Quannacut Outpatient Services, Stony Brook Medicine: Driving Breakthroughs in Addiction Treatment

By Allison Gorman
Wednesday, April 1, 2020

With a newly expanded, state-of-the-art facility in Riverhead, Stony Brook Medicine’s Quannacut Outpatient Services expands the reach of multidisciplinary, evidence-based addiction treatment across Eastern Long Island.

Suffolk County has been the epicenter of New York’s opioid crisis, with almost 350 fatal overdoses in 2017 and 2018 alone. But it is also home to a healthcare facility perfectly equipped to meet the crisis head-on. Quannacut Outpatient Services, part of Stony Brook Medicine, has been a regional leader in Medication for Addiction Treatment (MAT) for more than a decade.

What makes Quannacut stand out is not just its early adoption of MAT, the most effective form of treatment for opioid use disorder. Quannacut also takes an evidence-based approach to treating a broad range of addictions, with its highly trained clinicians and its seamless integration of medical, psychological and behavioral health care, including off-site services at Stony Brook Eastern Long Island Hospital. Together, the staff is leading an unrelenting push to improve access to comprehensive addiction treatment on the North Fork, South Fork and throughout Eastern Suffolk County.

Training and continuing education are vital to the treatment of substance use disorders. Richard N. Rosenthal, MD, Professor of Psychiatry at Renaissance School of Medicine at Stony Brook University and Director of Addiction Psychiatry at Stony Brook Medicine, lectures to treatment and support staff team members Cori Kapopoulos, LCSW, CASAC; Jayne Pertz, LMSW; Serafina Zoda, CASAC; Administrative Office Manager Cheryl Daters; Office Assistant Denise Elias; and Samantha Rubinstein, LCSW.

Research has shown that time is among the main determinants of whether someone gets addiction treatment, says David Cohen, Director of Outpatient Addiction Services at Stony Brook Eastern Long Island Hospital. “When a person has a revelation that they need help, sometimes that window closes quickly. So to me, the No. 1 thing is to remove as many barriers as possible.”

But even timely treatment isn’t effective without long-term, multidisciplinary support. Quannacut provides both under one roof.

Last November, Quannacut celebrated the grand opening of a newly expanded 14,000-square-foot facility in Riverhead. With triple its original space, Quannacut is adding medical and psychotherapeutic staff and has largely met its goal of accommodating 700 adult patients a year, up from 300, and as many as 20,000 annual patient visits — five times its previous capacity.

In a region where addiction treatment has been scarce and disjointed, Quannacut’s new reach will have a lifesaving impact.

“I think the field as a whole is starting to understand the idea of harm reduction. Just because someone uses, it doesn’t mean hope is gone.”
— David Cohen, Director, Quannacut Outpatient Services

Debbie Malone, LCSW, CASAC, and team members Karen Lintvin, LCSW, Administrative Office Manage Cheryl Daters, Secretary Cynthia Alvarez, Samantha Rubinstein, LCSW, Serafina Zoda, CASAC, and Kirsten Cisco, CASAC-T, review aspects of group therapy — a most effective approach to the treatment of substance use disorders.

Evidence-Based Treatment

Central to Quannacut’s mission is the longstanding philosophy that addiction is not just a manifestation of unresolved psychological/emotional issues — it is a disease.

“For so long you heard people saying that, but addiction wasn’t really being treated like a disease from a medical standpoint,” Cohen says.

Based on national surveys, he estimates that 85% of the rehabilitation facilities in the region operate from a 12-step-based philosophy, which isn’t effective for all substance use disorders.

Richard N. Rosenthal, MD, Professor of Psychiatry at Renaissance School of Medicine at Stony Brook University and Director of Addiction Psychiatry at Stony Brook Medicine, is helping to further develop Quannacut’s program, which provides customized treatment incorporating several evidence-based approaches.

In addition to psychiatric treatment and medication, Quannacut offers group and individual psychotherapy, which may involve cognitive behavioral therapy, motivational enhancement therapy, motivational interviewing, family behavioral therapy or even mindfulness-based approaches, among others.

Dr. Rosenthal says that psychosocial treatment, while a mainstay for treatment of stimulant-use disorder and alcohol-use disorder, has not proven especially effective as a standalone treatment for opioid-use disorder. In fact, opioid-use disorder has a 90% relapse rate for patients who detox without MAT.

“For most kinds of outpatient [opioid] treatment, if you try to recover through 12-step and other support systems without stabilizing medication, you do it at your own peril,” he says.

Quannacut helps patients get sober and then promotes long-term abstinence by countering factors known to trigger full-blown relapse, he says. Medication can help offset a temporary slip-up; therapy can empower patients to implement abstinent-supportive coping skills. The slower work is helping patients build social-emotional scaffolding that provides support when life throws them a curveball. Failure, grief, and financial or legal issues are potentially destabilizing stressors.

“You want to help people move toward positive and healthy reinforcers in the environment, which means reengagement with family, promotion of intimacy, engagement in work or education, and spiritual development. It’s all important,” Dr. Rosenthal says.

The addition of primary care services has been invaluable to meeting patient needs and avoiding use of emergency rooms and inpatient episodes. Jarid Pachter, DO, Medical Director of Quannacut Outpatient Services and Colleen Sachnievich, LPN, begin an examination.

Dr. Pachter reviews records with medical team members Colleen Sachnievich, LPN, and Aisha Walston, Outpatient Service Tech.

Medical, Psychotherapeutic Approaches

Physical problems are also stressors, and they can directly or indirectly result from substance use. That’s why patient intake at Quannacut includes a medical exam — to identify and address all the patient’s health challenges, not just the addiction that prompted treatment.

People with an addiction warranting intervention likely have other addictions, including cigarettes and alcohol, which respectively kill 480,000 and 88,000 Americans a year. The vast majority of Quannacut’s patients are smokers, Cohen says.

“Any patient being treated for a substance use disorder also needs to have good medical care and be screened for diseases like hypertension and diabetes and lung disease,” says Jarid Pachter, DO, Medical Director of Quannacut Outpatient Services. “Patients who are using IV drugs need to be screened for hepatitis C and treated accordingly.”

Quannacut has incorporated primary medical care in its addiction treatment for several years, despite a shortage of space and equipment. Now with three exam rooms — each equipped for various screenings and tests, including EKGs — Quannacut can provide short- or long-term primary care to any patient who needs it.

While improved medical capacity is a highlight of the new facility, Dr. Pachter is just as excited about the expansion of Quannacut’s psychiatric services. Like most primary care doctors, he’s had to address patients’ mental health needs when psychiatric providers are scarce.

“I deal with psychiatric illnesses, but that’s not my specialty,” he says. “There are patients I’m treating by default.”

Between 30% and 50% of people with addiction have a co-occurring psychiatric illness, Dr. Pachter says. With more psychiatrists and licensed therapeutic staff, Quannacut can better help that underserved population.

Quannacut will also benefit from Stony Brook’s new psychiatric residency program at Eastern Long Island Hospital. The first cohort of third-year students will begin their rotation at Quannacut in less than two years, Cohen says. He hopes some will choose to stay and practice on Long Island.

As Quannacut adds staff to both its inpatient and outpatient treatment sites, Dr. Pachter can get his patients into psychiatric care expeditiously, while patients with unaddressed health issues, such as chronic pain contributing to their substance use, can receive prompt, appropriate medical attention.

“East of Riverhead, especially, there’s a lack of primary care and psychiatric care, and certainly a minuscule amount of expertise in substance abuse disorder,” Dr. Pachter says. “With expanded primary care and psychiatric services, we’ll be able to handle a large proportion of the patients who are struggling with these problems, east and west of Riverhead.”

Integrated care contains three core elements. David Cohen, Director of Outpatient Addiction Services at Stony Brook Eastern Long Island Hospital, and Dr. Pachter confer with Psychiatric Director Kent Hoverkamp, MD, and psychiatrist Dan Klages, MD.

Continuum of Care

And they are struggling. Some 80% to 90% of Quannacut’s patients have had substance use or mental health treatment at another facility, Cohen says.

Relapse is common with addiction treatment. It may take up to eight years for a patient to fully stabilize with no symptoms, Dr. Pachter says. But the disjointed care most patients receive after initial treatment compounds the problem. Even if they receive MAT in an emergent care or inpatient rehab setting, they’re typically referred to an outpatient program that offers counseling alone.

“Counseling is great, but it’s not a recipe for long-term success and abstinence,” Dr. Pachter says. “These patients need medical care. They need primary and psychiatric care. And the difference with our program is that we have an integrated set of care offerings … all under one roof.”

Quannacut provides a continuum of care enhanced by its other programs at Stony Brook Eastern Long Island Hospital (which offers acute care detox, inpatient rehabilitation and inpatient psychiatric care), as well as Stony Brook University Hospital and Stony Brook Southampton Hospital. Because these facilities share a calendar and EMRs, patients who stay within the Stony Brook Medicine hospital system are at low risk of receiving treatment that can lead to relapse.

“Having access to several acute care facilities, hospitals and outpatient providers, we can provide a more cohesive, communicative, comprehensive plan for each of our patients, so the primary team is informed about the patient every step of the way when they’re out of our sight,” Dr. Pachter says.

Within all levels of behavioral health treatment at Stony Brook, coordination is quick and paperless. If a patient isn’t progressing in outpatient treatment, for example, Dr. Pachter can arrange a seamless transfer to rehab.

Stony Brook Medicine is also leading a regional effort to double the number of people treated with buprenorphine by making EDs a point of contact, Dr. Rosenthal says. “For people who are appropriate, we’ll induct them right then and there and then make the appropriate referral. We’ve gotten that up and running at Stony Brook University and Southampton, and we’ll be doing that at Eastern Long Island Hospital as well.”

Highly individualized care is a trademark of Quannacut Outpatient Services. Cohen reviews a patient case with Clinical Supervisor Jose Vargas, LCSW, CASAC.

Experts in Complexity

A defining feature of Quannacut is the expertise of its staff. Dr. Rosenthal created the Division of Addiction Psychiatry at the former Beth Israel Medical Center, now Mount Sinai Beth Israel. Dr. Pachter is a board-certified addiction specialist. Every physician at Quannacut is certified to prescribe MAT, including buprenorphine, naltrexone and Antabuse.

Cohen, who came to Quannacut in 2001, led the transformation of its treatment program from the original 12-step model, gradually increasing the percentage of its therapeutic staff with at least master’s-level clinical training from 20 to over 85.

Such expertise is essential to treating a patient population characterized by multiple diagnoses and significant life challenges.

“Complexity is what we deal with,” Dr. Rosenthal says.

Here’s a typical case:

Last October, a male in his mid-20s came to Quannacut from Stony Brook Eastern Long Island Hospital. He had multiple addictions, including heroin, cocaine, benzodiazepines and marijuana. He’d been drinking since age 12 and smoking since age 14. Despite three prior stints in rehab and one as an outpatient (none at a Stony Brook facility), he’d never strung together a month of continuous abstinence.

As a child he was regularly physically and verbally abused. There was sexual abuse too. He had PTSD. The patient had a high school diploma and some college. He had a work history but no job.

He had no comorbidities, but he had another dangerous condition common to addicts: homelessness. According to the CDC, homeless people have a mortality rate four to nine times higher than that of people with homes. His providers at Quannacut took the young patient’s homelessness as seriously as they did his addiction.

Last November, Quannacut Outpatient Services, part of Stony Brook Medicine, celebrated the grand opening of a newly expanded 14,000-square-foot facility in Riverhead.

Always Hope

Quannacut’s overarching goal is to eliminate barriers to treatment. It waives referrals and patient screenings, has walk-in hours, accepts all insurance, and offers self-pay treatment on a sliding scale. To reduce regulatory barriers, Quannacut is applying for licensure as Long Island’s first integrated clinic under the Office of Addiction Services and Supports.

But homelessness is a formidable barrier — “probably the No. 1 thing that undermines treatment,” Cohen says.

To help meet that need, Quannacut has expanded its sober houses from 10 to 18 male beds. (The long-term goal is to add more, including female beds.) While most sober houses limit stays to a few months, Quannacut will house patients indefinitely as long as they’re stable.

“From a clinical standpoint, it takes a year just to get your emotional equilibrium,” Cohen explains.

The young man who arrived at Quannacut last October was given a bed there the same day. (The house manager screened him while he was still in rehab.) The next day, Quannacut sent him to the Department of Social Services to get a housing subsidy, as 90% of its housing patients do. A day later he was evaluated for treatment. He was placed in multiple therapy groups, began weekly individual psychotherapy and started psychiatric treatment and MAT.

As of press time, he’s still living in the sober house.

Quannacut celebrates these incremental successes knowing they might not hold. Statistics suggest this young man will likely relapse. If he does, and wants to try abstinence again, he’ll know where to go.

“The old-school philosophy was to kick someone out if they relapse, which never made sense to me,” Cohen says. “Relapse happens. If someone needs a more structured or higher level of care, that’s different. But the idea is to help them work through it, identify the underlying problems and patterns, and try to resolve it. We can’t help them if they’re not here.”

At Quannacut — a Native word meaning “hope” — there is no one and done.

The “ Q” for Quannacut; Quannacut is a Native American word for hope.

Meet the Practitioners

Richard N. Rosenthal, MD

  • Professor of Psychiatry, Renaissance School of Medicine at Stony Brook University
  • Director of Addiction Psychiatry, Stony Brook Medicine
  • Medical school: State University of New York, Downstate Medical Center
  • Residency: Psychiatry (Chief Resident), Mount Sinai Hospital
  • Directed one of the first five Addiction Psychiatry fellowships in the US

When a state-of-the-art health facility opens, the inevitable focus is on technology. Quannacut, which moved to a newly expanded 14,000-square-foot facility in Riverhead last fall, has plenty of that. From its videoconferencing equipment to its capacity to deliver telemedicine and tele-psych to remote communities on Eastern Long Island, the message is clear: Excellent health care happens here.

But when Richard Rosenthal, MD, gazes around Quannacut, his focus is on subtler things. Well-appointed waiting rooms. A layout that enhances patient flow. Large windows overlooking the woods.

“It doesn’t feel institutional,” he says. “It feels like a private facility in the sense that it’s welcoming, comfortable and pretty.”

As one of the country’s first addiction psychiatry directors, before it was an official subspecialty, Dr. Rosenthal has long understood how the clinical environment can shape treatment.

In 1984, he was hired by Beth Israel Medical Center, now Mount Sinai Beth Israel, to run its pioneering dual-diagnosis unit for psychiatric patients with substance use disorder. He walked into chaos. Patients fought and threw chairs. There was destroyed art on the walls and a broken piano in the corner of the group room.

Dr. Rosenthal had everything in the patient areas replaced and protected so no one could vandalize it. Before long, no one wanted to.

“The unit started to calm down,” he says. “When something got messed up, we repaired it quickly, because the message to patients was, ‘We respect you. You have a medical problem. You’re not a bad person.’”

Quannacut sends the same message. That’s by design.

Jarid Pachter, DO

  • Medical Director, Quannacut Outpatient Services
  • Medical school: University of New England College of Osteopathic Medicine
  • Residency: Family medicine (Chief Resident), Plainview Hospital

In addiction medicine, you’re playing the long game. Backsliding is the rule rather than the exception, and the timeline — and ultimately the outcome — are beyond your control.

Then again, the same goes for family medicine, says Jarid Pachter, DO, who has a primary care practice in Southold in addition to being Medical Director and an addiction specialist at Quannacut. He sees dozens of patients a week who, despite his best advice, never manage to lose weight, stop smoking or start exercising.

In other words, that dynamic is not unique to addiction medicine.

In fact, Dr. Pachter says, it’s uniquely gratifying to deliver clinically appropriate, humane care to people who so often feel stigmatized not just in social settings, but also in medical ones.

“When you approach patients the way we do at Quannacut, they have an appreciation that exceeds, in some respects, that of patients with other diseases,” he says. “When they’re in a setting where the clinicians actually understand the disease and approach them like people, their forward progress is so rewarding that it eliminates the frustration.”

Visit ELIH.StonyBrookMedicine.edu to learn more.