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Researching and testing new treatments for substance misuse disorder

A graphic of four differently sized heads represent four different instances of information processing, ranging from chaotic to highly ordered.

The potential and the proven

While a go-to substance misuse treatment has yet to be identified, there are effective ways that can help people recover.

The outlook improves each day.

And that message deserves amplification every day, because misconceptions about a lack of solutions only fuel the struggle, according to Harshal Kirane, MD. The former director of addiction services at Staten Island University Hospital, Dr. Kirane is now medical director of Wellbridge, Northwell Health’s soon-to-open addiction treatment and research center in Calverton, NY.

Medication-assisted treatment (MAT) and cognitive behavioral therapy have emerged as meaningful ways forward. A large body of research supports the use of buprenorphine and methadone to effectively treat opiate addiction. Yet these medications can be very difficult for patients to access, according to Dr. Kirane.

Northwell Health is working to increase access to MAT in inpatient and outpatient settings to accommodate the best approach for each individual.

“By taking the time to talk to patients, we can take a more targeted approach,” Dr. Kirane said. “We can calibrate these medications for a given patient and take into account other medical considerations to help develop the most feasible treatment plan.”

But Northwell practitioners do not consider medications as a panacea in and of themselves, said Brian Pritchard, LCSW, associate executive director at South Oaks Hospital. The behavioral health team also provides a more holistic model of care, in order to better support patients as they work toward recovery.

“We are integrating mind, body and spiritual components of care, beyond our MAT programs,” Mr. Pritchard said. “We are making sure to include more diversity in our programs so patients can translate the experience they have here into how they live their everyday lives. That’s the essence of our mission—to do whatever it takes to help people get back to living their lives.”

quotation mark By taking the time to talk to patients, we can take a more targeted approach.
Harshal Kirane, MD

The next wave

As Northwell Health expands MAT programs across its hospitals and treatment centers in metro New York, it is also looking toward the future—investing significantly in new tools, strategies and programs.

Wellbridge, an inpatient detoxification and rehabilitation center being developed in Calverton, will serve as a “learning laboratory” and educate Northwell physicians about personalizing treatment plans, said Bruce Goldman, LCSW, director of addiction services at Zucker Hillside Hospital.

“We will learn directly from our patients what works best — and that will help inform us how healthy people with addiction disorders can best recover and who responds best to what kind of outpatient or inpatient services,” he said.

Jonathan Morgenstern, PhD, Northwell’s director of substance abuse services, said Wellbridge will perform basic science research as well as investigations into new technologies that may expand treatment options.

“One project we are working on is building a mobile recovery coaching platform,” he said. “There are a variety of digital apps that may be able to integrate aspects of recovery and treatment for an individual patient. At Wellbridge, we can work to better understand where and when such apps may have the most effect.”

Wellbridge will also study the specific genes that contribute to risk, and how they may influence treatment, said Dr. Kirane.

“The use of genetic information to help calibrate and guide the type of interventions to offer patients is gaining attention in all fields of medicine,” he said. “But it’s really exciting to have the capacity to help us evaluate and engage folks who are in treatment for substance use disorders, [people who] can participate in more formal research studies that may help create a framework for this kind of precision medicine.”

He is seeing positive changes gain momentum. “Over the past few years, there’s been a dramatic shift in how we think about addiction, particularly in light of opioid-related issues,” Dr. Kirane said. “We still have quite a long way to go but Northwell is building partnerships locally and nationally not only to address the broader public health concerns of substance misuse, but also to develop new strategies to screen, treat and support people who are living with these kinds of disorders.”