November 17, 2023
Addressing the need for accessible SUD treatment for Alaskans
November 9, 2023
By Jennifer Walker
Earlier this year, Christopher Dietrich, PA-C, DSc, CAQ-Psych, helped open Banyan Alaska, a substance use disorder (SUD) treatment facility in Wasilla, Alaska, that primarily serves veterans. The first patients who came to this new 24-bed rehab program were homeless and unemployed veterans. One was using opioids and methamphetamines and had a history of attention deficit/hyperactivity disorder (ADHD), depression, and trauma from both his childhood and military service, which led to post-traumatic stress disorder (PTSD) symptoms.
Dietrich, a part-time provider at the clinic, and the care team treated the patient with psychotropic medications to address the ADHD and PTSD symptoms, in addition to individual and group psychotherapy sessions. Dietrich also prescribed Suboxone and then Sublocade, monthly injections to treat opioid dependence and help with stabilization during withdrawal. The patient, who stayed at the clinic for four months, was also connected with the behavioral health department at the Veterans Affairs Administration in Anchorage, where he found resources to further help with his recovery.
Dietrich has long been involved in behavioral health. Before he became a PA, he spent eight years as the associate director for an organization that operated more than 100 group homes in the greater Arizona area for kids and adults who have mental and developmental disabilities. As a PA, he has worked with Orion Behavioral Health Network for nearly 10 years and is currently medical director. So, when he was offered the opportunity to help open Banyan Alaska, Dietrich knew the role would be a natural fit for him.
“We don’t have enough substance abuse treatment places here,” said Dietrich, who also comes from a family of veterans, including his dad, who was in the U.S. Navy, and his sister, who recently retired after 20 years of service with the U.S. Air Force. “The benefit of care can have a profound impact, so I like ensuring access and making sure that people have [that] care. This is exactly what I do along with my team of colleagues.”
Embracing the Behavioral Health Specialty
In 2009, Dietrich moved to Alaska, where his sister and her family were stationed, so they could support each other during military deployments. During that time, Dietrich completed his PA rotations across the state. He did primary care training in Nome in Northwest Alaska, where he spent time working with specialty groups who came to Norton Sound Regional Hospital to provide care. This allowed him to gain experience working in cardiology, dermatology, women’s health, and more.
Having been exposed to a variety of specialties within medicine, Dietrich did not plan to work in behavioral health as a PA. Then he did a pivotal rotation with a medical examiner’s office in Anchorage, where he saw how untreated psychiatric and behavioral health challenges can lead to tragic outcomes, such as suicide.
“At the end of the day, the most significant outcomes in behavioral health [are because] individuals were not taking medications, had no access, or weren’t actively in therapy or behavioral health. That’s the reality of it,” Dietrich said. “So, this experience brought me back to psych. I started to think, ‘This is what I’m okay at [based on] my experiences and there is tremendous unmet need. So, I should probably be doing this.’”
While in school, Dietrich interviewed with Arom Evans, M.D., who had his own practice, Orion Behavioral Health Network. Prior to graduation, Dietrich joined the team there to assist with day-to-day operations. After becoming licensed, he began actively learning from Evans, who had become one of his mentors. In the beginning, Dietrich and Evans were the only providers at Orion Behavioral Health Network, and they worked solely with adolescent patients, ages three to 22. Several years later, they expanded to also provide care to adults. Today, their clinical team includes five therapists and nine providers, including seven PAs.
Orion provides in-person and hybrid care to patients in Alaska, Florida, and Texas. This geographic span allows them to bridge care for their patients—an especially important element of their practice given that about 30% of their patient panel is in the military. “When our patients move, we get to help extend care for them for a while and sometimes continuously if they move to an area where we still have a license,” Dietrich said.
At Orion Behavioral Health, Dietrich—who sees 60 patients a week and has a patient panel of more than 300 patients—has a “knack” for working with neurodivergent disorders: The majority of his patients have ADHD, autism, and/or major depression, and some have bipolar disorder. One of the biggest challenges in working with this population is addressing the stigma that surrounds psychiatric medications and hospitalization. Patients might not want to take medications because of the fear that they will lead to negative outcomes, and they might be against hospitalization due to feelings like shame that can come with this type of treatment.
Dietrich brings his dog, Jameson, to the clinic most days as his “secret weapon” in helping encourage patients, especially adolescents, to open up during appointments. He never pushes his patients to undergo any course of treatment, but does stress that medications are not the driving force of bad outcomes—especially when patients are well-monitored—and that sometimes hospitalization is the most appropriate next step for treatment. He also tries to help his young patients and their families see that behavioral health diagnoses can be as serious and are as worthy of treatment as physical diagnoses.
“We have no problem going to the ER when we get into a car accident,” Dietrich said. “Severe depression and significant behavioral health issues can be the same level of need. But there’s this barrier that says, ‘No, I don’t go to the ER, I don’t get care when it reaches this level of severity, I don’t go to the hospital for that.’ I try to make sure patients are safe, give direction when they are in more acute stages, and to [ensure] there’s a logical thought process about what is going to help them.”
Dietrich’s method of working with his patients has changed since he began to experience symptoms of acute intermittent porphyria, a rare blood disease in which the body cannot convert compounds called porphyrins into heme. This disease can cause severe pain and metabolic issues, and it can affect every system of the body. It took Dietrich three years to get this diagnosis. After seeing about 20 providers, who could not explain his symptoms, Dietrich found a case study published in Sri Lanka that sounded similar to his. This was the beginning of him getting the treatment he needed.
“My patient care philosophy has profoundly evolved from my own journey with a rare condition,” Dietrich said. “This experience [was] marked by years of being overlooked and has taught me the critical need to listen deeply to our patients. I acknowledge that medical presentations can defy expectations and prioritize empathy and innovative problem-solving in our practice. [And I] understand that every diagnosis might not follow a textbook.”
Providing Much-Needed Treatment to Veterans in Alaska
In 2020, about 5.2 million veterans had a behavioral health condition, and more than 50% did not receive treatment in the prior year, according to the Substance Use and Mental Health Services Administration. For veterans who have a substance use disorder, the number who did not receive treatment in the previous year skyrocketed to 90%.
At Banyan Alaska—which is one of 16 Banyan Treatment Center facilities located in eight states across the country—about 90% of the clinic’s nearly 40 patients are veterans. Most of these patients have opioid use disorders, as well as a high level of fentanyl use. Many also suffer from alcohol abuse and may use co-occurring substances like marijuana, methamphetamines, nicotine, and tobacco.
“What I’ve learned is that most of our patients have not just substance use but also comorbidities like childhood trauma and trauma from a career of service, especially military members, and they’ve probably had them for a long time,” said Dietrich, who also used to work in corrections, where he was involved in addiction medicine, helping to make sure inmates were safe while going through withdrawal. “I can’t think of a patient that has just substance use as the only concern, so [we] also look at other things that maybe went untreated for a long time.”
Dietrich and the team of clinicians and therapists at Banyan Alaska, a 24-hour partial hospitalization facility, offer continuous care. This begins with medically-assisted treatment with Suboxone and Sublocade to help patients through the withdrawal and recovery process. Patients also participate in therapy and other programming. “This integrated care model ensures that every individual has access to consistent, therapeutic support guided by our professionals throughout their six- to 12-week stay in our structured environment before they transition to outpatient care,” Dietrich said.
PAs who are interested in working in similar roles in behavioral and mental health will likely find many job opportunities across the country: More than 8,000 professionals are needed to fill gaps for the 160 million Americans who live in a mental health professional shortage area, according to The Commonwealth Fund. “The reality is that these providers are needed,” said Dietrich.
“I’m privileged to offer dedicated care to our veterans at Banyan Treatment Centers and to honor their service with our teams’ commitment to their health and recovery. Working with them and seeing some of this journey to their own wellness that all of us as humans go through—that’s been the most rewarding.”
Jennifer Walker is a freelance writer in Baltimore, MD. Contact Jennifer at [email protected].
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