A new federal grant will allow researchers at the Yale School of Medicine to conduct substance abuse treatment research by bringing patients into primary care facilities, rather than isolating them in specialized clinics.

Associate professor of medicine David Fiellin received over $3 million in grant money earlier this month to further his research from the National Institutes of Health and The Robert Wood Johnson Foundation. Fiellin said one of the main obstacles in combating the overall substance abuse problem is that treatments, such as rehabilitation programs, are currently not available to all who need them. The National Institute of Drug Abuse also awarded him $2.9 million over five years to support his study of how to improve the administration of Buprenorphone, an opiate derivative commonly used to treat addiction.

One of Fiellin’s goals is to investigate unanswered questions about the type of counseling and therapy that substance abusers need to expedite their recovery from heroin and prescription drug addictions. Only about 20 percent of people with substance abuse problems receive the care they need, he said.

“The problem of narcotics dependence and heroin dependence has been growing over the past 10 years,” he said. “3.5 million people are addicted to prescription drugs and one million to heroin.”

Another major focus of Fiellin’s research will explore the effectiveness of bringing substance abuse treatment out of traditional locations such as methadone clinics and into physicians’ offices.

The Drug Addiction Treatment Act of 2000 allows doctors to prescribe addiction-fighting drugs like Buprenorphone from their offices, which has provided easier access for patients, he said. Prior to the enactment of this law, only specialized drug treatment facilities could prescribe such medications.

Preliminary results from Fiellin’s clinical trials indicate it is possible to successfully treat both patients who are in the process of recovery and those who are still using drugs in primary care units.

His research has involved clinical trials in which all patients are prescribed medication. Half the subjects received counseling only from their doctor, while the other half received treatment from both their doctor and drug counselor. Fiellin’s early studies also show that for patients on medication, 15-minute counseling sessions from trained nurses are as effective as those from drug counselors.

Assistant professor of medicine Lynn Sullivan’s research also targets the incorporation of drug treatment into primary care and clinical settings from specialized clinics. She said this move would motivate more people who suffer from substance abuse problems to seek treatment than if they had to go to another facility.

“For the general population, who seeks out treatment in doctor’s offices, integrating drug treatment will expand treatment options,” she said. “People who have problems with heroin and prescription drugs might not want to seek out help in traditional sites.”

Sullivan also said that while the privacy, comfort and anonymity of clinical settings will compel patients to seek treatment, being at a primary care facility also helps them understand that substance abuse is a valid medical problem. The same could be true for adolescents in similar situations, she said.

Stephanie Park ’08, a member of Yale’s Community Health Educators who specializes in substance abuse education, said many barriers that prevent effective treatment stem from the stigma surrounding substance abuse problems.

“There are a lot of misconceptions about substance abuse,” she said, “People don’t realize that it’s a disease and it can’t be helped, so any kind of treatment or therapy that [people with substance abuse problems] can get will be good for them.”

Fiellin said the grant money he received will go toward treatment for a greater number of patients, additional counseling sessions, and the expansion of research to provide greater information for those on either side of the substance abuse issue.

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