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FRONTIERS • PUBLIC HEALTH
Utilizing Technology in the Age of Addiction Writer: Haleigh Pine • Editor: Daniel Berkovich
I
magine you’re thrown into the middle of an emergency room, in charge of too many people, responsible for too many patients, having piles of paperwork. And you haven’t been trained for any of it. This is the reality for most social workers. The internship, residency, fellowship, attending structure we all know from Grey’s Anatomy doesn’t exist in the realm of addiction therapy. Recent graduates don’t have clinics to practice in or resources on the level of students in medicine, psychiatry and even dentistry. They get thrown into an underfunded and chaotic system, which has only been exacerbated by the pandemic. Dr. David Patterson Silver Wolf, associate professor at the Brown School and director of the Community Academic Partnership on Addiction (CAPA) is working towards dissolving this problem. As chief research officer, he has developed a clinic in which interns receive supervised patient interaction and are paid for time and billed for services, like in medical models. This initiative increased patient completion rates by 11% over six months. Patterson Silver Wolf compares this to graduating high school, where just the act of finishing the program leads to better health outcomes.
As chief research officer, he has developed a clinic in which interns receive supervised patient interaction and are paid for time and billed for services, like in medical models.
Therapists have unsustainable caseloads of 75-100 people and struggle to answer basic questions about both open and closed cases. When a patient walks into a clinic, they are often assigned the therapist that is “up next”— the one who has the lightest caseload or is free at that moment. Furthermore, there are patient biases inherent in the treatment system. When looking for therapists, patients don’t have access to information about their education, experience or other factors that are available when choosing a doctor. According to Patterson Silver Wolf, therapists aren’t necessarily rewarded for excellence and many times mediocre treatment is the norm.
Therapists have unsustainable caseloads of 75100 people and struggle to answer basic questions about both open and closed cases.
Social workers are taught that every patient has an equal chance at recovery, but there is evidence behind opposing claims. According to Patterson Silver Wolf, the field needs to consider that patient completion rates are at least partially dependent on the therapist’s demographic profile. In one study, white male therapists have statistically significant success rates in every race and gender match compared to other genders and demographics, while nonwhite male therapists had no female patients (1). This brings up concerns
In one study, white male therapists have statistically significant success rates in every race and gender match compared to other genders and demographics, while nonwhite male therapists had no female patients. about what is defined as “success” in therapy, as nobody would recommend to only employ white male therapists. This relates to the importance of more accountability in therapy with higher standards, as well as matching patients with therapists based on demographics and other valuable data instead of random assignment. A study by Dr. Lisa A. Marsch explains the benefits of technology-based therapeutic tools such as computerized assessments, behavior therapies, prevention interventions and recovery support programs (2). She suggests that tools can be used in addition to traditional treatment methods or to replace pieces of their patient interaction. This would allow clinicians to treat more clients and have more time to manage specific crises for those with the greatest needs. Another possibility is the implementation of technology as stand-alone intervention, benefiting those with limited access to care, such as residents of rural areas. “Services are based on therapists’ good intentions and bad intuitions. Therapists and the organizations they work, have no real-time and real-world
