Help! I’m Alone in the Office with an “Oxy” Shopper Sandra B. Coleman, PhD Director, Behavioral Medicine Eastern Maine Medical Center Family Medicine Residency Program 44th STFM Annual Spring Conference April 27 – May 1, 2011

Highlights From Addiction Curriculum Teachers in Recovery The Eye Opener Stories from the Post-Cradle Era

“Teachers” Meet the Residents (Year 1) Recovering* addicts from a local drug rehab program Meet the residents and teach them the many ways addicts and physicians “live” together * Step 4 – making a “moral inventory”

Recovering Addict Teachers Life Stories Family Histories Route to Drug Addiction

Life Stories and Route to Addiction Abuse – Physical and Emotional Divorce/Separation Marijuana / ETOH “On the Streets” Drugs / Sex Addiction Crime

Drugs and Doctors  How addicts “win” their physicians help  Behavioral Cons Dress/Appearance Drama (pain)

Resident Reactions (R1) Ewa- “I liked the time we spent with them (the recovering addicts) – it is a great idea!” “My own family never did drugs. I don’t like to drink and don’t understand it, but I am learning how to accept it in patients.” “They have very ‘scary stories’. It is hard to believe that one man started using drugs at 9 years of age.”

Resident Reactions (R1) Kim- “Useful and enlightening. My first impression was that if I had the male patient in my office/exam room I would want the door behind me and not want him so close to the only way out. He seemed volatile and unpredictable.”

Resident Reactions Kim - continued “I had visions of him or others busting into my house and rendering me and my significant other immobile while he robbed us of possessions, food, or maybe abused us.” “I was concerned about how he would serve as a role model for his daughter.”

Resident Reactions (R1) Tad – “I was depressed to realize just how much introspection, personal strength, and external resources it requires to overcome addictions.” “It seemed like they had to string together a long chain of metamorphoses', each one independently difficult and painful, to finally become the person they wanted to be.” “Love of one's own children seemed to be one of the few things on earth that could rival the power of addiction.”

Resident Reactions (R1) Katherine – “It was very eye-opening.” “Later when I approach patients with addiction, I’ll have them in my mind.” “Previously, I would think ‘suck it up’ but now I’ll have them in my head.” “…a very valuable experience.”

Feedback from Senior Residents Q1: “What was your initial response after meeting with recovering addicts in the first resident year?” Empathy, Compassion, & Desire to Treat. N = 10 Q2: “After a few years of training, to what extent do your previous attitudes still prevail?” Empathy, Compassion, and Desire to Treat. N=9 Diminished Interest or Refer Out. N=2

Feedback from Senior Residents Q3: “What is your sense of competency and knowledge in treating addiction disorders?” Moderate Degree of Competency. N = 8 Overall, Still Feel Inadequate. N = 6

Feedback from Senior Residents Q4: “In my future practice after graduation…” Interest in continuing to learn and treat patients with addictive disorders. N = 9 Not interested in addiction treatment. N =2 Others had qualifications, i.e. “Would like to limit treatment of patients with addictive disorders.”

Feedback from Senior Residents Q5: “What was the most significant component of residency training for addiction disorders?” Faculty Education/Training. N = 7 Referral Sources Within Residency Program. N = 3 Own Clinical/Personal Experiences. N =2 2 Respondents would have liked to have seen a rotation in a drug rehab program.

Curriculum Themes & Highlights The Recovering Addict Teachers A Family Systems Approach to Understanding Substance Abuse The Role of Genograms

Genograms & Addictive Disorders Intergenerational Transmission of Addiction Themes: ETOH, Suicide, Early Death, Drug Abuse

* McGoldrick M. & Gerson R., (1985), Genograms in Family Assessment. New York: W.W. Norton & Co. *

Themes from Coleman Research & Clinical Case Experience The 1970’s thru the 2000’s Family Factors & Drug Abuse Major Findings:  Death  Loss  Separation & Household Changes  Family History of ETOH  Spirituality

As the Residency Years Go By Screening, Brief Intervention, Referral for Treatment (SBIRT) Patient Care Lectures Rotations

SBIRT GRANT * Screening, Brief Intervention & Referral for Treatment Patients enter data directly into EMR Includes AUDIT (Alcohol Use Disorders Identification Test) Includes DAST-10 (Drug Abuse Screening Test) * Maine Health Access Foundation (MeHAF) award for Integrating Behavioral Healthcare & Primary Care Services for Substance Abuse Families (3 yr grant)

Lectures  Sexual Addiction  Other Addictions: Food Gambling Shopping On-line Pornography  Clinical Case Challenge

Snow play beats drugs any day! ~Ryker & Matilde