Addictions are an expanding and vital area of research here at Duke. In 2012, Duke Psychiatry instituted a division specifically focused on addictions research and treatment. Within this division is the Family Care Program, which provides outpatient treatment to help pregnant or mothering women overcome drug addictions and be the best parents possible, while also providing services to their children. We are proud to have caring faculty members who treat mothers with addictions.
Our featured expert, Toby McCoy, PhD, is a Clinical Associate in the Department of Psychiatry and Behavioral Sciences and the Director of the Family Care Program. Dr. McCoy had this to say about himself, "I am a clinician who has been lucky enough to work with talented colleagues here at Duke and to regularly see the power of resilience, hope, and good treatment in the lives of the women we serve. We at Family Care are eager to share our knowledge and answer any questions. "
In December 2013 and January 2014, the Duke Family Care Program was featured on two local television stations: WTVD (ABC) and WRAL (CBS), as well as on MSNBC
What sparked your interest in researching and treating pregnant and parenting women with substance abuse issues?
I initially became interested in this type of work because, since we try to help mothers and their children, it combines my background in clinical and developmental psychology. What has kept me involved though was the early realization that many of the women served by the Family Care Program have had very few advantages in life, have often been traumatized by some very difficult experiences, and benefit remarkably from some simple things that most of us take for granted – like being treated with basic respect, honesty, and kindness. The work is very rewarding in that way.
How has our understanding of substance abuse, specifically in mothers, changed over time?
There have been a couple of major areas of better understanding over the last 15 or so years. One is the rapidly increasing knowledge about how the brain functions and about the neurochemical basis of addiction. This has helped all of us (professionals, patients, family members, and the world in general) develop a more accurate and useful understanding of people with substance abuse problems. In the past, they were often thought of as just lacking will power or not caring about the catastrophic consequences of their use. But now we understand that there is a biological disease process underlying the compulsive use of substances. This understanding has also led to the development of medications that can improve treatment outcomes.
Another advance has been the development of a veritable alphabet soup of interventions that have been shown to be effective through well-designed research. These “evidence based treatments” include CBT (Cognitive Behavioral Therapy – changing the way we think), DBT (Dialectical Behavior Therapy – improving emotional regulation), CRT (Community Reinforcement Treatment – enhancing the positive benefit of abstinence), and MI (Motivational Interviewing – using a person’s own goals to guide them toward change). There have also been important advances in our understanding of the role of traumatic life experiences in initiating substance use and maintaining it. This is particularly true for women. Evidence-based treatments such as Seeking Safety have been developed to address the role of trauma in addiction.
These advances mean that the chances of overcoming a substance use disorder have greatly improved over the last few years.
What is your vision for the future of substance abuse research and treatment at Duke?
One component will be the increasing role of integrated physical and behavioral healthcare in the coming years. With integrated care, patients will be able to get more of their healthcare needs met in one setting with one treatment team. Mental health and substance abuse problems add considerably to the cost of treatment of the major physical health issues. As health care moves from a fee-for-service, procedure based reimbursement model to capitated or case rate models, cost containment will be essential – addressing behavioral health in the context of primary care medical treatment will be one avenue of achieving this.
Another important area in the future will likely be smking/nicotine ceessation. There is a considerable amount of research into this at Duke. Since smoking is a major factor in healthcare costs, there will be an increasing emphasis on effective treatment programs.
How is Duke uniquely positioned to lead interdisciplinary efforts to better understand difficult psychiatric issues such as substance abuse?
Duke has national and international leaders in each of the areas mentioned above. The effort to better understand future opportunities is by continuing to bring these leaders together for focused interdisciplinary conversations. The Addictions Division established by our chair, Sarah H. Lisanby, MD, and led by Joe McClernon, Ph.D. is an excellent way to further this conversation.