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Symposium Focuses on Substance Use Disorder

A man stands at a podium to the left of a projection the says "Welcome 1st annual Walter Reed Bethesda Substance Use Symposium". Rear Adm. David Lane provides opening remarks during a Substance Use Symposium last month at Walter Reed, hosted by the hospital, USU, and NIH, in an effort to bring providers together to discuss substance use disorders and relevant research.

By Bernard S. Little

Focused on the theme “Promoting Recovery Through Compassionate Care,” the Walter Reed Bethesda Substance Use Disorder Symposium drew health care providers, researchers, lawyers and others to the medical center Sept. 20 to discuss issues involving the misuse and abuse of drugs and alcohol.

Walter Reed National Military Medical Center served as the host site for the symposium, held in collaboration with Uniformed Services University and the National Institutes of Health.

“This [symposium] is a part of our ongoing educational initiative,” stated Dr. Christopher Spevak, director of the National Capital Region’s Opioid Safety Program and deputy director of the National Capital Region Pain Initiative and Wounded Warrior Pain Care Initiative at WRNMMC. He added that the program and initiatives offer monthly webinar training sessions concerning pain, substance use disorder (SUD), acupuncture and addiction. In addition, an opioid safety app is currently in development, Spevak said.

Dr. Carlos Blanco, director of the Division of Epidemiology, Services,
and Prevention Research at NIH, gives a presentation on research efforts
to better understand substance use disorders. The division leads the
National Institute on Drug Abuse's (NIDA) efforts to improve public
health by supporting research to understand and address the patterns,
causes and effects of substance use. (Image credit: Sarah Marshall)
Treatment and prevention for substance use disorder requires a multifaceted approach including education, research, intervention and clinical care, explained Navy Lt. Cmdr. (Dr.) Eric Pauli. The assistant professor and director for clinical education in the Psychiatric Mental Health Nurse Practitioner Program-Doctor of Nursing Practice Program at USU, Pauli said the military has a long history of providing premier substance abuse treatment, even treating former U.S. First Lady Betty Ford, who received care at Long Beach Naval Hospital for alcoholism and an addiction to opioid analgesics during the late 1970s. Ford’s care at the hospital helped serve as an impetus to the establishment of the Betty Force Center for treatment of alcohol and other drug addictions.

Dr. Carlos Blanco, director of the Division of Epidemiology, Services, and Prevention Research at the National Institute on Drug Abuse, a component of NIH, stated how addiction involves the inability to voluntarily reduce drug-taking despite the potential tragic consequences. A guest speaker during the SUD symposium at WRNMMC, Blanco explained people become addicted to drugs and alcohol because those substances affect the pleasure centers in the brain, creating a sense of well-being and happiness. People who become addicted to opioids and other drugs often do so because the drugs make the sense of pleasure stronger than pain, and “pain is the most common reason for seeking care in the U.S.,” Blanco said. Prolonged substance use can injure the brain, and healing takes time, he added.

Regarding the U.S. opioid crisis, Blanco, and fellow symposium guest speaker Dr. Robert L. Dupont explained that in 2015 there were more than 52,000 reported drug overdose deaths, and 33,091 Americans died of opioid overdoses. About half of those deaths from opioids, more than 17,500, were attributed to prescribed opioids.

Dupont, president of the Institute for Behavior and Health, Inc., and the first director of the NIH National Institute on Drug Abuse (1973-1978) and the second White House drug chief (1973-1977), added that 2.5 million Americans age 12 and older have a substance use disorder, most due to prescription opioid followed by heroin. He pointed out that reported deaths from drug overdoses in 2015 exceeded those reported from people who died as a result of car accidents (37,757), guns (35,763) and HIV (6,465) that same year.

Another concern brought on by the opioid crisis is increasing prenatal exposure, Blanco added. He pointed out that in 2004, there were approximately seven admissions for newborn withdrawal syndromes per 1,000 admissions, and by 2013, that number had increased to approximately 33 admissions for newborn withdrawal syndromes per 1,000 admissions.

Since 1999, opioid prescriptions have nearly tripled, and people misusing analgesics, directly and indirectly, obtain them by prescription, Blanco furthered. He added sources where pain relievers are obtained for misuse include a friend or relative (54 percent), prescription (36 percent), and other sources (about 10 percent).

“Complex biological, developmental and social aspects of substance use and addiction suggest multipronged responses,” Blanco continued. “We not only have to treat the disease, but really treat the person’s social environment and where that person lives. We can also improve the diagnosis, we can improve screening, we can improve engagement, we can increase retention [in recovery and addiction programs], and we can improve the quality of care,” he furthered.

Navy Cmdr. (Dr.) Eric Pauli, an assistant professor in the Uniformed Services University's Psychiatric Mental Health Nurse Practitioner Program, kicks off the Symposium  with welcoming remarks. (Image credit: Sarah Marshall)

Dupont added that while the opioid crisis is now garnering much attention, 90 percent of substance use disorders are rooted in drug and alcohol use beginning in the “uniquely vulnerable teenage years” with three gateway drugs: alcohol, tobacco and marijuana. He said in approximately 95 percent of the cases involving opioid overdose deaths, other drugs are present in the victim’s system.

“Prevention is about any and all drug use by youth,” Dupont continued. He added the Recovery Movement is “a powerful movement of individuals who have overcome addiction,” and more than 20.8 million Americans are in recovery from substance use disorder.”

Also during the SUD symposium, Neil Riley, an Army veteran and lawyer, discussed Veterans Treatment Courts, a new development in the legal system to address challenges veterans face when they return home. According to the U.S. Department of Veterans Affairs, Veterans Treatment Courts are based on the behavioral health courts begun in the 1990s with the goal of keeping those with behavioral health challenges, such as post-traumatic stress and substance use disorder, out of the traditional justice system. Instead, the courts may recommend them for treatment and tools to cope with their challenges. “This is a team effort,” said Riley. “The judge works with the prosecutor and the defense counselor. They may also bring in the local VA and health-care providers,” he added.

Closing out the symposium, Walker Reed Forman, lead public health advisor for the Substance Abuse and Mental Health Services Administration, explained the Screening, Brief Intervention and Referral to Treatment program offered by the agency. SBIRT is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse and dependence on alcohol and illicit drugs, Forman said.
“It’s in upstream approach,” Forman said of SBIRT. “We may all take a walk along the stream of substance exposure and most of us never dip a toe into this stream, but some of us do, approximately 27 percent of us. Some people may venture further into the water and never notice that the stream is picking up speed, and they end up going downstream at an increasing pace.” He added SBIRT provides a lifeline for those people to let them know that they need to get out of that stream because the waterfall, which is addiction, is just around the bend.

The National Suicide Prevention Lifeline is at 1-800-273-TALK (8255).
The Center for Substance Abuse Treatment (CSAT) can be reached at 1-800-662-HELP.

Read more about what USU is doing to combat the opioid epidemic.