Since receiving a Comprehensive Addiction and Recovery Act (CARA) state targeted response grant in 2017, the Chicago-based Gateway Foundation has worked with substance use disorder patients in emergency settings and facilitated their enrollment into treatment programs. The program has found success by implementing quick screening practices and partnering with provider organizations that meet patients’ diverse needs.
At the upcoming virtual Cocaine, Meth & Stimulant Summit, Gateway Foundation executive director Sally Thoren will discuss the foundation’s work, specifically around moving patients from hospital settings to addiction treatment and the effectiveness of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model.
Ahead of the Stimulant Summit, she spoke with Addiction Professional about engaging patients at the time they are most receptive to seeking treatment, what Gateway Foundation looks for in partner providers, and why there are additional challenges associated with stimulant use disorder patients vs. those with other substance use disorders.
Editor’s note: This interview has been edited for length and clarity.
What was the thought process behind the development of your organization’s strategy for helping patients in crisis, including the implementation of an SBIRT model?
Engaging people in that crisis moment makes perfect sense. It’s logical when we think about the nature of the disease of substance use disorder. The insidious nature of the illness includes strong denial and perhaps a mistaken belief that “I can control it” or “I can stop at any time.” And also, we know the symptoms that come with withdrawal are really intense. So, if we can intervene when someone feels vulnerable or recognizes that they are in a serious place in the disease progression, we feel like we have a good opportunity to persuade someone to get to care. … Also, if they’re in a hospital and they don’t have access to the substances that are going to resolve those feelings of withdrawal, that’s a good window. It’s a small window, but it’s an opportunity to strike when they’re open to hearing about another path.
As far as choosing SBIRT, we wanted a model that was available in the public domain. We wanted it to be brief because hospitals are fast-paced environments, and patients often don’t feel well. So, they have a low tolerance for a long diagnostic session. SBIRT fit our needs.
How do you identify ideal partner provider organizations and build those relationships?
We know everybody’s needs are different. We wanted to identify hand-off partners to help us serve every population. We wanted to make sure we had hand-off providers who take every type of insurance. I’m in Illinois, a Medicaid expansion state, so there were many different Medicaid plans. We needed to identify partners that took every plan Illinois offers. Not surprisingly, meeting everybody’s needs is not a one-stop proposition, so we had to find multiple providers to meet the needs of individuals. We need mental health providers that also serve substance use disorder patients. We need housing partners. We need providers with robust case management services that can assist our clients with developing life skills. Clients face food and housing insecurities, so we want providers that can assist with them accessing Medicaid and food stamps. Then, there are geographic considerations. We wanted to make sure we had hand-off providers in many different communities so that they were accessible no matter where patients live. It doesn’t do us any good to connect patients to mental health and substance use services if they’re located two hours away from their home or a sober living housing solution that didn’t have any local treatment services.
The thing our partner providers like about the work that we do is that we’re delivering them a medically stable patient. They are coming from the hospital, so their acute medical needs are met. We’ve already had those engagement conversations, so we’re already breaking through that ambivalence that’s common when someone is contemplating entering SUD treatment. We’ve done all that, so we have a motivated client. We have pre-qualified them, so to speak, and then we are literally delivering them from the hospital to their admissions appointment. We are reducing those last-minute barriers to admission. And we’re matching the client to the services that the agency provides. If your primary language is Spanish, I’m going to link you to a Spanish-speaking service provider. We do that upfront legwork.
Why do you feel that patients with stimulant use disorder face additional stigma and pose other unique challenges vs. patients with other types of substance use disorders?
We know all substance use disorder patients experience stigma, but I believe there is an additional stigma associated with stimulant use disorder because of the erroneous belief that stimulant use is—and I’ll say this in quotes—“not really addictive” and that there is more of an intentional aspect to the use. “You don’t have to use every day; you choose to use every day.” The misconception arises from the fact there isn’t a physiological or life-threatening withdrawal syndrome like we might see with alcohol or benzodiazepines, or the widely publicized overdose deaths with opioids, especially with fentanyl. The public seems to believe users can just stop using, it’s not as bad as some other substances, and there’s a choice to use. We know that’s not true, and in fact, 40% of all overdose deaths involve stimulants, so it is certainly a deadly illness and overdose is a deadly proposition. We also know from our hospital partners that detecting stimulant use disorders in the midst of a health crisis—I come to the hospital for reasons such as stroke or heart attack…Acute stimulant intoxication looks like a psychiatric episode. The things medical caregivers are going to tend to are the physical, medical issues. Down the road, it may occur to them that the genesis of the issue is related to substances, but the first challenge is to care for that acute health crisis. It’s missed in a lot of regards, and it’s misunderstood for the reasons I mentioned earlier.
I think we also face a challenge in engaging stimulant use disorder patients because there is no medication-assisted treatments for stimulants. We don’t have a methadone, buprenorphine or any medicines that address those intense emotional withdrawals. We need the medical community to give the same kind of attention to stimulants as opioids. That’s why we have the Summit, right?