Transformed thinking gives rise to center of excellence in addiction medicine

Daniel Sumrok, MD, admits that in his days as a military physician, he likely perpetuated the same stigma toward addicts that he and his colleagues fight hard against today.

“When I saw the yellow cirrhosis patients come through the VA, I ducked for cover too,” says Sumrok, who ultimately would educate himself about addiction's reach into all aspects of healthcare and who now directs the Center for Addiction Science at the University of Tennessee College of Medicine.

As Sumrok spoke with Addiction Professional this week about the center having received the first Center of Excellence in Addiction Medicine designation by The Addiction Medicine Foundation this month, he said something one doesn't hear too often from a physician—or even an addiction counselor or specialty program director. Sumrok considers patients with substance use disorders to be among the most pleasant individuals to treat.

“They are wonderful to take care of. They don't miss appointments,” he says. “They come in and say things like, 'My marriage is back together. I got a promotion at work. You saved my life.'”

The Addiction Medicine Foundation, a national organization that accredits physician training programs in addiction medicine, has honored the University of Tennessee center for integrating clinical addiction treatment, research, academic training and community outreach under one unified mission and operation. The foundation's executive vice president, Kevin Kunz, MD, MPH, explains that while other institutions also incorporate all of these elements into their work, the Center for Addiction Science stands alone in truly coordinating them as a center of excellence, as opposed to what he commonly sees as “silos of excellence” that don't regularly communicate.

In addition, the center's high-profile presence in a community that like many others has been beset by opioid addiction bears special recognition, Kunz stresses. “They're not hiding in a dark corner, saying, 'We do this [service], but we don't talk about it,'” he says.

Learning curve

Getting to that point certainly was a process. Sumrok recalls that when he first started talking about establishing an addiction-focused center in the medical school, he observed “a visible flinch in most of the faculty.”

Stigma remains a potent force in the medical community in general, Sumrok says, as does the tendency to keep operating according to tradition. In addition, “There is still some skepticism about the effectiveness of addiction treatment,” he says. “It is up to us in the field to show our chops.”

Part of that involves highlighting the many quality-of-life domains that show significant improvement when a person with a substance use problem receives high-quality treatment, Sumrok indicates.

He says the urgings of another former military doctor who heard him talk about the extent of addiction in his home community convinced him to pursue specialized training. Sumrok decided to attend a series of Harvard University seminars on addiction, would later receive the training needed to become a certified prescriber of buprenorphine, and became a member of the American Society of Addiction Medicine (ASAM).

He credits much of the Center for Addiction Science's growth to the vision of the executive dean of the College of Medicine, David Stern, MD. Sumrok originally had intended to focus on fellowship training at the university, but Stern made it clear that he also wanted the school to host world-class research, comprehensive treatment and a strong presence in the community.

Through a combination of contract arrangements and in-house service development, the center now provides an array of direct-care services that include medication treatment, cognitive-behavioral therapy, motivational enhancement therapy and 12-Step facilitation. Part of its training effort involves encouraging pain specialists to employ effective alternatives to opioids in their treatment.

Community impact

Kunz says establishing the kinds of operations that merit a center of excellence designation requires not only some local champions, but also financial resources. “We'd like to find funding to help develop these,” he says.

He believes that if other entities choose to become as high-profile in their community as the University of Tennessee center has, it will go a long way toward reducing stigma. “The community will begin to see treatment as a reasonable solution, and will be glad to have one of these operations in town,” Kunz says.

Kunz's organization has been instrumental in major developments such as the announcement earlier this year by the American Board of Medical Specialties that addiction medicine is now a recognized medical subspecialty. 

Sumrok has come to see addiction as no different from other chronic diseases, both in the opportunity to achieve good outcomes and in the benefits that accrue to society as a result. He also says that like other serious illnesses, psychological trauma is a major contributor to the disease's onset and progression.

“Our communities benefit so much from treatment,” Sumrok says. “The studies have shown that for every dollar invested in treatment, the return is anywhere from seven to 12 dollars.”