Counteracting the Effect of Stigma on Education for Substance Use Disorders

Assessing pain in persons with opioid use disorder: Approaches, techniques and special considerations

Pain and opioid use disorder (OUD) are inextricably linked, as the former can be a risk factor for the development of the latter, and over a third of persons with OUD suffer concomitant chronic pain. Assessing pain among people with OUD is challenging, because ongoing opioid use brings changes in pain responses and most pain assessment tools have not been validated for this population. In this narrative review, we discuss the fundamentals of pain assessment for populations with OUD. First, we describe the biological, psychological and social aspects of the pain experience among people with OUD, as well as how opioid-related phenomena may contribute to the pain experience in this population. We then review methods to assess pain, including (1) traditional self-reported methods, such visual analogue scales and structured questionnaires; (2) behavioural observations and physiological indicators; (3) and laboratory-based approaches, such as quantitative sensory testing. These methods are considered from a perspective that encompasses both pain and OUD. Finally, we discuss strategies for improving pain assessment in persons with OUD and implications for future research, including educational strategies for multidisciplinary teams. We highlight the substantial gaps that persist in this literature, particularly regarding the applicability of current pain assessment methods to persons with OUD, as well as the generalizability of the existing results from adjacent populations on chronic opioid therapy but without OUD. As research linking pain and OUD evolves, considering the needs of diverse populations with complex psychosocial backgrounds, clinicians will be better equipped to reduce these gaps.

Substance Abuse Stigma: Concept Analysis

ABSTRACT

Substance abuse stigma is a social phenomenon that negatively impacts individuals who use illicit substances or alcohol. This stigma includes the derogatory terms used to describe people who use substances; perceptions that individuals with alcohol and substance use disorder are dangerous, immoral, and of weak character; and the public blaming of the addicted people for their addiction. Substance abuse took the life of over 100,000 Americans between 2020 and 2021, and one identified barrier to treatment is the stigma associated with substance abuse. When someone is ashamed, they are less likely to seek treatment, and when someone is seeking help and is greeted with negative preconceptions, they are again deterred from treatment. The stigma exists in multiple layers of society including the general public, policy makers, the police, doctors, and nurses and within the person using the substance. The purpose of this article is to define substance abuse stigma in multiple contexts and explore its effects on treatment.

A call for increased addiction psychiatrist engagement in medical student education

BACKGROUND AND OBJECTIVES

Addiction psychiatrists are ideally trained to provide trainees with supervised clinical experiences in caring for patients with co-occurring substance use disorders and other complex psychiatric disorders.

METHODS

This is a call for addiction psychiatrists to step up as clinical champions in medical student education. Our targeted audience is practicing addiction psychiatrists who do not currently have medical students on their clinical services.

RESULTS

We suggest several approaches to incorporating learners into existing addiction psychiatry clinical services both at academic institutions and in the community.

DISCUSSION AND CONCLUSIONS

For medical schools without addiction psychiatrists on faculty, we suggest unique solutions for collaborating with external educational venues.

SCIENTIFIC SIGNIFICANCE

There is limited literature on the role of addiction psychiatrists in providing supervised experiential learning experiences for medical students. There has been no previous publication specifically advocating for increased addiction psychiatrist engagement in the clinical education of medical students.

"From All Walks of Life": Attending an Alcoholics Anonymous Meeting to Reduce Addiction Stigma Among Medical Students

OBJECTIVE

Substance use disorders (SUDs) are stigmatized conditions in medicine, with negative attitudes toward patients with SUDs beginning to form in medical school. Only a few studies with small samples show that attending an Alcoholics Anonymous (AA) meeting may help decrease addiction stigma. This study examined whether attending an AA meeting impacts medical student attitudes toward patients with SUDs and any gender and age group differences within these attitudes.

METHODS

As part of their psychiatry clerkship, 138 third-year medical students attended an AA meeting and wrote reflection essays discussing expectations before the meeting, feelings while there, and thoughts on how these feelings might affect patient care. The authors performed a thematic analysis to identify themes and t tests to compare theme frequency by gender and age group.

RESULTS

A primary theme in student responses was a reduction in stigmatizing attitudes, which was broken down into three subthemes: complexity of addiction (46%), diversity of people with addiction (37%), and practical applications (66%). Practical applications comprised compassionate care (53%) and intention to address SUDs clinically (35%). While no gender differences were found in theme frequency, younger students showed significantly higher frequency of all themes.

CONCLUSIONS

Attending an AA meeting can challenge medical students' stigmatizing attitudes about addiction and increase flexibility of thinking. Younger students' biases may not be as solidified, stressing the importance of early exposure to patients in recovery during medical school. Attending an AA meeting and reflecting on the experience may be one way to decrease addiction stigma among medical students.