Hospital programs bring health, hope to people struggling with substance use

YNHH’s Addiction Recovery Clinic (ARC) provides medical and psychological care to patients and educates other healthcare providers about treating people with substance-use disorders. From left are: Dana Cavallo, PhD, clinical psychologist; Stephen Holt, MD, ARC co-medical director; Anna Zimmerman, MD, resident; Jeanette Tetrault, MD, ARC co-medical director; Angela Xu, MD, resident; and Robert Palmer, medical student.

Opioid addiction has gotten a lot of attention in recent years, and with good reason. But substance-use disorders have been a problem nationwide for generations – particularly alcohol-use disorder. “This population is greatly underserved and there is so much work to be done,” said Marcie Tratnyek, LCSW, Yale New Haven Hospital substance-use disorder social worker. “So much of our work focuses on reducing the stigma associated with this insidious disease. Treating substance-use disorder patients with the same care and concern as patients with other diseases is critical to good care.”

Nationwide, 10 percent to 25 percent of hospitalized patients have substance-use disorders, including a large percentage with alcohol-use disorder (AUD). While opioids cause about 130 deaths a day nationwide, AUD-associated complications result in 250 deaths daily. Excessive alcohol consumption contributes to cardiovascular disease, increases the risk of many cancers and can damage the liver, pancreas, brain and other organs.

Over the years, Yale New Haven Hospital has developed and partnered with other organizations on programs to help patients with AUD and other substance-use disorders. These programs include medications to reduce alcohol cravings, counseling and/or peer support. Tratnyek works with inpatients, then ensures they receive continued support after discharge.

The Yale Addiction Medicine Consult Service (YAMCS), part of the Yale Program in Addiction Medicine, launched last fall. In addition to treating hospitalized patients with substance-use disorders, providers with YAMCS and the hospital’s outpatient Addiction Recovery Clinic at the Saint Raphael Campus educate other healthcare professionals about treatments, including FDA-approved medications.

“Any primary care physician could prescribe these medications, but less than 5 percent of patients with AUD receive treatment nationwide,” said Stephen Holt, MD, Addiction Recovery Clinic co-director. “The medications are very effective, but providers need to learn about them and use them.”

Melissa Weimer, DO, YAMCS medical director, has found naltrexone to work best for most of her patients with AUD to reduce heavy drinking and alcohol craving. They can receive a once-monthly, intramuscular injection or start on a daily oral prescription while hospitalized.

“Naltrexone is not a controlled substance, the oral form is inexpensive and it has been in use since the 1970s,” she said. “But if you ask patients with alcohol-use disorder if they’ve been offered it, 90 percent will say ‘no.’”

The most effective treatment plans also include counseling and support. The Addiction Recovery Clinic has an on-site clinical psychologist, and YAMCS refers interested patients for mutual support and counseling.

Seven years ago, YNHH launched the Recovery Volunteers program, which is overseen by Tratnyek, Deirdre Doyle, RN, patient service manager, Medicine (EP 4-6 and 7), and Lynelle Abel, system director, Volunteer and Guest Services, Yale New Haven Health. Anthony Salvati is one of 20 program volunteers who visit hospitalized patients and connect them with recovery support programs and outpatient resources. The program’s primary aim is to help patients, but it has also reduced hospital readmission rates.

“Whether or not I successfully plant a seed of recovery for them, they’re seeing somebody they can identify with, and how I’ve gotten better,” said Salvati, who has been sober for 15 years. “I leave knowing that I’m doing my best to pass along the gift I’ve received.”

Mark Sevilla, RN, vice president Patient Services, Behavioral Health and Emergency Medicine, acknowledged that substance-use disorders are particularly challenging to treat, and that many patients relapse. “These are the patients we see most often in the hospital,” he said. “But we know that with good medical care, counseling and peer support, many other people turn their lives around.”

Other Yale New Haven substance-use disorders programs and services include:

• Project ASSERT: A YNHH and Yale School of Medicine program that has connected more than 52,200 Emergency Department patients with community-based alcohol and drug treatment services. (See related article, Project ASSERT celebrates 20 years.)
  
  
• Yale New Haven Psychiatric Hospital inpatient and outpatient adult and adolescent substance-use disorder programs. An adult Dual Diagnosis Inpatient Program treats patients with substance-use disorders and psychiatric illness.
  
  
• The Steward House at Silver Hill: A partnership between YNHHS, Yale Medicine and Silver Hill Hospital to treat people with significant executive or professional career responsibilities who have developed serious mental-health or substance-use problems.