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Workshop: No Wrong Door: Engaging The Difficult To Engage Patient

According to National Survey on Drug Use and Health, 16.5% of U.S. adults had a substance use disorder (SUD) in 2021. Despite this high prevalence, up to 93.7% of adults with SUD do not receive treatment. In the past year, 96.8% of adults with a SUD who did not receive treatment at a specialty facility did not think they needed treatment. If only 3.2% of people with SUD feel they need treatment, how do we engage the other 96.8% of people who may not acknowledge a need for and/or be ready to seek care? This workshop is will begin by reviewing current epidemiological trends on pursuit and receipt of treatment by individuals with SUD. Next, we will review social determinants of health (SDoH), including race and ethnicity, as they relate to SUDs. We will consider the importance of recognizing and addressing SDoH in patients with SUD as a strategy to engage and retain patients in care. We will then illustrate the concept of ‘no wrong door’ and ‘meeting patients where they are at’ through motivational interviewing (MI). We will showcase MI skills for engaging patients who may otherwise be deemed ‘difficult’ to engage. We will conclude with a robust interactive discussion of cases by participants and presenters. This workshop is a collaboration between the AADPRT Addictions Committee and AAAP Education Committee in an ongoing effort to strengthen partnerships between the organizations.

Learning Objectives
  • Review current epidemiological trends regarding substance use disorders prevalence and treatment rates.
  • Examine social determinants of health, including race and ethnicity, and identify their relevance to SUD treatment access and retention
  • Outline motivational interviewing skills that can be incorportated into clinical practice in order to engage even more difficult to engage patients
Keywords / Topics
  • Epidemiology of Addiction Treatment Receipt
  • Social Determinants of Health
  • Motivational Interviewing
Alexis Ritvo, MD, MPH, Chairperson


Alexis Ritvo, MD MPH is Assistant Professor of Psychiatry and the Addiction Psychiatry Fellowship Program Director at the University of Colorado (CU) School of Medicine. She directs a co-occurring disorders subspeciality clinic in the CU Medicine Outpatient Psychiatry clinic. 

Alëna Balasanova, MD, Co-Chair


Dr. Alëna A. Balasanova is an associate professor at the University of Nebraska Medical Center (UNMC) in the Department of Psychiatry and also holds an appointment in the College of Allied Health Professions. She is dually board certified in psychiatry and addiction medicine. After obtaining her undergraduate degree from The Johns Hopkins University, Dr. Balasanova went on to earn her M.D. at Harvard Medical School and completed residency training at Boston University Medical Center. As the Director of Addiction Psychiatry Education for the Department of Psychiatry in the College of Medicine, Dr. Balasanova has developed novel educational programs for medical students, residents, fellows, and allied health professionals. Dr. Balasanova was the founding director of the Outpatient Addiction Psychiatry Clinic and also developed and now co-directs the inpatient Addiction Psychiatry Consultation Liaison Service, both at the Nebraska Medical Center. Dr. Balasanova’s professional interests lie at the intersection of medical education and stigma reduction. She has presented and published nationally and internationally on addiction psychiatry education and destigmatizing substance use disorders; in recognition of this work, Dr. Balasanova was awarded the prestigious American Medical Association Foundation Award for Health Education in 2020, the American Psychiatric Association Irma Bland Award for Residency Education in 2022 and Nancy Roeske Award for Medical Student Education in 2023. Dr. Balasanova was also named the Nebraska Medical Association Young Physician of the Year in 2021. Dr. Balasanova is also the recipient of the American Psychiatric Association Irma Bland and Nancy Roeske Teaching Awards for residency and medical student education.

Michael Dawes, MD, Presenter


Michael Dawes, MD is Clinical Professor of Psychiatry, and Program Director for the BU/VA Addiction Psychiatry Fellowship. Dr. Dawes earned undergraduate and medical degrees from the University of North Carolina at Chapel Hill. He is board certified in Adult Psychiatry, Addiction Psychiatry, and Addiction Medicine, and has training and experience in Child and Adolescent Psychiatry. He has been the recipient of a Mentored Clinical Scientist Development Award from the National Institute on Drug Abuse examining developmental trajectories for children at high risk for developing substance use disorders. He has been PI and Co-Investigator on numerous clinical studies and prospective studies funded by the National Institutes of Health, Veterans Health Care Administration, and other funding sources. His NIH research examined relationships among impulsivity, substance use disorders, and suicidal behavior in adolescents and adults. He has research interest and experience in conducting clinical trials in substance-abusing adolescents and adults. Dr. Dawes has interest and experience in designing and implementing health-equity focused continuous quality improvement and systems redesign projects. He has strong interest in training fellows and residents to do clinical research, including research and implementation science addressing access to treatment for individuals and populations with substance use disorders and co-occurring mental health disorders while addressing social determinants of health. 

John Renner, MD, Presenter


Dr. Renner is Professor of Psychiatry, Boston University School of Medicine, and Associate Chief of Psychiatry for the VA Boston Healthcare System. He Graduated from Yale University and Case University School of Medicine and Completed His Psychiatric Residency at the Tufts- New England Medical Center. in 1969, Dr. Renner Served as a Psychiatrist with the Us Navy in Vietnam, and since 1979 He Has Been Working at the Boston VA in Their Outpatient Addiction Treatment Program. in Addition to His Clinical Activities at the VA, He is Associate Director of the Boston University Medical Center General Psychiatry Residency Program and Director of Their Addiction Psychiatry Residency. Dr. Renner Has Written and Lectured Extensively on the Treatment of Alcoholism and Drug Addiction. He is a Member and Former Chair of the American Psychiatric Association Council on Addiction Psychiatry, Former Chair of the APA Council on Adult Psychiatry and Former Chair of the APA Expert Advisory Panel on Addiction Psychiatry. in 2018, Dr. Renner Co-Edited the 2nd Edition of the APA Handbook of Office-Based Buprenorphine Treatment for Opioid Use Disorder. He is Past-President of the Board of Directors of the American Academy of Addiction Psychiatry, and a Member of the Data Safety Monitoring Board for the Clinical Trials Network of the National Institute on Drug Abuse, a Member of the Clinical Advisory Committee of the Physician Health Service of the Massachusetts Medical Society, a Consultant to the Department of Psychiatry, Massachusetts General Hospital, and a Member of the Faculty of the Harvard Medical School Division on Addictions. 
Availability: On-Demand
Cost: FREE
Credit Offered:
1.25 CME Credits
1.25 Other Professionals Credits
American Academy of Addiction Psychiatry
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