Brian Quinn, MD, is a board certified adult psychiatrist and specialist in addiction treatment at St. Vincent Stress Center in Indianapolis. The Stress Center sees a high volume of patients (about 4,000 visits a month) by offering both inpatient and outpatient programs for adults, adolescents and senior patients. Among many responsibilities,

Dr. Quinn oversees a special 10-bed unit, which was established about three years ago for patients with a dual diagnosis of substance addiction and mental health issues.

St. Vincent Stress Center is across the street from St. Vincent Hospital in Indianapolis. Though many patients are referred through St. Vincent Hospital’s emergency room, many others are referred from other St. Vincent affiliates throughout the state, as well as other nonaffiliated hospitals in Indiana.

“We maintain a true dual-diagnosis approach which I believe is unique to St. Vincent Hospital and Stress Center in Indianapolis,” Dr. Quinn explains. “About 80 percent of patients who come here are treated, not only for substance use or substance addiction, but also for a co-occurring mental health condition. Things like PTSD, depression, anxiety disorders or more serious psychotic or severe mental health disorders, like schizophrenia or bipolar illness.

“Being able to address dual disorders is a very important aspect of any substance abuse treatment center. At St. Vincent Stress Center, we can refer patients directly to our inpatient units, if that’s what’s medically necessary, or our outpatient programs, either partial hospitalization programs, which are five days a week, or intensive outpatient programs, which are three days out of the week.

“Those admitted to the Stress Center receive the highest level of medical care for their addiction treatment. They’re inpatient, they’re on a locked unit, they have 24/7 nursing, monitoring, they’re seen by a physician daily. That is the highest level of medical treatment that one can receive. So, these patients must have something else that’s going on; for example, they might be suicidal, so they are admitted to the Stress Center for that, in addition to detox from opiates.”

Dr. Quinn’s staff can often stabilize the mental health condition relatively rapidly with inpatient treatment, which includes therapy and a supportive structure. But opiate use is more challenging as far as successful outcomes largely because the length of inpatient treatment is relatively short-term, with the average length of stay somewhere between four and six days. There are medication options, such as naltrexone, an opiate blocker, which minimize the chance somebody would relapse after discharge. Problems can arise, however, when that patient needs to be treated for at least seven days after their last opiate use. The reality is for many such patients, insurance is not going to cover that length of stay.

So, for patients with opioid addiction and underlying mental health issues, the spiral is sadly predictable: Once a person’s tolerance for opioids is too high, or they become addicted, they begin to seek alternatives to prescription opioids, often low-cost heroin. Relapse rates are extremely high for patients with these addictions. Dr. Quinn sees patients who admit themselves for detox and cannot get past the physical part of the process and discharge themselves because “many are not able to endure that amount of suffering.”

A startling fact: Most patients will enter an opioid addiction rehabilitation program an average of seven times.

“It is extremely hard for them to maintain sobriety on their own,” said Dr. Quinn.

“I think the bridges between specialties like mental health, primary care and pain management have to be integrated. The work that Dr. Amy LaHood does in educating so many physicians is helpful in creating better awareness among healthcare providers. And she has identified a real need for more services with pregnant women with opioid addiction,” Dr. Quinn continued. “Ultimately, I think the goal for every health ministry, every system, is to better integrate these specialists into primary care settings to improve outcomes for patients.

“We want and need to expand our services here in Indianapolis, so we are also working on providing outpatient clinics tailored specifically to people with opioid-use disorders to provide them appropriate medication-assisted therapy after being discharged.”

Dr. Quinn says they measure success with patient satisfaction data, but more specifically and personally, through those patients who complete initial treatment plans and prepare for next steps through support and therapy in their communities.<