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Special Edition: Ask the Expert, SAMHSA’s First Chief Medical Officer, Elinore F. McCance-Katz, M.D.

(8/2/2013)

Special Edition: Ask the Expert, SAMHSA’s First Chief Medical Officer, Elinore F. McCance-Katz, M.D. Answers Questions Submitted by Recovery Month Audience

SAMHSA recently appointed Elinore F. McCance-Katz, M.D., as its first-ever Chief Medical Officer (CMO).  In this capacity, she will provide medical-scientific expertise to SAMHSA's major behavioral health efforts, including those promoting the prevention of mental illnesses and substance use disorders, as well as the treatment and recovery of people living with these conditions.

Dr. McCance-Katz will also work with leading scientists in the field of behavioral health to ensure that SAMHSA advances effective, state-of-the-art, evidence-based approaches to promoting the Nation's behavioral health services.  She will also represent SAMHSA on key departmental groups requiring medical expertise and work with stakeholder groups on clinical issues.

"As SAMHSA's Chief Medical Officer, Ellie will greatly enhance SAMHSA's ability to bring the best available medical science and clinical perspective to bear in promoting all aspects of the Nation's behavioral health," said Administrator Pamela S. Hyde, J.D. " Her widely respected expertise, extensive experience, and passion for applying science to help people make her the perfect choice to start this new, critically important position at SAMHSA."

In this special edition of Recovery Month’s Ask the Expert Dr. McCance-Katz answers questions submitted by the Recovery Month audience on a variety of topics related to prevention, treatment, and recovery from substance use and mental disorders.

Learn more about SAMHSA’s new CMO on the SAMHSA website: http://www.samhsa.gov/newsroom/advisories/1305203306.aspx


1) Question: What does chronic schizophrenia mean?  Does it mean you will have schizophrenia for the rest of your life, and that you need to take prescription drugs for the rest of your life?  Does it mean you will go from drug to drug, and when one fails, you have to try another drug?  How can one be in recovery from chronic schizophrenia – what does recovery mean for this kind of diagnosis? 

Answer: Schizophrenia is a serious mental disorder that is characterized by symptoms that can affect all aspects of thinking including attention, perception, emotion, and memory. These symptoms occur over a spectrum of severity and result in varying degrees of social and functional impairment. About 1% of the American population is affected by schizophrenia, but individuals with this mental disorder use about 10% of hospital beds in the United States, underscoring the serious and disabling potential of this illness. Schizophrenia usually begins in late adolescence and early adulthood. The disorder can have a relatively sudden onset over, for example, 2-3 weeks, but more common is a gradual onset with a prodromal stage where some symptoms are present, but not enough to make a diagnosis possible and this period occurs prior to the onset of an episode in which a person may experience hallucinations or delusions, speech problems that may result in difficulty with communication with others, disorganized behavior and/or diminished experience of emotion and communication or interaction with others. Symptoms must be present for at least 6 months before a diagnosis can be made. For most, schizophrenia is a chronic disorder. It can be treated with medications that help with the thinking problems associated with the disorder. However, the medications have side effects and it is important for the doctor and clinical team to work closely with the patient to determine the most helpful medication(s) that produces the fewest side effects. Because of the difficult side effects that some experience, discontinuation of medication is not uncommon. In such cases, where symptoms then recur causing another medication to be given, it may seem like a person is going from medication to medication, but working closely with someone and listening to their needs and concerns followed by close monitoring of response to the medication and adjustment as needed can help to steady the course for an individual coping with schizophrenia. The reality is, as I mentioned earlier, that the natural course of schizophrenia includes its occurrence  across a spectrum of severity. Long term outcomes include sustained, complete recovery to chronic mental illness with severe disability. Most recover from the initial episode of the disorder and some have a fairly benign course of illness. Others will have more severe problems that will require ongoing medical care and assistance with life needs. Even those with severe illness can have meaningful lives and make significant contributions to society. With attention to an individual’s needs, support from the therapeutic team including ongoing psychiatric and medical care, assistance with housing and employment, work with family and other caregivers, and peer support to assist with navigation of concerns as they arise, those with schizophrenia can and do recover.

2) Question : I am a beginning Chemical Dependency Professional Trainee, and want to believe that cultural adversity, and a genetic predisposition to addiction, can be overcome by positive beliefs and hope in a better future.  Does epigenetics support my belief that constructive societal influence and beneficent environments can overcome and conquer addiction?

Answer : Positive beliefs and hope can contribute to recovery from addiction, but for those who have the serious condition of addiction to drugs or alcohol; these are unlikely to be sufficient for successful treatment. The chronic use of substances in amounts that produce the neurobiological changes including psychological and, for some substances, physiological changes and medical and psychosocial consequences that we know as addiction require full evaluation and treatment. This will include physical examination, laboratory testing including toxicology screen, a complete medical, psychiatric, and substance abuse history, discussion with the person regarding the course of substance abuse, previous treatments and response, and their treatment preferences regarding the current episode given the available resources. Treatment may require a period of medical withdrawal to help a person safely stop substance use, as well as counseling, family therapy, assistance with housing and vocational rehabilitation, and peer support. Ongoing medication assisted treatment for relapse prevention will be needed by some depending on the problem substance. People with substance use disorders need access to all of the modalities shown to be helpful and effective in the treatment of addiction.

3) Question : Why isn't addiction treated like other mental illnesses (especially when it comes to length of treatment options)?  Isn't the brain's chemistry measurably changed resulting in dysfunctional behavior like other mental illnesses?

Answer : Substance use disorders have a history of being viewed as ‘moral failings’ or bad choices. This has resulted in barriers to treatment as well as limitations type and duration of treatment. Over the last 25 years, we have learned that substance abuse produces changes in the brain. These include changes both to brain structure and function, some of which last long after substance use is ceased and may contribute to risk for relapse. There remains a lack of understanding of this information by many including some healthcare decision-makers. The Affordable Care Act is important because treatment for substance use disorders is an essential health benefit. This means that treatment for substance use disorders must be provided to those in need and this will be a substantial contribution to the improved health of many affected Americans. 

4) Question : What is the difference between "trauma informed care" and "Peer Support - lived experience"?  Is it semantics?  Does it affect different funding streams?

Answer : Trauma-informed care is an approach to treatment that recognizes that many with mental disorders are survivors of trauma and that the effect of trauma in their lives can influence responses to services. Trauma informed care shows sensitivity to the traumatic experiences of the individual in an environment that respects the person, provides information and evidence-based treatment, and instills hope. Trauma informed care is an approach that seeks to understand what a person has experienced rather than determining what is wrong with the person and in doing so, assists the person with their recovery.  Peer support services are those provided by individuals who have lived experience with behavioral health problems. Peer support services include a range of interventions including peer run programs and counseling in individual and group settings. Peers who may have had experiences similar to the individual they are assisting can be a source of strength and support that can assist in recovery. Peers can certainly provide trauma-informed services, but trauma informed services are not unique to peers. All providers can offer trauma-informed care which can be an important component of mental health care.

 


Keywords: ask, the, expert, SAMHSA, first, chief, medical, officer, elinore, mccance-katz



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