Case Study: Psychiatric Treatment for People with Substance Use Disorders & their Caregivers
Founded in 1931, Silver Hill Hospital has a long history of helping people cope with psychiatric illness and addiction. As the opioid crisis has accelerated, the nonprofit psychiatric hospital in New Canaan, CT, has seen demand for its services increase. Connecticut has been hit hard by the opioid epidemic, with 917 accidental intoxication deaths in 2016—up from 357 in 2012, according to the state medical examiner.1 Fentanyl, a potent synthetic opioid, was detected in 483 of these deaths. Connecticut’s hospitals are experiencing some of the highest rates of opioid-related hospital inpatient stays in the country for both men and women, according to a 2017 report by the Agency for Healthcare Research and Quality.2
The first step for patients who come to Silver Hill is to meet with one of the team’s 14 psychiatrists for evaluation. Four members of the team are board certified in addiction medicine and/or addiction psychiatry. Often, patients who seek treatment for addiction need care for a co-occurring psychiatric disorder, such as anxiety, depression or bipolar disorder. Silver Hill is experienced with working with patients with complex, co-occurring mental illnesses, including schizophrenia and schizoaffective disorder, as well as eating disorders. In cases where people with opioid addiction have a co-occurring disorder, Silver Hill’s psychiatric team will devise a treatment plan that addresses both disorders.
For some patients, the hospital recommends inpatient care, whether for psychiatric treatment or medically supervised withdrawal from the drugs they are dependent on. Those who need less supervision may nonetheless need residential services, a step down from inpatient care. Residential services are offered in a homelike setting and patients have access to hospital services. Among those residential services is a program for people with dual diagnoses, such as a substance use disorder and a psychiatric condition. There is also an extensive outpatient program in which some patients come to the hospital three days a week for three hours or more per day. Family members have access to support groups and counseling; with permission, family can provide updates on how patients are doing once treatment has ended.
Programs like Silver Hill are very sought-after, with medical professionals most willing to refer patients. In a recent Economist Intelligence Unit survey sponsored by Cigna, both practitioners and members of the general public frequently saw psychiatric care and counseling for people suffering from opioid addiction and their families as an important element of programs to address opioid addiction (read more about the research here).
For patients struggling with opioid addiction, Silver Hill will, when needed, recommend medication-assisted treatment (MAT). “For most patients, it is a discussion,” says Eric D. Collins, MD, physician in chief at Silver Hill and associate clinical professor of psychiatry at Columbia University College of Physicians and Surgeons. However, MAT is typically administered at Silver Hill in conjunction with a range of psychosocial services: cognitive behavioral therapy, which helps patients identify problematic thought patterns and how their thoughts affect their feelings and behaviors, and elements drawn from dialectical behavioral therapy, which helps patients regulate their emotions and tolerate distress.
“Those skills are often necessary for people who use substances to calm their emotions and to relieve their distress,” says Dr. Collins. “If they have other tools or ways to manage distress, they are better able to abstain during the rest of their lives, which is the goal.”
Patients from a wide range of demographic groups come to Silver Hill. Dr. Collins says there is no “typical patient.” Silver Hill has a history of working with a Department of Veteran Affairs (VA) hospital on Long Island for patients with complicated cases that were beyond the staff’s expertise, says Dr. Collins. Typically, private insurance covers Silver Hill’s inpatient program; the residential program is usually self-pay. To cover the cost of treatment for patients who cannot afford it, the hospital fund-raises more than $1 million every year.
Silver Hill is currently revamping its procedures for collecting outcomes data so the data can be published as part of formal academic research and will be working with the Yale University Institutional Review Board to publish them. “We think every program should meaningfully and reliably track outcomes,” he says.
Current data the hospital has gathered show that about 70% of people coming out of its residential programs stayed in touch for a year. Among that group, says, Dr. Collins, “about 70-80% were believably reporting sobriety.”
Although that percentage may seem low, he notes, “Addiction is a chronic, typically remitting and relapsing illness that does respond to treatment.” Silver Hill aims to be there to prevent those relapses through psychiatric care, so patients can resume their everyday lives.