Until the 1980s, treatment for alcohol use was separate from treatment for drug use, and neither had ever been integrated with psychiatric care. Research at McLean Hospital was highly influential in bringing them together as a single therapeutic paradigm.
“At that time, offering addiction treatment within a psychiatric program was quite innovative,” said Roger D. Weiss, MD, the Tayebati Family Endowed Chair in Psychiatry, and chief of McLean’s Division of Alcohol, Drugs, and Addiction (DADA)—the first division to be established at McLean.
“Because many people are addicted to more than one substance and often have co-occurring psychiatric disorders, an integrated model makes sense.”
“It’s all one brain,” said DADA Clinical Director Hilary S. Connery, MD, PhD. “We offer drug and alcohol treatment within a psychiatric context, so patients can get all the care they need in one place.”
In fact, the division offers a consultation program to assist McLean clinicians in other areas whose patients have substance use issues on top of their primary psychiatric diagnosis.
High Stakes
This recognition is critical because the stakes are as high as ever for those caught in the web of addiction. For example, the longstanding alcohol-use gap between males and females is closing—for the first time, adolescent girls are drinking more than adolescent boys.
Also, the interrelationship between psychiatric illnesses and addiction is clear. For example, one in four suicides involves alcohol, and having bipolar disorder increases one’s risk for developing a substance use disorder by eight- to ten-fold.
Hilary S. Connery, MD, PhD, and Roger D. Weiss, MD
As for the kinds of drugs McLean clinicians see their patients using these days, substances like alcohol, cocaine, and heroin are being joined by prescription drugs, opioids, fentanyl, methamphetamine, and—now that it is more potent and accessible than ever before—cannabis.
“The good news is that all these are treatable,” said Connery, “and with our continuum of care, patients can move to different levels as they improve.”
Proof of Concept
At the most basic level, DADA provides routine outpatient services for evaluation, medication management, and specialized group therapies.
The middle level of care includes three residential programs: Fernside Addiction Recovery Program; the Addiction Treatment Center at Naukeag; and the men’s residential program in Belmont, Massachusetts, which is part of McLean’s Law Enforcement, Active Duty, Emergency Responder (LEADER) program. The highest level of care involves inpatient programs for medical stabilization and detox/withdrawal management.
Rocco A. Iannucci, MD, director of the Fernside program, explains some of the main reasons why people struggling with addiction choose McLean for treatment.
“Often people have tried other approaches that didn’t work, possibly because the treatment focused solely on substance use without taking psychiatric issues into account,” he said.
“Many people understand that things like anxiety, depression, and past trauma can contribute to addictive behaviors, and they want a deeper dive in their therapy. In addition, their families want a more nuanced understanding of what’s going on with their loved ones.”
This scientific but compassionate approach yields positive results, largely because DADA treatments are evidence-based. “We have done clinical research since 1980 and participate in many large, multisite trials, as well as lead studies on opioid use disorder,” said Weiss.
The breadth of research at DADA includes Dr. Dawn E. Sugarman’s studies of digital interventions and the role that menstrual pain plays in substance use, as well as investigations into the impact of marijuana on the brain by Dr. Staci Gruber, an international expert on cannabis.
“Substance use is one of the biggest mental health problems in the country today,” said McLean Trustee Josef H. von Rickenbach, a devoted supporter of research in this area.
“Backed by its wonderful leadership, the Division of Alcohol, Drugs, and Addiction has a track record of groundbreaking discoveries. Here is where innovation happens and then forms the basis for new and better treatments. I am proud to support the Division and all who work there.”
Going Green
Of course, philanthropic support is essential to maintaining—and growing—the broad roster of care programs and research projects undertaken at DADA.
“Donor investments have been hugely important for our division. They have provided seed money for our junior investigators, enabling them to jumpstart their careers with pilot studies that can lead to federal grants,” said Weiss.
“Philanthropy was key in helping us establish Fernside. And in the past year, I was honored to be the inaugural incumbent of the Tayebati Family Endowed Chair in Psychiatry, which supports my current work and will bolster the division long into the future.”
Addiction is an ongoing societal crisis, and the stresses of life can make nearly anyone susceptible to substance use. Combining proven treatments with forward-thinking research, McLean’s Division of Alcohol, Drugs, and Addiction helps people turn over a new leaf and live healthier lives.
