Macon doctor travels to White House with new strategy in war on substance abuse

lfabian@macon.comDecember 13, 2013 

Patients in the emergency room expect to be asked how they are feeling.

They might not be as ready to answer questions about how much they drink or whether they take illegal drugs.

Over the past five years, that is exactly what has been happening in emergency triage rooms at The Medical Center of Central Georgia.

The three-pronged approach of screening, brief intervention and referral to treatment, or SBIRT, is designed to identity unhealthy alcohol and drug use before serious addiction problems fester.

Dr. Paul Seale, of Macon, who spearheaded the local project, was invited Monday by the White House to discuss the results of the clinical study operating at the Medical Center and Grady Health Systems in Atlanta.

Of the 300,000 people screened, more than 30,000 people received services. The majority of those did not have alcohol or drug use disorders, but were using at risky levels with binges or weekend partying.

“The earlier we talk to people with unhealthy use, there’s not as much denial and resistance,” Seale said. “They are more open to talk about it.”

With $5 million from the federal Substance Abuse and Mental Health Services Administration, or SAMHSA, the Medical Center saw more than 14,000 people receive patient education and brief counseling sessions. Those with more serious issues were referred to treatment programs.

Through follow-up queries, about 60 percent of those receiving counseling or treatment report they reduced their unhealthy alcohol usage.

“It’s a collaborative, non-confrontational approach that tries to identify and enhance people’s internal motivation to change their behaviors in a positive direction,” Seale said after speaking at the nation’s first Drug Policy Reform Conference in Washington, D.C.

Since 2008, 92 percent of emergency patients were asked: Have you had more than four or five drinks in one day over the last 12 months? How many days did that occur over the past year? Did you smoke pot or use another street drug or prescription medicine or sedative for non-medical reasons?

“Most people answer those questions about alcohol and drugs truthfully in the health care setting because they want help,” Seale said. “Research indicates many people are treatable.”

Shifting focus

For a quarter century, the White House’s Office of National Drug Control Policy has been waging the war on drugs with an initial focus on law enforcement.

Emphasis is now shifting to early intervention and treatment, said Seale, professor and director of research in the department of family medicine at The Medical Center of Central Georgia and Mercer University School of Medicine.

Seale, who worked with a team from the Georgia Department of Human Resources to write the SBIRT proposal, serves as co-medical director of the $15 million Georgia project and heads the Medical Center’s team.

While alcohol and drug users might reject family members’ questioning, clinical nurse Joshua White says Medical Center patients are not usually offended when he talks to them.

“They understand you’ve got to ask that kind of question. Some of them with more serious problems think it’s funny,” White said.

The motivational screening demands clear-cut questioning, said Sheri Leslein, the nurse manager for the emergency center.

“Ideally, we ask the question just as it says,” Leslein said.

The director of the Medical Center’s emergency center, Dr. Kalambur Panchapakesan, said patients are surprisingly cooperative, thanks to the staff.

“They have a knack for asking them,” Panchapakesan said.

White tries to read his patient’s personality and body language to determine how to proceed.

“It’s best to make light of it, especially if someone is sick, they don’t want to be talking about smoking crack,” he said.

Those with serious addictions do not typically seek treatment, but are a captive audience to hear about their risky behaviors once inside the hospital.

Patient representative Elizabeth Lattimore can advise folks where to turn for help.

Through counseling, she’s seen people come off the streets and find a stable place to live.

“They’ll say, ‘I have my house now, come and see me.’ This is just by someone stopping and taking time to listen,” Lattimore said.

Grants help out

Mercer University School of Medicine’s department of family medicine recently secured a $1 million grant to train nurse practitioners at several schools, including Mercer University in Atlanta and Georgia College & State University in Macon. The students will learn the early intervention techniques developed in the SBIRT program.

In another grant to Mercer, Seale also leads seminars to train primary care physicians to screen unhealthy drug and alcohol users and do brief interventions.

Dr. Matt Astin, who works in the Medical Center’s Level-1 Trauma Center, sees the screening as a way to reduce traumatic injuries from car wrecks and other accidents associated with impairments.

“It provides an extra screening for very high-risk patients,” Astin said. “Especially with trauma patients who drink. A lot are at risk for injuries.”

Although the main grant funding is ending, the Medical Center will continue screening patients.

Instead of a grant-funded, on-call team intervening, existing patient counselors like Vaishali Whisler will be alerted.

Whisler already assists patients with end-of-life and other issues and will add drug and alcohol referrals to her shift duties.

“I can still follow up regularly if they’re in the emergency center, or in a room and I can still do home follow-ups, too,” Whisler said.

Seale is excited the program could spread across the country through his appearance at the White House conference.

Prevention will become even more critical once Medicaid dollars are further stretched under health care reforms.

“We actually save health care dollars,” Seale said.

Medicaid research in Washington state shows more than $150 was saved per patient, per month, in similar interventions, he said.

“We’re excited to be doing what SAMHSA calls taking research to the bedside, techniques that work,” he said. “Now make it go out and work in the real world.”

To contact writer Liz Fabian, call 744-4303.

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