Helping SUD Providers Help Diverse Patients: Race, Incarceration, Pain, PTSD

Race: In “Can You See Us? Providing Culturally Competent Treatment for Persons of Color,” presenters at CCSAD (Cape Cod Symposium on Addictive Disorders) in September, criticized the phrase “I don’t see color.” That’s not the right way to look at diversity in therapeutic settings, they said, because only by “seeing” color can providers make sure programming is culturally relevant to their patients. As it is, racial and ethnic minority groups have less access to treatment for substance use disorders (SUDs). By “seeing color,” providers show respect for the barriers these patients face, which helps them develop therapeutic alliances.

Incarceration: In “Improving Treatment Outcome for Formerly Incarcerated Clients in SUD Treatment, Roland Williams explained that the process of being incarcerated itself results in maladaptive personality traits. These traits are required for survival in the jail and prison environment, but also impede successful treatment for substance use disorders. While treatment providers are well aware of the challenges this population presents, staff sometimes themselves are biased against these patients. For this reason, it’s important to train staff to engage with and motivate these patients, beyond providing the medications that patients with opioid use disorder need. Clinical interventions include Cognitive Behavioral Therapy (CBT), Motivational Interviewing, and counseling which is aimed specifically at relapse prevention. There are common mistakes made by providers, which are mostly due to their own prejudices. Specific cross-cultural accounting techniques can help address these barriers, helping patients and counselors alike get past victimization and towards recovery and healing. Post Traumatic Stress Disorder can be caused by incarceration: recognizing this alone is a great start.

PTSD: “Addiction and Trauma Recovery: Through an IPNB Perspective” focused on the importance of “connection” in treatment. Using “Interpersonal Neurobiology” (IPNB), a field in which providers help patients find “certainty,” treatment teams can understand the interaction between PTSD and SUDs in the brain.

Pain: In Comprehensive Pain Recovery, presenters noted that the leading reason for patients to go to doctors is pain. However, there are ways that treatment providers – especially, OTPs – can treat pain, not only with medications, but cognitively and emotionally. In particular, patients with chronic, debilitating pain can improve their quality of life with such comprehensive programs.

A note on buprenorphine: Finally, in “Buprenorphine Maintenance: Is There an End-Point or is it Life-Long?” James Berry, MD discussed the many problems with patients tapering from – or being tapered against their will from – buprenorphine. Sometimes it’s because of loss of insurance, other financial pressures, employment issues, pressure from family, side effects, stigma, or simply wanting to make a statement. There is little research on this area, and if patients are going to taper, there need to be realistic expectations of the risks, and more importantly, a removal of barriers to maintenance.

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