Mariel Gingrich, MPHJune 3, 2019
After serving as a Navy corpsman during the Vietnam era, Dan Sumrok, MD, DFASAM, ABAM, ABPM, published an article in the West Virginia Medical Journal on what he perceived as a connection between combat experience and physical and behavioral health problems: “Suicide; child and spouse abuse; jail terms; and, psychiatric and physical maladies are the public health legacy of the Vietnam War.” Years later, a team of researchers at Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) would publish the landmark Adverse Childhood Experiences (ACE) Study, which demonstrated a relationship between experiencing trauma and poor health later in life. Though Dr. Sumrok admits his original definition of trauma was limited — taking into account only trauma experienced during combat — his interest in trauma-informed principles was apparent from early in his career.
Integrating a Trauma-Informed Approach for Patients with Substance Use Disorder
Dr. Sumrok’s approach is deceptively simple: It acknowledges that a lack of empathy and understanding between patient and provider poses a serious barrier to care.
Today, Dr. Sumrok has a practice of approximately 200 patients in rural Tennessee struggling with substance use disorder. He provides medication-assisted treatment (MAT), motivational enhancement therapy, cognitive behavioral therapy, 12-step facilitation, and leads individual and group therapy sessions. Many of his patients have achieved incredible results: nearly all are employed, and only two are currently involved with the criminal justice system — one of whom is seeking to regain child custody. Some of his patients drive for hours to take part in group therapy. Though he acknowledges the chronic shortage of behavioral health care providers in rural areas as a factor, he believes that his patients travel great distances because he offers something different — a trauma-informed approach to care.
Upon beginning treatment with Dr. Sumrok, patients fill out a questionnaire similar to the one used by Vincent Felitti and Robert Anda during the original ACE Study. They indicate whether, in childhood or as adults, they experienced things such as violence, abuse, or neglect. Once they complete the questionnaire, Dr. Sumrok reviews their answers with them, one by one. He then explains that traumatic experiences put people at greater risk for developing maladaptive coping mechanisms, of which substance use disorder is one. Rather than positioning their illness as a failure of character, he congratulates them for their strength in seeking treatment. Over time, he builds a relationship with each patient, helps them address what has happened in their past, and teaches them new, healthier coping mechanisms.
Dr. Sumrok’s approach is deceptively simple. Yet, it represents a paradigm shift toward a model of health care that values relationships over efficiency, and quality over quantity. It acknowledges that a lack of empathy and understanding between patient and provider poses a serious barrier to care. This is particularly true, he mentions, when a patient seeks treatment for a condition as stigmatized as substance use disorder. “Unfortunately, Americans have difficulty accessing their physician, and many are ill-informed about issues regarding addiction. Ideally, treatment [for substance use disorder] would be no different than the delivery of medical care for any other condition. You’d just receive the care.” Instead, he notes, patients with substance use disorder often face many bureaucratic and logistical barriers to care, including having to travel long distances to treatment and limited access to MAT. Most of these barriers, he contends, are based on little evidence, and reflect outdated cultural beliefs about addiction.
Training Tomorrow’s Addiction Medicine Providers in Trauma-Informed Care
We want to hit them from the beginning with this message — so that when they’re old like me, they won’t have to relearn their framework. It’s something that will just become second nature.
In addition to treating patients, Dr. Sumrok dedicates his time to train medical students at the University of Tennessee’s Health Science Center’s (UTHSC) College of Medicine to ensure a new generation of addiction medicine providers understand the value of a trauma-informed approach to care. Every student learns the CDC’s prescribing guidelines for opioids for chronic pain, as well as the rudiments of addiction medicine. UTHSC also offers one of the nation’s small — but growing — number of fellowships dedicated to addiction medicine.
“We want to hit them from the beginning with this message — so that when they’re old like me, they won’t have to relearn their framework. It’s something that will just become second nature,” he says. “And they’re going to think of things that I never thought of, they’re going to have tools available I never did, and they’re going to discover a path forward in ways that I can’t imagine today, and likely have each other to lean on for support.”