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A study in innovation: Reinventing substance use disorder intervention

The fields of education and psychiatry value researchers who are willing to combine fresh ideas with traditional solutions. That kind of open-minded approach led Ayana Jordan, MD, PhD, to an epiphany as she sought a better way to help poor people struggling with drug addiction. Though it happened in church, her epiphany was not religious in nature. Jordan realized that the influence and support of the African Methodist Episcopal Zion Church could provide the transformative experience people needed when they didn’t have much trust in health care. Through her positions as assistant professor of psychiatry and director of the Yale Global Mental Health Program, she was able to draw on colleagues and church leaders to break new ground in addiction interventions.

Raised in Pittsburgh, Jordan began her award-studded academic life with an undergraduate degree in biology from Hampton University in Virginia, a school steeped in Black history and culture with a progressive mandate. She embarked on an MS in pathology at Albert Einstein College of Medicine of Yeshiva University in the Bronx, then stayed on for an MD/PhD program.

Completing the combined degree program is a rare accomplishment for any student. The number of Black women who achieve it is miniscule. “I planned to go into internal medicine and infectious disease,” she said since she earned her PhD in immunopathology. But during the program, she did clinical work in psychiatry in the South Bronx. “I had never seen that level of poverty in the U.S. It really struck me,” she said. This experience changed the trajectory of her career. “I realized I could make a bigger impact in the underserved and marginalized communities. There is such a big mistrust in those communities around mental health and mental illness.” The existing interventions weren’t working, and she felt compelled to find a solution.

“To improve outcomes for marginalized populations, we need to involve them from research to clinical interaction—every step of the way,” Jordan explained. This kind of community-based participatory research wasn’t an option in most residency programs. At Yale, she found an environment that supported her vision to integrate the cultural and religious aspects of people’s lives while also addressing the disparities that can hold them back from improved mental health. Jordan also discovered a community in need: According to the National Institutes of Health, Connecticut is among the top 10 states for overdose deaths from opioid abuse. She arrived in New Haven in 2011, as the rate of opioid deaths in the state started to climb dramatically.

During her residency, she served as program-wide chief resident in psychiatry; completed a fellowship in addiction psychiatry; amassed a dozen awards, including the Resident Recognition Award from the American Psychiatric Association (APA); and found an innovative approach to community intervention. When Jordan arrived in New Haven, one of her top personal priorities was to find a Black church. She joined Varick Memorial AME Zion Church, which has a long tradition of participation in studies at Yale. Knowing that the Black church had been instrumental in changing how people thought about HIV, Jordan realized the church community could help with another stigmatized epidemic: mental illness, specifically substance use disorder. She approached the pastors to propose a pilot of a community-based treatment program within the church.

While it may sound a bit like 12-step meetings held in church halls, which Jordan acknowledges can help many people, this program is quite different. “Here we are focused on being Black, being spiritual, [and] the church itself is involved in the care,” she said. “It’s not about bringing people to Jesus, and participants are often not part of the congregation,” she explained. “It’s about a safe place where people can get help.” The pilot program was held in Dixwell Avenue Congregational United Church of Christ. It included evidence-based computerized cognitive behavioral therapy, and received an overwhelmingly positive response.

At the same time, Jordan hoped to bring a faith-based initiative to Blacks with opioid-use disorders throughout the state. That led to a collaboration with Chyrell Bellamy, MSW, PhD, associate professor of psychiatry, on a program called Imani Breakthrough (imani means “faith” in Swahili). With input from peer facilitators and church leaders, they added the traditions and values of the church to a curriculum based on the Citizens-Community Enhancement Project, an intervention shown to be effective for people with serious mental illness that includes substance-use disorders.

The foundation of Imani Breakthrough is the 5Rs model from the Citizens’ Project, created by Michael Rowe, PhD, professor of psychiatry, and his colleagues. The model emphasizes the “rights, responsibilities, roles, resources, and relationships” of community members. Imani Breakthrough also incorporated a support system that encompasses spiritual, social, financial, emotional, environmental, intellectual, physical and occupational aspects of life—the “Eight Dimensions of Wellness,” as outlined by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.

Imani Breakthrough aims to help people gain independence without relying on perennial attendance at meetings. The program involves 12 two-hour weekly meetings and refers patients to medication-assisted treatment and wellness counseling when appropriate. It also includes one-on-one support to address such factors that might compromise success as issues with housing, jobs, and transportation.

When the program launched, hundreds of people came. The success led to further funding for another year. Jordan and Bellamy are now expanding the program by designing a version for the Latinx community. “The next challenge is preparing a large randomized controlled trial to determine if partnering with the faith organizations works better than traditional substance-use clinics,” Jordan said.

While Jordan has won many awards and accolades, one of her favorites was bestowed at Yale’s commencement last June: the Faculty Diversity Award. “I wanted to recruit residents and faculty that are reflective of the population, to make sure all kinds of people are at the table—race, gender, point of view, where we trained, and more. You can’t be an excellent physician unless you are aware of the cultural identity that patients bring into the room and take that into consideration in the treatment plan. Yale psychiatry is starting to reap the rewards of being focused on inclusion.”

Jordan said she hopes to help everyone find a path to recovery, regardless of past failures. “My ultimate dream is to open up a substance-abuse wellness center that not only deals with the biological aspects of substance use, but equally addresses the social determinants of health,” she said.