Recovering Hope

Adelphi Nursing Professor Fights the Opioid Crisis

Every day, more than 100 Americans die from opioid overdoses, a number that has surged due to the use of synthetic opioids like fentanyl.

“The opioid crisis has become real to many people, who are now seeing it firsthand in their communities and realizing how devastating it is,” said Marissa Abram, Ph.D., clinical assistant professor in the College of Nursing and Public Health at Adelphi. “Nurses are essential to identifying addiction and getting people into recovery.”

In a recently published article in Issues in Mental Health Nursing (January 2018), Dr. Abram explored the role of registered nurses working in the field of substance use disorder treatment, a topic with little existing research literature. She found that most nurses value their role in caring for patients with substance use disorders, but they struggle with the reality that addiction cannot be “cured.” Evidence-based studies show that patients relapse often. It’s an ongoing and chronic condition akin to diabetes, Dr. Abram argues.

“Nurses are the people in the healthcare chain that build trust with patients and spend time with most of them, so they’re a crucial link in helping people get into recovery programs and need to be empowered with more information,” Dr. Abram said. “We’re dealing with a public health crisis, and the culture of nursing—and nursing education—should reflect that.”

Dr. Abram’s interest in treating substance addiction began after college, when she became a certified alcohol and substance abuse counselor and interned at ACCESS, an alcohol and drug abuse clinic in Islip, New York. “It was such a dynamic team—the nurses and other clinical staff—and I loved the work. It truly inspired me,” she said.

After getting her B.S. in Nursing from Adelphi in 2008, Dr. Abram spent several years as a medical-surgical nurse in the intensive care unit at Stony Brook University Medical Center, simultaneously earning her M.S. in Nursing. In 2011, she took a job as a psychiatric nurse practitioner at the drug treatment program at Phoenix House in Hauppauge, New York, where she specialized in behavioral health and co-occurring disorders. Two years later, Dr. Abram returned to Adelphi to begin studies for a Ph.D. in Nursing.

More than 10 years of nursing experience have given Dr. Abram a comprehensive understanding of the science behind addiction. “Substance use disorder is a disease of the brain,” she said. “The limbic system is the part of the brain that generates feelings of pleasure. The system is activated by activities like eating and sex—things we need to do to survive as a species—and it’s also activated by substances. Opioids directly affect the limbic system because the brain registers them as ‘this is good,’ and then it wants more.”

The social stigma attached to substance use disorders presents another hurdle. While some believe that treating substance addiction as a disease encourages addicts to take less responsibility for themselves, Dr. Abram disagrees. “Just as with other diseases, persons with substance use disorders have a genetic predisposition, and then there are environmental factors,” she said. “They can be viewed unsympathetically because their persistent cravings lead to maladaptive types of behaviors, such as disruptions in work and family life, as well as acts with legal ramifications.”

Dr. Abram’s course curricula reflect her nursing philosophy and research. Because drug abuse often goes unrecognized despite its frequent presentation, she is teaching nursing students to consider drug-related diagnoses that may not be initially obvious. “If a young patient comes to the emergency room with significant chest pain, there are three obvious places to go as nurses: cardiac, respiratory or gastrointestinal distress,” Dr. Abram explained. “But what is the underlying cause? There’s a possibility that this person used cocaine and is having a coronary spasm.” By broadening their awareness, nurses can prevent patients with a substance use disorder from slipping through the cracks.

Dr. Abram also advocates a stronger support system among mental health professionals. She collaborates with Adelphi’s School of Social Work and the Gordon F. Derner School of Psychology in their joint C-SPAN (Collaboration–Social Work, Psychology and Nursing) initiative, a training program for professionals that teaches an evidence-based and comprehensive approach for early identification and intervention for people with patterns of drug abuse. C-SPAN is supported by a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) obtained by her colleagues Victor Labruna, Ph.D., and Mandy Habib, Psy.D.

In a recent session, students learned and practiced a “motivational interview,” a technique in which healthcare providers raise the topic of drug abuse with a patient and then offer to work together to negotiate a plan of action. The technique is part of a therapeutic strategy that attempts to move patients from a place of ambivalence and help them find their motivation for change. “Patients can recover,” Dr. Abram said. “Nurses are on the frontline of this fight, and we need to teach them the best techniques for treatment and prevention.”

Marissa Abram ’08, Ph.D. ’17, was a 2015 Adelphi 10 Under 10 alum and a 2017 Modern Healthcare Excellence in Nursing Awards Rising Star. She works closely with Adelphi’s C-SPAN (Collaboration–Social Work, Psychology and Nursing) initiative, a federally subsidized program that trains healthcare professionals to identify emerging patterns of drug abuse in patients and to intervene successfully.