Jonathan Avery

5 Questions With Dr. Jonathan Avery

Fighting the stigma surrounding substance use disorders — including among fellow physicians

Jonathan Avery

Dr. Jonathan Avery is on a mission: Remove the stigma surrounding addiction so that it’s recognized for what it is — a brain disease that requires medical treatment, not a personal moral failure.

“My biggest message when I speak to anyone about addiction is that we need to start talking about it everywhere, all the time,” says Dr. Avery, Vice Chair of Addiction Psychiatry and Program Director of the Addiction Psychiatry Fellowship at NewYork-Presbyterian/Weill Cornell Medicine. “Substance use disorders should be part of the general conversation because everyone is at risk for them. And when it does happen to someone, they need to know that it’s not their fault and that there are options to help them get better.”

The medical community is not immune to the stigma. That’s why physician education and training is a major focus of the Program for Substance Use and Stigma of Addiction, which Dr. Avery founded in 2019. “There are a lot of misconceptions about substance use patients that color our narratives,” he says. “We sometimes lose sight of the fact that there are more people in recovery in the United States than those with active substance use, so there are a lot of wins to be had if you can get past the stigma and see each patient as an individual.”

Dr. Avery spoke with NYP Advances to discuss why erasing the stigma is so key to combatting addiction and how he’s working to change the attitudes of health care providers.

When did you know that you wanted to pursue psychiatry as a field, and addiction psychiatry as a specialty?

My father was a hospice physician and worked closely with psychiatrists as he helped care for people at the end of their lives. When I was young, I volunteered at hospice organizations and got to film patients telling their stories, which helped give them a voice and was therapeutic for them, their families, and their caretakers. Giving people a way to let their voices be heard is what interested me in psychiatry early on.

Later when I was in medical school, I became interested in addiction psychiatry specifically because, like with the hospice patients, these are patients who often aren’t given the space to tell their stories. There is a stigma attached to their experiences and illnesses. People discouraged me from getting into addiction psychiatry because it was a challenging field; they said that there weren’t a lot of resources available and that I would experience a lot of disappointment. But being told not to do it made me want to pursue it even further.

When you founded the Program for Substance Use and Stigma of Addiction, what were your goals for it, and how are you working to achieve them?

First, we want to understand the different variables that contribute to such a profound stigma, even in the places where patients should feel the safest, like in their homes, within the judicial system, and with their medical providers. Substance use co-occurs often with psychiatric disorders, and a lot of substance use develops as self-medication for unaddressed psychiatric or psychological conditions. So, we need to understand addiction as a brain disease and recognize it as a condition where, with good treatments, people do get better.

Dr Avery sitting in a meeting

That relates directly to our second goal, which is to develop interventions to combat the stigma. We can do this by raising awareness, improving attitudes toward addiction, and encouraging doctors to pursue a specialty in addiction as a career. We’re particularly focused on breaking the stigma within the medical community because we can’t make meaningful advances in addiction crises, such as the opioid epidemic, until we improve our attitudes towards those with substance use disorder.

One of the big things I’ve discovered in my research is that the attitudes of health care providers toward patients with substance use disorder is worse than toward patients with other medical or psychiatric conditions, and these attitudes get worse over time. That’s why we do so much work helping doctors think about these patients in a different way. The irony is that doctors have more substance use than their age-matched peers, and one-third to two-thirds of us have substance use disorders in our family.

We need to understand addiction as a brain disease and recognize it as a condition where, with good treatments, people do get better

Our interventions with medical professionals include a lot of educational videos and in-person seminars about addiction stigma, along with exposure to people in recovery and family members who have lost loved ones to addiction. We’re also testing novel technologies in collaboration with the Massachusetts Institute of Technology to help clinicians learn how to have empathy toward people with substance use disorder. We’re using affective technology (technology that helps interpret human emotion) to record physicians as they interact with virtual patients and give them feedback on the degree to which they displayed empathy and openness. This is especially important with telehealth, because sometimes your face is all the patient sees. The goal with these role-playing games is to make the intervention as engaging as possible so that you can’t help but actively learn and challenge yourself.

At this stage of your career, what accomplishments are you proudest of?

There are two things that stand out the most to me. One was launching a naloxone rescue kit training program at the hospital in 2015 that’s saved hundreds of lives over the years. We’ve been doing naloxone training over the past eight years not only at the hospital but around the city, including at homeless shelters, schools, bars, and clubs. I’m proud that we were ahead of our time when it came to naloxone, and it’s been rewarding to be able to make an impact in the community.

Dr. Avery presenting in a meeting

The other thing I’m proud of is creating an addiction psychiatry fellowship to train the next generation of addiction psychiatrists. There’s so few of us in this specialty — only about 1,200 across the country — so I felt like I had to do something to help address the deficit in providers. We choose two fellows a year who receive mentorship and additional training in addiction psychiatry, as well as conduct research.

When you look back to early in your career, was there something you worked hard to improve upon to become a better psychiatrist?

As I was going through psychiatry training, I was nervous about working with kids and families. I didn’t think I was good at it. Children and adolescents scared me, and I found complex family dynamics intimidating. But addiction is a disease of adolescence — 70% to 90% of addiction emerges in adolescence — so I had to know how to treat them. Family members also need help and support, but they often don't get it; that's why we started the family program at NYP. So while I was nervous and intimidated by those things, I really leaned in. I partnered with good family therapists and child and adolescent psychiatrists to learn from them and become better.

What is most rewarding about working at NewYork-Presbyterian and Weill Cornell Medicine? Why did you feel this was the right place for you?

Because of the early discouragement I got about going into addiction psychiatry, I really appreciated it when the mentors I had at NewYork-Presbyterian and Weill Cornell Medicine encouraged me to grow the addiction psychiatry programming here to make us a leader in this space.

Dr. Francis Lee, our Chair in the Department of Psychiatry, and Dr. Philip Wilner, our Executive Vice Chair, have really partnered with me to prioritize addiction psychiatry at NYP. The previous Chair, Dr. Jack Barchas, and one of my earliest mentors, Dr. John Barnhill, were also very critical in helping me develop programs. Really, all the people empowering me to grow the addiction program and saying, “Hey, you can do this. Don’t worry about the stigma; in fact, let’s study the stigma, let’s develop interventions and help folks,” is what made me know this was the right place for me.

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Dr. Jonathan Avery: Fighting the stigma surrounding substance use disorders — including among fellow physicians

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