Motivational Interviewing on an Addiction Consult Service: Pearls, Perils, and Educational Opportunities

Marcovitz, David; Sidelnik, S. Alex; Smith, Mariah; Suzuki, Joji

doi:10.1007/s40596-020-01196-y

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…14,23,24 ACS offer an opportunity for students to learn about caring for patients who use substances from experts in addiction medicine and psychiatry who use MI and harm reduction approaches to meet patients where they are at; cultivating compassion and respect for this marginalized population. 25 Integrating medical students into ACS sends the message that learning how to care for patients with SUD is important and a priority for the clinical institution. Role modeling by faculty, fellows, and residents and collegiality with social work and peer specialists communicates to medical students the importance of collaboration and teamwork.…”

Section: How Acs Can Rewrite the Hidden Curriculummentioning

confidence: 99%

Rewriting the Hidden Curriculum via Addiction Consult Services: Meeting Patients Where They Are At

2023

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Addiction Consult Services (ACS) deliver evidence-based care for patients with substance use disorder (SUD) during the course of general hospital admissions. Stigma toward patients with SUD is a known phenomenon and is part of the "hidden curriculum" that permeates medical training and healthcare settings. ACS have the potential to rewrite the hidden curriculum around SUD and to teach medical students and other trainees how to compassionately care for this patient population. Here, the authors explore the role of stigma within the hidden curriculum of medical training and outline how ACS can successfully contribute to combatting this stigma. The authors highlight two institutions' approaches to educational initiatives that incorporate health professional trainees into ACS. The authors end by providing a vision of how expansion of ACS can promote interdisciplinary learning for healthcare providers amidst the changing landscape of SUD treatment in the USA.

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Section: How Acs Can Rewrite the Hidden Curriculummentioning

confidence: 99%

Rewriting the Hidden Curriculum via Addiction Consult Services: Meeting Patients Where They Are At

2023

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“…Another therapeutic component of some ACS that has reduced patient-directed discharges was the integration of peer mentors, which have been shown to help engage marginalized patients to improve patient and provider experiences 35,77 . As well, ACS frequently utilizes evidence-based psychotherapeutic interventions that could have reduced readmissions, such as therapeutic metaphors and motivational interviewing, which may be more acceptable to patients and more productive in effecting change than direct advice 78,79 …”

Section: Discussionmentioning

confidence: 99%

“…35,77 As well, ACS frequently utilizes evidence-based psychotherapeutic interventions that could have reduced readmissions, such as therapeutic metaphors and motivational interviewing, which may be more acceptable to patients and more productive in effecting change than direct advice. 78,79 Several studies identified how intersecting social and structural forces within the hospital could shape the acute treatment experiences of SUD patients and lead to worse SUD outcomes. 35,38,75,76 One study found that continued substance use in hospitals and premature patient-directed discharges were driven by suboptimal pain and withdrawal JUNE 2023 management.…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

Bahji

Brothers

Mauer-Vakil

et al. 2023

Canadian Journal of Addiction

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Background: Addiction Consult Services (ACS) have become an emergent clinical intervention for persons with substance use disorders (SUD) requiring hospital-based care. However, there have been few recent evaluations of the evidence for the effectiveness of ACS on SUD outcomes.Objective: We aimed to assess the effectiveness of ACS for persons with SUD on a range of SUD-related outcomes.Methods: We systematically reviewed peer-reviewed scientific literature measuring ACS outcomes. We searched 5 electronic sources (PubMed, MEDLINE, CINAHL, Cochrane, and EMBASE) from database inception through April 2021 and hand-searched article bibliographies for additional records. In addition, we considered any interventional or observational study design presenting original data and appraised study quality with the Joanna Briggs Institute checklist. Assessed outcomes included pharmacotherapy initiation in-hospital and postdischarge, retention in addiction treatment, length of hospital stay, 30-day readmissions, deaths, and patientdirected discharges. Finally, we conducted a narrative synthesis due to study design and outcome measurement heterogeneity.Results: From the initial pool of 1057 records, 26 studies (n = 12,823 participants; 60% male; mean age: 41 y) met review inclusion criteria. Most ACS provided pharmacotherapy, usually medications for opioid use disorder; add-on services varied, with some also providing psychotherapy (69%), discharge planning services (23%), and infectious disease consultation and treatment (19%). Overall, 7 studies (27%) observed positive impacts of ACS compared with control interventions on postdischarge engagement in addiction treatment and reduced addiction severity. Four studies (15%) reported no significant impacts of ACS versus control interventions on postdischarge care utilization or injection drug use frequency. The remaining 15 studies (58%) described the uptake of ACS-delivered treatments by hospital-based samples of patients with SUD but did not compare against a control condition.

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“…We believe applied education involving iterative practice and feedback in the clinical setting should become standard in undergraduate and graduate medical education, where too often brief lectures on MI are insufficient to disrupt overlearned behaviors based in traditional problem-solving approaches. 13,14 Model curricula exist but need to be expanded upon across clinical settings. 15 Finally, we hypothesize from our experience that such education must extend to the very attendings and preceptors who will be best positioned to "pay it forward" to their subsequent trainees by acquiring concrete skills in motivational interviewing.…”

Section: Discussionmentioning

confidence: 99%

More Effective Communication During Inpatient Addiction Treatment

Marcovitz

Kast

2023

Substance Abuse

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In this commentary, the authors argue that historical approaches to inpatient addiction treatment favoring more confrontational, expert-centric, or paternalistic undercurrents continue to permeate the hidden curriculum in medical training. These older approaches unfortunately continue to inform how many trainees learn to approach inpatient addiction treatment. The authors go on to provide several examples of how clinical challenges specific to inpatient addiction treatment can be addressed by employing principles of motivational interviewing, harm reduction, and psychodynamic thought. Key skills are described including accurate reflection, recognition of countertransference, and assisting patients to sit with important dialectics. The authors call for greater training of attending physicians, precepting advanced practice providers, and trainees across these disciplines, as well as further study of whether systematic improvements in such provider communication may alter patient outcomes.

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Motivational Interviewing on an Addiction Consult Service: Pearls, Perils, and Educational Opportunities

Cited by 7 publications

References 23 publications

Rewriting the Hidden Curriculum via Addiction Consult Services: Meeting Patients Where They Are At

Rewriting the Hidden Curriculum via Addiction Consult Services: Meeting Patients Where They Are At

The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

More Effective Communication During Inpatient Addiction Treatment

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