About George Kolodner

Looking for new ways to make treatment more effective and accessible has always been a central focus in my professional work. That aspiration motivated me in 1973 to design the first three-hour outpatient rehab program for people with alcohol use disorders. That model, which ultimately became known as “intensive outpatient” or “IOP,” has become a mainstream level of treatment not only for substance use disorders, but for other psychiatric disorders as well.

This ultimate widespread acceptance, however, did not come quickly. I routinely encountered confident assertions that if a person “really” wanted to recover, they should definitely seek treatment in a traditional inpatient rehab program. Many years passed before studies showed that, for most patients, the outcomes were equivalent at both levels of care, with IOP having the advantage of being much more accessible.

I learned that by preceding the outpatient rehab with outpatient withdrawal management and then following it with weekly continuing care, I could create an integrated, comprehensive treatment model that reduced the premature terminations that have plagued treatment for substance use disorders (SUDs).

I found that my psychiatric training and familiarity with medications allowed me to identify and treat co- occurring mental health conditions at the same time as substance use disorders in an integrated program rather than having the disorders treated in parallel programs or sequentially. In some cases, this had not been done before and I gave presentations and published papers to familiarize other clinicians with these ways of making treatment more effective.

 

Specifically:

• 1970’s. Using lithium shortly after it became available to treat co-occurring bipolar disorders so that people with alcohol use disorders finally had the stable moods necessary to establish sustained recovery.

• 1980’s. Using stimulant medication to stabilize a subset of patients with cocaine problems, who were trying unsuccessfully to self-medicate Attention Deficit Hyperactivity Disorder.

• 1990’s. Uncovering the high prevalence of childhood trauma histories in people with SUDs, especially women. Identifying this issue, which was often a hidden cause of relapse, allowed the issue to be addressed thus improving the likelihood of recovery from an SUD.

• 2000’s. Encouraging patients with opioid use disorders to remain on Suboxone (buprenorphine beyond withdrawal management to prevent relapses).

Looking for new ways to make treatment more effective and accessible led me, in 2022, to establish the Triple Track Smoking and Vaping Cessation program. In this case, I was motivated from two directions. The first was my frustration with the lack of attention paid to nicotine by most programs treating other substance use disorders. I was dismayed to see people doing well in their recovery from what were called their “drugs of choice,” but getting sick and sometimes dying from the use of what seemed to me to be their ultimate drug of choice. As was my initial experience with establishing the effectiveness of outpatient rehab, I continue to encounter confident assertions from people in the recovery support community that quitting nicotine will endanger early recovery. Research has shown that this is not the case and that in fact the opposite is sometimes true – continued use of nicotine can lead to SUD relapses, just as is the case for using any other addictive substance.

The second motivational force came from the fact that the field of smoking cessation treatment, which did focus on nicotine problems, usually achieved treatment outcomes that were much lower than the outcomes that I was accustomed to seeing in my work with other SUDs. Most smoking cessation programs did not use the clinical interventions routinely used in SUD treatment programs. I thought that if I were to apply to nicotine what I had found to be effective with other substances, my nicotine patients would have better outcomes. I have been pleased to find that, by using such an approach, these better outcomes have been
achieved.

Effective treatment of SUDs was not something that I learned during my otherwise excellent medical training at the University of Rochester, where I went to medical school, and Yale University, where I completed my psychiatric residency. Not until I was serving as a physician in the Navy Medical Corps at Bethesda Naval Hospital did I see effective treatment. My experience there awakened me to the pleasure of accompanying people in the transition from the misery of an addicted life to the rewards of recovery. The existence of effective treatment is moot, however, if it is not accessible, so I have worked to remove
potential barriers for Triple Track. As was the case for my IOP model, Triple Track is in network with most major health insurance companies to reduce the financial burden for patients. Similarly, treatment sessions are scheduled at various times in the day.

In addition, the Triple Track program is delivered entirely via telehealth – the emergence of which has been transformative in expanding access to treatment. When the COVID pandemic led the government and insurance companies to reduce their restrictions on telehealth, clinicians and their patients discovered how much could be accomplished when treatment was delivered in this manner. Tradeoffs do exist – in-person services have some clear advantages. On balance, however, I think that the significantly improved access makes up for what is lost.

In addition to treating patients, I worked to ensure that physicians in training did not have the same experience that I had had in never having seen the hopeful side of SUDs until later in their careers. For many years as a Clinical Professor of Psychiatry at Georgetown University School of Medicine, I had the entire third year medical school class visit my IOP rehab program in small groups. For this and other work, in 2006 I received the Outstanding Teacher Award for the Department of Psychiatry. In addition, as a Clinical Professor of Psychiatry at the University of Maryland School of Medicine, I supervised a six-month rotation of psychiatric residents through the continuing care phase of my treatment program so that they could get a sense of the type of remarkable progress that SUD patients made following the management of their withdrawal symptoms and stabilization in the rehab phase of treatment.

I was committed to letting my colleagues in general psychiatry know about the good outcomes that were possible for patients with SUDs and the benefits of outpatient treatment. At the American Psychiatric Association, I was appointed to the Addiction Council from 1996 to 1999, as well as the Addiction Treatment Committee from 1999 to 2008, serving as the Vice-Chair from 2005 to 2008. Following the 2010 legalization of medical cannabis in Washington, DC, I was invited to make a series of presentations to the medical community in DC and Maryland. This led to my being named the 2015 Psychiatrist of the Year by
the Washington Psychiatric Society.

I also devoted time to letting my addiction medicine colleagues at the American Society of Addiction Medicine (ASAM) know what I was learning. In 1976, I presented three papers at the ASAM annual meeting, subsequently making other presentations over the next 45 years. In 2013, I was the Lead Editor of the “Withdrawal Management” chapter of the Third Edition of the ASAM Criteria, a standard textbook inthe field for determining the setting in which patients should receive their treatment. Most recently I have been working to increase the amount of attention paid to nicotine by ASAM as Chair of their Nicotine and Tobacco Special Interest Group from 2023 to 2025.

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There is never an end to the process of making treatment more effective and accessible. I understand that these changes are not always immediately embraced, but I look forward to continuing the effort.