Thrive by IU Health

February 20, 2018

Dr. Chambers Discusses Mental Illness & Addiction

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.

What else?

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.

Watch Dr. Chambers discuss addiction and mental health.

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.

Latest Stories

Filter from

January 18, 2021 What to Expect After COVID-19 Vaccine As the COVID-19 vaccine rollout has expanded to more Hoosiers in recent days, you may b... January 18, 2021 IU Health COVID-19 Data IU Health is committed to being a trusted source of information for the public during t... January 15, 2021 IU Health Arnett announces leadership promotions Christopher Mansfield, MD has been promoted to Associate Chief Medical Officer (ACMO) f... January 08, 2021 Chief Nursing Officer receives DNP Marilyn Riley, vice president and chief nursing officer at IU Health Frankfort, recentl... January 08, 2021 IU Health Arnett Hospital announces retirement of President Daniel Neufelder, FACHE, president of Indiana University Health Arnett and the West Cen... December 20, 2020 She’s a respiratory therapist with asthma, and she’s on the front lines Jody White didn’t have to treat COVID-positive patients at Methodist Hospital, but opti... December 18, 2020 Physicians implore their communities to take COVID vaccine when it's time IU Health infectious disease physicians from around the state feel confident in taking ... December 17, 2020 IU Health begins COVID-19 vaccines: 'Light at the end of a very long tunnel' IU Health took possession of the first COVID-19 vaccines in central Indiana on Wednesda... December 17, 2020 Coping with Grief and Loss This Holiday Season The holiday season is often a time of year in which a wide range of emotions can arise.... December 17, 2020 Behavioral health numbers up; Fighting holiday stress during a pandemic The past year has been filled with anxiety, disappointment, and heartache. Never has it... December 16, 2020 Veteran nurse: ‘I can’t tell you how hard it is to see that lonely patient in bed’ For more than two decades she’s sat at the bedside of her patients. Now, IU Health Nurs... December 15, 2020 ‘Baskets of Cheer’ boost front-line teams During a stressful day, a quick cup of coffee or snack can make a big difference, espec... December 15, 2020 New program allows patients to heal at home In April, when the impact of the pandemic began to hit home, IU Health had an idea to h... December 15, 2020 COVID-19 vaccine: Freezers ready to store; Staff ready to administer first doses It’s been a long time coming but now, a new vaccine is making its debut in the fight ag... December 14, 2020 Steps to Eating Healthy at Home It may be an understatement to say that the year 2020 has been quite the whirlwind. The... December 13, 2020 First patient who received COVID-fighting infusion: ‘Hardest part was the needle’ When she signed up to receive a new monoclonal antibody to help ward off her symptoms o... December 12, 2020 Wigs can help cancer patients feel sense of control When you combed or brushed your hair this morning, you likely didn’t think much about h... December 11, 2020 Watch: IU Health experts answer COVID-19 vaccine questions With COVID-19 vaccine approval just around the corner, IU Health experts address a numb... December 10, 2020 Generational Trauma: Breaking the Cycle of Adverse Childhood Experiences How Our Understanding of ACEs Provides Better Healing Care for Adults “The child is th... December 10, 2020 First a Riley patient; Now at 25, athlete is a patient at IU Health Simon Cancer Center At the age of three he became a patient at Riley Hospital for Children at IU Health. No... December 09, 2020 COVID-19 Vaccine: What You Need to Know With COVID-19 cases on the rise in Indiana and across the country, a ray of hope exists... December 09, 2020 IU Health vascular team’s phone app focuses on blood clots and COVID patients As health care providers piece together the impact of the deadly coronavirus, a team of... December 08, 2020 Indiana University Health Arnett welcomes new Chief Nursing Officer, Allison Shuttz, MSN, RN, NE-BC Allison Shuttz, MSN, RN, NE-BC, has been appointed Chief Nursing Officer for Indiana Un... December 08, 2020 For two years, this young mom could not speak Her 2-year-old was just a baby when Maranda Slusser stopped talking. Two more children ... December 04, 2020 Tranquility Spaces Provide a Respite For Frontline Team Members Sometimes even heroes need a break … a chance to slow down, take a breath, gather their... December 03, 2020 Hospital chaplain: From bedside compassion to hospitalized care She’s sat at the bedside of new moms and patients undergoing radiation therapy. She’s a... December 02, 2020 “I thank God I’ve come through it” As a COVID-19 “long hauler,” Sarah Hagan found help through IU Health’s Convalescing CO... December 02, 2020 She cares for patients with COVID and carries on her mother’s legacy Her mother worked for IU Health, and for two decades this nurse has followed in her foo... November 30, 2020 Calling a Code Lavender If you’ve watched a hospital-based television show, you’ve probably seen the following ... November 30, 2020 Hospital workers – Giving hearts on holidays and every day They work tirelessly every shift, every day. Most never anticipated living through a pa... November 29, 2020 He was looking for a liver giver and she delivered Wayne Brown posted on Facebook that he needed a new liver. A long-time friend saw his p... November 24, 2020 IU Health Frankfort Hospital now open The new IU Health Frankfort Hospital is open and ready to serve you. A fence around the... November 24, 2020 Nurse down 75 pounds: ‘Self-care is vital, especially during a pandemic’ As a progressive critical care nurse, Kristy Fields sees many patients treated for symp... November 23, 2020 Q4 2020 Quarterly Report: COVID-19 brings community together, while social distancing Crystal Hinson Miller, chief philanthropy officer for Indiana University Health and pre... November 23, 2020 Father of five girls gets wish with hospital bedside wedding Seven weeks ago, Matthew Rynearson was diagnosed with a neuroendocrine tumor. When he e... November 20, 2020 Transplant Gratitude Triggers $1 Million in Funding Technically, Jerome Josephs received a kidney when he underwent a transplant at IU Heal... November 19, 2020 In the Midst of a Pandemic, Three Foundation Team Members Achieve International Certification Diane Buzzell, Julie Paolillo and Kate Konzen have several new letters after their name... November 19, 2020 Rock band member chooses IU Health for testicular cancer treatment Minnesota native Ryan Keyes came to Indianapolis to play drums in a rock band. Now, he’... November 18, 2020 Offering help to go tobacco-free during COVID-19 People who are tobacco users and who vape have a higher chance of getting COVID-19. IU ... November 17, 2020 How to Stay Safe & Healthy This Holiday Season With COVID-19 cases surging across the state, it may be time to rethink your traditiona... November 17, 2020 Long-time nurse known for educating the next generation of nurses She has been at the bedside of countless patients – the sickest of the sick, and Marcia... November 15, 2020 Father Donates Kidney to Young Son: “It’s a Huge Sigh of Relief” By IU Health Senior Journalist T.J. Banes, tfender1@iuhealth.org It was in her 20th we... November 13, 2020 Double transplant patient on quest to educate young adults with diabetes Even before his first transplant, Mike Davis knew the importance of self-care for diabe... November 12, 2020 How to Cope with Holiday & COVID-19 Stress With COVID-19 cases on the rise and the holidays around the corner, you may be feeling ... November 12, 2020 Lung cancer patient, non-smoker: ‘Anyone with lungs can get cancer’ It started with a mild cough that wouldn’t go away. Now Shauna Dalton is taking meds tw... November 11, 2020 Veteran’s Day – A family legacy for IU Health doctor IU Health Dr. Kevin Rice talks about his journey to the medical field and his service i... November 10, 2020 Nurse who had COVID-19: “The positive is I can donate plasma to help others” The numbers are the highest they have been in months. COVID-19 continues to be a deadly... November 09, 2020 TCC Gives’ donated iPads help IU Health patients and families connect The isolation created by the COVID-19 pandemic has weighed heavily on everyone, but it ... November 08, 2020 ‘Hospital at home’ patient: ‘They spoiled me. I couldn’t have asked for better care’ In April, IU Health launched a program for ill COVID-19 patients that allowed them to r... November 05, 2020 New glucose management option helps COVID-19 patients Since the beginnings of the COVID-19 pandemic, healthcare professionals have learned th... November 02, 2020 Risky tumor removal threatened patient's ability to talk & swallow Daniela Gomez started experiencing severe headaches when she was 14 years old. For six ... November 01, 2020 First Altruistic Living Liver Transplant at IU Health After 10 years with an autoimmune liver disease, Matthew Prather was told it was time f... October 29, 2020 A look back at LifeLine rescue of crash victim: “A life-defining moment” It was in the early morning hours when LifeLine flight nurse Mike Collins was summoned ... October 28, 2020 First living liver recipient: Three months later and patient enjoys new life When Kelly Kinkade’s health began to decline, she turned to IU Health’s top-ranked tran... October 26, 2020 3 Healthcare Topics Every Hoosier Should Know About Before They Vote As we approach Election Day on Tuesday, Nov. 3, healthcare continues to rank high on ju... October 25, 2020 He thought he had COVID-19; Nurse practitioner suspected something else Ryan Gillen is beyond grateful. He says one special nurse who discovered his illness, i... October 22, 2020 Cancer patient, 28: ‘People say 2020 has been bad, but for me it’s a blessing’ He’s young, launching his professional career and he’s facing the challenges of a cance... October 22, 2020 For this student nurse, COVID unit has helped her grow PCA Kate Davenport: “It’s so important to meet people where they are and offer support,... October 21, 2020 Grant Expands Dementia-Support Services in Southern Indiana “It really does take a village when it comes to dementia care,” said Dayna Thompson, an... October 21, 2020 What Characteristics are the Most Important Part of a Safe & Effective Weight Loss Program? In today’s digital age, you can find weight loss plans everywhere. From diet pills that... October 20, 2020 This doctor has a reason to be a real man wearing pink Each year, the American Cancer Society raises money and awareness for breast cancer wit... October 15, 2020 Elementary teacher, 28, diagnosed with breast cancer Both her grandmothers had breast cancer, but Sarah Clark had no reason to believe her d... October 14, 2020 When Minutes Count: Know Risk Factors for Stroke Stroke is the fifth leading cause of death and is a leading cause of long-term disabili... October 14, 2020 Putting on the White Coat: Celebrating an IU School of Medicine Bicentennial Scholar Image courtesy of IU School of Medicine Where once walked a scribe, following doctors ... October 13, 2020 Infant Loss: Two Mothers Open their Arms to Those who suffer Two Nurses at IU Health Arnett both suffered the loss of their precious newborns. Their... October 12, 2020 Philanthropy Funds Rooftop Garden to Offer Patients, Loved Ones and Team Members a Breath of Fresh Air In the midst of uncertainty and stress, it’s important that all of us take a moment to ... October 12, 2020 Understand the importance of safe sleep While the prevalence of Sudden Infant Death Syndrome (SIDS) in the United States has de... October 12, 2020 Olcott’s Gift Paves Way for Nurse Navigation at the New Regional Academic Health Center Joan Olcott will be long remembered as an important figure in the Bloomington community... October 11, 2020 Breast cancer patient found lump two weeks before mammogram At the recommendation of her family physician, Kelly Kelso scheduled a mammogram. Two w... October 09, 2020 Merriman Award Honors Compassionate Team Members Statewide Five IU Health team members around the state have won the “Lynda,” the Lynda A. Merrima... October 09, 2020 From Riley to University Hospital – Patient relies on music therapy He first came to IU Health as an infant and recently when he came back as an adult, Nat... October 07, 2020 Former school bus driver fights pancreatic cancer For 25 years, Alan “Dale” Albright drove a school bus. He looked at the kids on his rou... October 06, 2020 How Could My Alcohol Use Affect My Family? “It’s just one more drink.” “I haven’t had any legal problems.” “I worked really hard t... October 06, 2020 IU Health midwifery practice invites women to “call the midwife” In a nod to the popular PBS television series “Call the Midwife,” four IU Health nurse ... October 01, 2020 Mother’s devotion: Driven to improving mental health care After years of experiencing firsthand her son’s diagnosis of mental illness, Joan Ester... September 30, 2020 LifeLine crew reunites with seriously injured teen airlifted to Methodist It was his second time to board a LifeLine helicopter and this time, Brandon Stuckwish ... September 29, 2020 How to Recognize & Prevent Heart Disease During COVID-19 Have you given much thought to your heart this year? During the COVID-19 pandemic, ma... September 29, 2020 IU Health, IPS launch career development program at Crispus Attucks Upon graduation and completion of the fellowship program, students will be guaranteed a... September 28, 2020 Grant Connects People in Rural Communities to Emergency Behavioral Care Thanks to a new grant secured by IU Health Foundation, people in rural communities in n... September 24, 2020 White Memorial helping patient move from a motorized cart to walking the fields Gene Dallinger suffers from COPD and started working with pulmonary rehab at IU Health ... September 24, 2020 From North Africa to the U.S.: Expatriate encourages community engagement A native of Algeria, Mohamed Merzoug joined IU Health’s Community Outreach and Engageme... September 24, 2020 As he retires: Transplant leader dedicated to patients and hospital community After more than a decade of serving as IU Health’s Medical Director of Kidney & Pancrea... September 23, 2020 Lab worker driven by niece’s death from sepsis Thousands of children die each year as a result of severe sepsis. Matthew “Trevor” O’He... September 22, 2020 Methodist childbirth educator looks forward to Riley move The new maternity tower at Riley will centralize all inpatient and newborn care so even... September 21, 2020 In Pursuit of Health Equity: An Evolution in Healthcare At the crossroads of storylines between the COVID-19 pandemic and summer-long protests ... September 21, 2020 Practicing Mindfulness During Times of Uncertainty The COVID-19 pandemic has underscored the fact that things in life can be out of our co... September 18, 2020 IU Health Arnett donates masks to local food banks Indiana University Health Arnett is donating masks to local food banks to help improve ... September 17, 2020 Two surgeries, one day - Father donates kidney to son When his son’s kidneys began to fail, Shannon Dobrucki did what most fathers would do –... September 16, 2020 IU Health Foundation’s Jessica Journey Receives International Industry Honor “Serving people with excellence, compassion, ethics, and positivity” has earned Jessica... September 15, 2020 Her nursing career is an extension of her life of empathy for others Melyssa Sams started her career later in life but she’s always been headed toward nursi... September 15, 2020 Hospital dietitian first came to IU Health as a pediatric patient Long before she even knew about careers in healthcare, Jennifer Golding was a patient a... September 14, 2020 Wear a Mask Because You Care … and Because It Works One of the best ways to protect yourself, your loved ones and the people in your commun... September 14, 2020 Why it’s Crucial to Get Your Flu Shot in 2020 2020 has taught us a lot of lessons. One major lesson being the importance of maintaini... September 10, 2020 Nurse: “I chose IU Health because I trust the oncology care” There are hospitals closer to her home, but when DaJuana Moore was diagnosed with breas... September 09, 2020 College student recovering from bone marrow transplant When she discovered the mass two years ago, Mayra Rodriguez completed treatment at IU H... September 09, 2020 IU Health Foundation Funds Officer Down Kits for Tipton Police & Tipton County Sheriff's Departments Pictured from Left: Thomas Sliwa, MD – Emergency Medicine; Brad Robins – Sergeant Tipto... September 09, 2020 IU Health Foundation Grant Helps People Quit Smoking Indiana ranks fifth-highest in the nation for tobacco use, but the IU Health West Centr... September 08, 2020 IU Health Team Member Gives to Transform Healthcare Inequities For Craig Brooks, transformation manager for IU Health Physicians, “transformation” is ... September 07, 2020 Healthcare at home with virtual visits As the COVID-19 case number increases throughout Indiana, more and more Hoosiers are fa... September 04, 2020 Indiana University Health Tipton Hospital opens COVID-19 testing site TIPTON, Ind. – Indiana University Health Tipton Hospital understands the need for a loc...