, is lacking⁴. While approximately 20% of psychiatric patients have comorbid SUD, guidelines require that only 2% of psychiatric residency training (1 month during 4 years) be SUD-centered⁵. Addiction specialty training is a mosaic of Addiction Psychiatry and Addiction Medicine (the latter originating from psychiatry, family medicine, or internal medicine) whose curricula are heterogeneous⁶. Addiction colleagues simply may not share common professional identities or training experiences.

How to integrate whole-person addiction care into the treatment of the medically ill in an under-staffed and fractured health system? C-L psychiatrists occupy unique roles in the borderlands of psychiatry, addiction, medicine, and surgery; perhaps no other clinicians are better positioned to innovate. This general session is sponsored by Transplant Psychiatry and Addiction-Toxicology SIGs and its presenters hail from different geography and career stages.

Dr. Lunny, a C-L fellow, discusses (15 minutes) general models of SUD education from medical school through training programs. She explores complexities and opportunities arising from divisions between Addiction Medicine and Addiction Psychiatry; their integration may shape the future care landscape. She also explains the importance of SUD integration into primary care.

Dr. Winder, a transplant psychiatrist, presents (15m) on SUD integration into solid organ transplantation and hepatology (including interfaces with social work and care management) stemming from his role in co-founding in 2018 the nation's first embedded, co-located non-SOT ALD clinic in hepatology⁷.

Dr. Sidelnik, an Addiction C-L Psychiatrist, (15m) explores SUD integration into palliative care and pain management, including the important role that psychiatrists have in OUD and pain treatment.

Dr. Suzuki, an Addiction C-L psychiatrist, teaches (15m) about SUD integration into infectious diseases, particularly when long-term antibiotics are required.

Remaining time (15m) allocated for engaging question-and-answer and panel discussion.