David Murray isn’t sure if alcohol use caused his high blood pressure or if it was just a symptom of getting older. Either way, he does believe that alcoholism exacerbated the common medical condition.
“I think that drinking alcohol just escalated what would be minor symptoms for a healthy individual to the point where it almost disabled me,” said the 57-year-old patient at Wells House@Gale Recovery, a substance abuse treatment center in Frederick.
His appetite wasn’t good, either, and there were times when he would pass out on the job as a maintenance director at a nursing home in Florida, leaving the facility by ambulance.
“It was a combination of high blood pressure and low blood sugar combined with alcohol,” Murray said. “It got to the point where I knew I needed help.”
Somatic — or physical — health issues are common among clients at Wells House, who often experience medical problems along with or because of frequent substance use, said Christina Trenton, chief operating officer of the organization.
She estimated that about 75 percent of clients came in with physical complaints in addition to substance use disorders.
Diabetes, asthma, heart disease and high blood pressure are frequently seen among clients who enter the program. Infections such as HIV and hepatitis are also experienced frequently by intravenous drug users, said Dr. Kenneth Stoller, a psychiatrist and the director of the Johns Hopkins Broadway Center for Addiction.
Smoking is common among clients in his program and at the Wells House, which can result in chronic conditions such as emphysema and bronchitis.
“Oftentimes, by the time a patient reaches our level of care, they’re really not so good at taking care of their somatic needs,” Trenton said. “Or they’ve ignored them for a very long time.”
The agency’s growing awareness of those medical needs is what prompted Trenton and Brigitte Farrell, the director of grants administration, to apply for funding from the Community Health Resources Commission, an independent organization within the Maryland Department of Health.
The Wells House was recently awarded a $103,615 grant to establish medical services at the agency’s two locations in Frederick and Hagerstown.
Staff are planning how to best implement the funding and refer patients to treatment, Trenton said. The agency plans to hire a nurse practitioner, and — most likely — a medical assistant to handle physical health concerns and assess patients as they enter treatment.
Trenton envisions an integrated system in which all clients — even those without serious symptoms — could receive physical exams along with counseling and substance abuse treatment.
“My goal, honestly, is that every patient will get their medical history taken and get a physical done so we can give them recommendations for their health,” she said. “To go into this limiting ourselves, or just trying to triage our patients, is probably the worst way to go about this.”
Maryland is one of 21 states that established a Health Home Model, an optional benefit of the Affordable Care Act that allows providers to coordinate care for patients on Medicaid with chronic conditions.
While the model is open to certain clinics, the Wells House couldn’t receive funding under the program, Trenton said. Substance abuse treatment centers are not considered eligible providers, though community and mental health centers are included.
The new grant gives the agency a chance to introduce a more integrated care model and meet the needs of its patients, Farrell said. Wells House was one of only 15 organizations to receive funding, out of 46 total applicants.
Stoller said that physical health is often left unaddressed at substance abuse treatment centers, where clients also struggle with addiction and — frequently — underlying mental health conditions. But he and Trenton acknowledged that somatic health struggles can be a barrier to recovery among many patients, who also go through the physical pain of withdrawal at the beginning of treatment.
“Early in recovery, if patients go through pain or discomfort, they often turn to old coping strategies that involve using drugs,” Stoller said.
“For folks with substance use disorders, their ability to cope is often very low in those early days of recovery,” Trenton echoed. “They might not be equipped to tackle and take initiative when it comes to health problems, and those conditions certainly make recovery more challenging.”
Studies have also shown that co-locating health services makes it more likely that a client will follow through with treatment, Stoller said. Having a physician on staff makes it easier for that provider to establish relationships with substance abuse patients, who often enter treatment without much trust in the medical community.
Patients with addiction often have limited resources or few reliable forms of transportation, Stoller added, which can also make it difficult for them to book or travel to doctor’s appointments.
Murray has witnessed that difficulty firsthand during his time at the Wells House. One friend in the program recently struggled with a cold but wanted to avoid medication that might cause a false positive on a urinalysis test. As a result, he said, his friend had to figure out a way to pay for and travel to an appointment at an office across town.
Murray himself has been dealing with a persistent cough, but isn’t sure how best to treat it on his own. Taking cough drops caused him to fail a recent urinalysis, a stressful experience that scared him away from over-the-counter treatments.
“I think having a nurse here would be a good thing,” Murray said. “Then I could have just checked in with them and asked if there was anything they recommended.”
Somatic health services are just one of many new treatment options the Wells House has been implementing in recent months — a direct reaction to the changing face of addiction. The organization has also introduced alternative treatments such as music therapy and trauma-informed yoga, Farrell said. The services are a recognition of the often-complex and co-occurring conditions faced by many patients at the agency.
“It used to be, say 25 years ago, that very few people were using multiple substances or had multiple substance dependence,” Trenton said. “That’s changed a lot, and certainly the opioid crisis has really changed the face of the patients we are treating. They do come in with multiple issues that have been ignored for a very long time.”