This past November, I attended the Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) annual conference. I came away feeling energized about the behavioral health and substance use work we do at ICH, and connected to a community of inspiring practitioners and researchers. Reflecting on the sessions I attended as well as my conversations with others in the field, two themes in particular continue to resonate with me:

People are more than their diagnosis

First, I was struck by the scope of the topics we talked about at the conference—of course, some presentations were focused on the medical aspects of addiction treatment, like methadone dosing protocols, evidence-based treatment for alcohol use disorder, the merits of injectable vs. sublingual buprenorphine, etc. Understanding effective treatment approaches for substance use disorders is critical, but only one piece of the puzzle. Throughout the conference, presenters were focused on people more than patients—encouraging us to always remember that individuals are more than their diagnosis and that recovery means more than just reducing or stopping drug use. Treating addiction is about supporting people to achieve a high quality-of-life, defined by the World Health Organization as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. This means not stopping at treating a person’s substance use disorder, but also supporting them with whatever else they need to build a fulfilling and personally meaningful life. This can feel like an insurmountable task in a system that is not set up to provide this kind of comprehensive, whole-person support, and where access to even basic medical care or social services can be a major challenge. However, there are innovative programs that are working on this: at the conference, I heard a presentation from UIC Mile Square Health Center in Chicago, which is partnering with an Opioid Treatment Program (OTP) to provide methadone treatment on-site within an integrated primary care/behavioral health care model at a federally qualified health center (FQHC). This allows patients with opioid use disorder to receive effective treatment in the same location where they can get care for other medical or behavioral health conditions, as well as connections to community resources for housing, transportation, food, and more. 

The impact of the overdose crisis is far-reaching and will last for generations

The other major takeaway from the conference was around the impact of the overdose crisis for families, communities, and frontline workers. There was a striking emphasis on children and families in the conference sessions, which prompted me to do more research and reflect on the accumulating impact of overdose deaths. A recent article in the American Journal of Public Health estimated that more than 1.4 million children in the US have lost a family member to overdose, with the authors warning that “the full consequences of the overdose crisis will continue to define public health for decades to come.“ An estimated 1 in 3 adults have been impacted by overdose loss, and a growing number of parents and caregivers have also lost a child to overdose; drug overdose/poisoning is now the 3rd leading cause of death among children and adolescents in the US, with a sharp increase in recent years. Frontline workers are also heavily impacted by overdose and loss, and Dr. Naburan Dasgupta from the Opioid Data Lab has emphasized that “the accumulating grief is a tangible threat to public health capacity.”

More than 100,000 people have died from overdose each year for the past few years, and the grief and trauma in families and communities is pervasive and multigenerational. We know that this kind of traumatic loss is associated with a range of negative outcomes, including increased risk of substance use disorders, and some researchers are naming this as a public health emergency. Here at ICH, we are working with some organizations providing trauma and grief supports through the Mosaic Opioid Recovery Partnership grant program (funded by the Massachusetts Opioid Recovery & Remediation Fund and powered by RIZE Massachusetts Foundation), and I hope to see growing investment in this area in the coming years. 

So what does all this mean for us researchers and evaluators? Personally, I’m reminded that all of the topics we work on at ICH are connected, and that building healthy communities doesn’t happen by treating individual health conditions separately from one another, or separately from the social and community conditions that people live in. This makes me think about finding more connections across our projects and developing research ideas that bring together our staff’s collective expertise in behavioral health, trauma, immigrant health, maternal & child health, health equity, and more. It also reinforces how important it is to ask intended beneficiaries about their own goals and priorities when designing programs, and helps me to think more broadly about the kinds of outcomes that we should be looking at in evaluations. While the future of public health in the US is uncertain as we begin this new year, ICH remains committed to being a partner in supporting health and wellbeing for people who use drugs and their families and communities. I hope we’ll have a chance to put some of these ideas into practice as we move forward together.