Each day, there are more than 130 opioid-related overdose deaths in the U.S., according to the National Institute on Drug Abuse. Approximately 21-29 percent of patients prescribed opioids for chronic pain misuse them, and between 8-12 percent develop an opioid use disorder. Among the many clinicians grappling with this public health crisis is Joji Suzuki, MD, Director of the Division of Addiction Psychiatry at the Brigham. Joji holds a Doctor of Medicine from the Boston University School of Medicine, where he also completed a fellowship on addiction psychiatry. Today, he’s responsible for directing the Brigham’s entire spectrum of addiction services, spanning everything from outpatient treatment, inpatient consultations, pain management in high-risk populations, counseling, detox and much more. BWH Clinical & Research News caught up with Joji to find out more about his passion for psychiatry and patient care, his perspective on the national opioid crisis and how motivational interviewing can be thought of as a patient-provider dance.
Q: What is driving this crisis?
JS: First, substance use disorder has been fragmented from standard medical care for years. If you had a drinking or heroin problem, a doctor would have probably told you that they don’t treat it and referred you to a community program, such as AA, or detox. Patients across the country were told that whatever door they were knocking on was the wrong door. Mainstream medicine never really took responsibility for treating substance use disorders. Even today, if you go to a typical medical school, you’re taught very little about substance disorders.
Second, clinicians across the country are faced with a dilemma on how to safely treat pain without overprescribing and relying on opioids. At the Brigham, we are cognizant of this dilemma every day. It’s our job to care for each patient in a responsible and effective way, and to ensure that our staff is fully capable of managing pain safely. It’s also our job to determine how best to connect patients with appropriate treatment services and support.
At the end of the day, the opioid crisis is a systemic problem. It’s about how we as states, agencies, medical schools and hospitals address substance use disorders as a system rather than as a single health care institution. Given the magnitude of scope, we cannot address the crisis alone. All parts of the system must play their part, and this crisis has exposed the deficiencies of our system. Right now, our national response has been too slow and too inadequate. A lot of people are trying but many of the efforts are not coordinated.
Q: How can physicians help patients who have been swept up in the opioid crisis or other forms of addiction? What behavioral health techniques do you use to help patients?
JS: I am a big proponent of motivational interviewing, which is a clinical approach that tries to accomplish behavior change by evoking from the patient his or her own reasons for and desire to change. Simply put, it’s the difference between listening to your patient versus telling them what to do. The traditional approach included a wise doctor and a novice patient, focusing solely on education, such as how to be healthy. While this approach is necessary when patients are acutely ill, this dynamic can lead to a wrestling match in patients struggling to change their unhealthy behaviors. The new approach focuses on an intricate, collaborative partnership – like a dance.
Q: Can you give us an example?
JS: I will often use the example of smoking cessation. In the past, a clinician would have told a patient to stop smoking, use nicotine patches and call a number for more information. The thing is, just because you recommend a change doesn’t mean the patient will do it. The patient is coming to you for help, and when they don’t follow through with a recommendation, clinicians often resort to using a more directive or coercive approach. Many patients do not respond to that. Because our natural human tendency is to resist, telling people what to do often leads to an argument.
With motivational interviewing, the whole point is to find out why the person wants to change and quit smoking. It’s our job to strengthen the patient’s intrinsic motivations by identifying the positive values that already exist. Oftentimes, when patients face unhealthy behaviors or conditions, such as smoking or obesity, they really want to change – they just feel torn about it. The goal is to help them strengthen the side that wants to change. While seemingly straightforward, it’s like learning a new musical instrument or sport in that it takes a lot of practice and feedback. In addition to clinicians, probation officers and educators have started to adopt the technique as well.
Q: Any final thoughts?
JS: My team and I are committed to welcoming every patient and providing them with the support they need to begin their individual path to recovery. Addiction is not an infection that is treated and cured. It’s like diabetes or obesity; it requires a comprehensive treatment plan and ongoing provider support over a long period of time. If someone came in with a breast cancer diagnosis, we would do whatever we could as clinicians – we wouldn’t even think twice about helping. We must start looking at mental health and substance use disorder through the same lens.
If you or someone you know would like to seek support for substance use disorder, please contact the Addiction Recovery Program, an outpatient service in the Department of Psychiatry that helps patients with substance use disorder, at 617-983-7060, option 2.