Stephen D. Cannerelli / The Post-Standard âChemical dependency is the last frontier in terms of things we need to get out of the closet,â said Crouse Hospital chemical dependency therapist Tom Murphy. Here he chats with Crouse Hospital physicianâs assistant Jacqueline Barkley (center) and secretary Sheree Procopio.
Syracuse, N.Y. — Crouse Hospital wants to nip drug and drinking problems in the bud before they destroy people’s lives.
Crouse launched a random screening program earlier this year in its PromptCare urgent care center across the street from the Syracuse hospital. Its purpose is to identify patients at risk of developing serious substance abuse problems. Patients deemed to be at risk are offered on-the-spot counseling and/or referral to treatment.
“We want to help you at that point when there’s a chance to turn things around, before you get a bad needle or before you overdose,” said Tom Murphy, a chemical dependency therapist who does the screenings.
The program is known as Screening, Brief Intervention, Referral and Treatment — SBIRT, for short. Developed in the late 1990s at Yale New Haven Hospital, it’s being replicated nationwide.
Research done by the federal Substance Abuse and Mental Health Services Administration shows it can help motivate people with drug and/or drinking problems to change their habits.
A study done by that agency showed about 20 percent of people screened are at risk, 70 percent can be treated with a single brief intervention and the rest need follow-up services. It also found 74 percent of high-risk individuals reported lowering their drug or alcohol use after one or more treatment sessions, and nearly half reported stopping use.
Murphy said the screenings at Crouse are voluntary and few people refuse.
“Most of the time people are incredibly open. When I open the door, all of a sudden people have a lot to say,” he said. “Chemical dependency is the last frontier in terms of things we need to get out of the closet.”
During the first three months of the year, 123 of 364 patients screened at Crouse were determined to be at risk. Of those, 74 were referred to a follow-up service.
Murphy said he expected drinking problems to far surpass drug problems among patients screened. Instead, about 70 percent of people at risk are abusing drugs, especially prescription painkillers, he said.
“A lot of younger folks start popping oxycodone from mom’s medicine cabinet, then they buy it on the street, then they find heroin, which is much less expensive,” he said.
Upstate Medical University started screening trauma patients in 2009.
“When patients are in car crashes, assaults or falls and there’s alcohol and drugs involved, we want to take steps to prevent this from happening again,” said Maryann Fields, Upstate’s trauma nurse coordinator.
Crouse has the largest substance abuse treatment program in the Syracuse area. It operates an inpatient detoxification program, a 40-bed residential treatment center known as Commonwealth Place, the area’s only methadone clinic, and other services.
The SBIRT program complements those services, said Robyn A. Tangredi, nurse manager of behavioral health services at Crouse.
“We recognize this as another way to help,” she said.
Because Crouse treats so many people for substance abuse, some of those former patients in early recovery come to PromptCare for their primary care. Jason Ouderkirk, a former Bishop Grimes math teacher recovering from an addiction to prescription painkillers, was one of them.
He came to PromptCare twice earlier this year complaining of abdominal pains and flu-like symptoms.
Murphy screened him as part of the SBIRT program. “All my red flags went up,” he said.
Ouderkirk was on Suboxone, a drug used to reduce cravings in people addicted to painkillers and other opioid drugs. Murphy figured out Ouderkirk was getting sick and the cravings were returning because he had sharply reduced his dosage of Suboxone. Murphy contacted Ouderkirk’s doctor, who got him back on the correct dosage.
This happened when Ouderkirk was going through post-acute withdrawal syndrome, a set of symptoms that can occur for a year or more after a person goes through detoxification. During this period people in recovery are at high risk of relapse.
“To have people with the knowledge and understanding of where you are at was really helpful to me,” Ouderkirk said.
Murphy said many of the people he screens have never talked with a doctor about drinking and/or drugs.
“It can be an uncomfortable issue in primary-care settings,” he said. “It’s a tough conversation that nurses and doctors are not always comfortable with unless it’s incredibly obvious.”
Tangredi said primary care providers also may be reluctant to address the issue if they don’t know where to refer patients for treatment.
SBIRT works because people coming in with a medical issue are often scared and more receptive to addressing other health-related issues, according to Murphy. “They are here for a crisis and I focus on the opportunity,” he said.
Murphy tries to establish a quick rapport with patients and discuss alcohol and drug use in a nonjudgmental way.
Instead of telling patients they have a problem, Murphy tries to get them to see it for themselves. For example, if he’s interviewing a patient who drinks six beers a day, Murphy asks him or her to make a list of the pros and cons of consuming that much.
“It’s ultimately a decision a person has to make for themselves,” he said. “I can’t make it for you.”
Prompting people to open up about a drug or drinking problem is a key step in the healing process, he said.
“A lot of people have been holding in stuff for years because of shame, because of guilt and the havoc they have caused in their own lives and the lives of other people,” Murphy said. “The moments they are able to disclose that is nothing short of miraculous.”
Article source: http://www.syracuse.com/news/index.ssf/2012/05/crouse_launches_program_to_ide.html
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