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IU Health System is more focused than ever on behavioral health, and the way it impacts the lives of Hoosiers. That’s why we spoke with R. Andrew Chambers, M.D., an associate professor of psychiatry, as well as director of the Addiction Psychiatry Fellowship Program and director of the Lab for Translational Neuroscience of Dual Diagnosis & Development at Indiana University Health. We spoke with Dr. Chambers about the way the industry is approaching behavioral health, why it’s so difficult to find quality care providers, and how financial contributions from donors can make all the difference in offering the best care, from the best caregivers.
Dr. Chambers, how did you choose a career in behavioral health, specifically with a focus in addiction psychiatry?
I’m fascinated by the brain. I wanted to know, “How does the machinery of the brain work? How does it compare to, for instance, a computer?” The human brain is kind of a final scientific frontier, much like outer space is, and I was drawn to that. I began to understand that science is a way to help us understand how the brain works and how to use that knowledge to help people who are suffering from behavioral health illnesses, addiction and varieties of mental illness.
“Dual diagnosis” is a term we’re hearing a lot in behavioral health these days. What does it mean to diagnose and treat both a mental illness and addiction in a patient?
We’ve known for a long time that there’s an association between mental illness and addiction. When I was in training in the early 90s, the leading hypothesis to explain why they’re associated was the idea of self-medication – that people with mental illness are using drugs to somehow medicate their symptoms.
It did help to destigmatize mental illness, but the downside is that these drugs are not medications for people with mental illness; they generally make people even sicker. These are comorbid diseases, not medications.
And why is that such an important distinction?
One of the biggest problems with calling it self-medication is that it gives the clinicians a basis for not treating it. If you think of people as being only addicted and not mentally ill, then you’re only going to treat that addiction. But if you think of them as mentally ill and they’re using drugs, well, they’re just self-medicating… so you just treat the mental illness and everything else will take care of itself, right? And, of course, that doesn’t work.
So, if they aren’t self-medicating, what is actually going on?
What’s happening is that the brain disease of mental illness is accelerating and exacerbating the disease of addiction. I spent the bigger part of my early career understanding the relationship between mental illness and drug addiction in the lab, and learning how the brain circuits of mental illness set up the disease of addiction and worsen it. Much how HIV can make someone more vulnerable to infections or cancer, we know now that mental illness sets up and worsens vulnerability to addiction.
What do you think is the answer for patients with dual diagnosis?
Well, when you understand what’s really going on, it reframes your perspective on our entire mental health system, which is fragmented. Mental health and addiction care are pretty much split, and that’s true in Indiana and most of the country. Where that led me in terms of translating this science was really rejecting that old tradition and saying we need to merge, 100% merge, mental health care and addiction care. We need to build a system of clinics and professional teams that are competent and can deliver excellent standards in mental health care and addiction in whatever combination those illnesses present in individual patients.
How do we do that?
We hope that as we begin to discuss the need for integrated dual diagnosis care – which means that if you have a mental illness and addiction that you can get both of those treated by one team under one roof – we can extend the capacity of our behavioral health treatment system. We need physicians who are trained at the highest level in both mental health care and addiction care. And that’s exactly what addiction psychiatrists do. They’re able to deliver both types of care and integrate that care into one team.
What are the obstacles to overcome in getting this integrated care to the patients?
There are a number of major barriers, and the first is finding physicians who are willing to go into this specialty. The stigma that discourages patients from seeking care also discourages physicians from taking care of patients with this disorder. A consequence of that stigma is that insurance coverage is grossly inadequate for actually treating the disease.
There’s also a financial barrier. Our medical students and our residents are going into unprecedented financial debt. One of the things that the Indiana state government has done is set up a loan repayment program where you can apply, and if you commit to staying in the mental health or addiction field in Indiana for a certain number of years, the state of Indiana will step up and pay some of the loan debt.
How can you create momentum for integrated dual diagnosis care?
We need to build up the workforce and build up the knowledge and infrastructure to support these kind of integrated care clinics. IU School of Medicine has only trained eight addiction psychiatrists in its whole history. I’m one of those eight and I’m training more all the time. The size of the behavioral healthcare crisis in proportion to the number of individuals trained to treat this is totally upside down.
When it comes to integrated treatment, the model that we believe is the best model is not one where you only use medications and leave psychotherapy out of it, nor is it where you only do psychotherapy and you leave medications out of it. We believe that patients need a combination of different treatments – they need combinations of psychotherapies and combinations of different medications individually tailored to their illness.
Many of our donors have a personal connection with behavioral health. Why is it so important to have the support of our local communities, leaders, and philanthropists?
Anybody who understands the profound degree to which untreated mental illness and addiction touches every corner of American life also understands the impact that this kind of neuroscience and integrated therapy could have in treating our whole society. There is potential to make a difference that touches every single one of us – not just the people with these diseases, but our entire society.
Dr. Chambers has also written a book on what he calls the “2x4 model clinic” – a behavioral health facility that integrates mental health and addiction care with diagnostics, psychotherapies, medications and communications between physicians, insurance companies and law enforcement. The book will be available in December. If you’re interested in learning more about how IU Health Foundation is working to support behavioral health care, please contact Jeannie Sager, director of philanthropy, at 317.962.2207or via email.