Delivering Addiction Care Outside Traditional Settings

Ayana Jordan, MD, PhD, discusses how precision psychiatry must expand beyond biology to address the social, cultural, and structural realities shaping addiction and mental health care for historically underrepresented patients. The conversation explores how trauma, poverty, housing instability, health literacy, and stigma interact with substance use and serious mental illness—and why traditional clinic-based models often fail to meet patients where they are.

Dr. Jordan describes the work of the Jordan Wellness Collaborative, including partnerships that integrate addiction treatment into primary care, community settings, and faith-based institutions. She explains how peer facilitators, housing support, and trusted community spaces can dramatically improve engagement, retention, and outcomes. Looking ahead, she reflects on how emerging tools—from AI-supported care models to novel treatments for addiction—may further transform access and equity in psychiatric care.

Ayana Jordan, MD, PhD, is the Barbara Wilson Professor of Psychiatry at NYU Grossman School of Medicine and Principal Investigator of the Jordan Wellness Collaborative.

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TOPICS

• Expanding precision psychiatry beyond biological models
• Structural barriers to care: housing, literacy, and stigma
• Addiction treatment for historically underrepresented communities
• Integrating care into primary care, community, and faith-based settings
• The role of peer facilitators and lived experience in treatment
• Trust, safety, and engagement for patients with complex needs
• Future directions: AI, novel addiction treatments, and workforce training

This discussion is for educational purposes and does not substitute for individual clinical judgment or patient care.

Senior Producer: Jon Earle

Transcript

AYANA JORDAN, MD, PhD: When we think about precision medicine, we have to be thoughtful around—precise in what areas, of course, biologically, but also understanding how the psychosocial, cultural, and spiritual factors also play into it. So we're broadening our approach, not to just consider the patient-doctor interaction, but how are the things in the environment impacting the patient's ability to fully participate in our recommendations.

CHARLES MARMAR, MD: Welcome to Insights on Psychiatry. I am your podcast host, Dr. Charlie Marmar. I'm Chair of Psychiatry at NYU Grossman School of Medicine, where I direct a center for precision psychiatry and stress-related disorders. It's my great pleasure to welcome my distinguished guest on this podcast today, Dr. Ayana Jordan. Dr. Jordan is the Barbara Wilson Professor of Psychiatry in our department at NYU, and she is also the principal investigator of the Jordan Wellness Collaborative, a program with a deep mission to serve historically underrepresented patients with addiction and other related disorders. Ayana, welcome to our podcast.

AYANA JORDAN, MD, PhD: It's so good to be here with you. Thank you.

CHARLES MARMAR, MD: Tell us how you broadly think about addressing the problem of historically underrepresented patients.

AYANA JORDAN, MD, PhD: Yeah, I appreciate that, and having the opportunity to discuss it. I think it's really important to have a wider understanding that, yes, we're dealing with serious medical illnesses that are oftentimes complicated by trauma, so it's not enough to just focus on one particular addiction, not even a substance use disorder, but really thinking about how the development of being someone who has been historically excluded really impacts how someone appreciates or engages with care. So we expand the biological model to the biological, psychosocial, cultural, and spiritual model so that we're able to develop treatment plans and engage people into care that otherwise may not be traditionally involved in care.

CHARLES MARMAR, MD: Briefly, what have been the historic barriers and how are you addressing them?

AYANA JORDAN, MD, PhD: They are varied, right? We're dealing with, oftentimes, extreme poverty, not having adequate education. Literacy is a big deal. Homelessness or unstable housing, and oftentimes not having any comfort with the traditional mental health system. And so one of the ways that we've been able to address that in the Jordan Wellness Collaborative is bringing people into the treatment plan and having relationships where we can deal with all of those, right? So, for instance, we have partners in the city that will actually guarantee housing for our folks as long as they're engaged in treatment. We also have peer facilitators—those are people with lived or living experience in addiction and/or mental illness that will work alongside our patients to help them navigate the treatment planning. Those are a part of our team. So it's not just the psychiatrist who is involved, but it'll be a peer navigator, it'll be really a connection to city programming. And then, not only that, we have allied health professionals that work together and discuss the case. So when somebody comes in to see me, they are actually oftentimes blown away by the comprehensive plan that we create together.

CHARLES MARMAR, MD: There's the issue of literacy. There's an issue of health literacy.

AYANA JORDAN, MD, PhD: Absolutely.

CHARLES MARMAR, MD: Which is very complex.

AYANA JORDAN, MD, PhD: Yeah.

CHARLES MARMAR, MD: And what people read about on the internet, for example—many of our patients educate themselves with respect to health literacy from information they get from TikTok or otherwise.

AYANA JORDAN, MD, PhD: Don't get me started about how many doctors come into my office from TikTok and Instagram.

CHARLES MARMAR, MD: It's incredible, right?

AYANA JORDAN, MD, PhD: Yep.

CHARLES MARMAR, MD: So I think that related to that is the issue of stigma of mental illness.

CHARLES MARMAR, MD: Which is different in different communities and different cultures. How do you think about the stigma of mental illness in the communities that you're most deeply interested in serving, and how do you address that?

AYANA JORDAN, MD, PhD: Yeah, it's an excellent point. I want to go back to something you said, and I'll get to the stigma question for sure. But the importance of health literacy, I think, is really so good, and I want to spend a little bit of time because we're dealing with one of the worst drug overdose crises in this country. And it's interesting—people will come in from all different backgrounds and say, "You know, I am dealing with this particular issue," and they don't even realize that they are part of what we're calling the opioid crisis because they don't even know that the drug that they're using is indeed an opioid. So first, it's like, we can't even get to stigma if we're not even using language that folks can understand. Knowing that pills and oxys and all that are part of the crisis. So really being able to translate that is important. And then, for specific communities in general, for sure, there is a heightened stigma, but I have to say that for all people, it's really hard to go and see somebody when you're dealing with substance use because it still seems as if, "Oh, you are an addict." I would never use those words, but the stigma of even coming to see someone like me can be really great. So that's why we're working with our partners in medicine to really integrate the treatment into the medical home. That's another thing we're doing in the lab that I'm excited is testing—what are the ways in which people can engage in care if they go through their primary care and there happens to be an addiction expert there?

CHARLES MARMAR, MD: There's another issue that we have to think about, which you've given very deep and sensitive attention to, which is: How do we create an environment or setting where our patients can feel trust and safety?

AYANA JORDAN, MD, PhD: We are really at the forefront of developing an interesting way to provide evidence-based care, and we've shown that thousands over the years of people come and access treatment not in the hospital setting, not in the clinic, but also in faith settings. And so what we're doing and what we're testing out now—I'm so excited about this—is having physicians provide care in churches. And so we're in so many churches across the city, and we're able to show not only are people showing up, but they're staying in care and they can receive their medications right there with the physicians in the church.

AYANA JORDAN, MD, PhD: Isn't that awesome? I think—

CHARLES MARMAR, MD: It's amazing, yeah. Because think about how someone feels simply opening up and being vulnerable about sharing their addiction or other problems, but to do so in a place where they feel comfort and safety has enormous value to the therapeutic relationship.

AYANA JORDAN, MD, PhD: Absolutely. So there's already inherited trust. So we've already overcome that obstacle, and so how can we treat you?

CHARLES MARMAR, MD: If you think of a composite patient—

AYANA JORDAN, MD, PhD: Yeah.

CHARLES MARMAR, MD: —who represents a particularly difficult challenge for you, what would such a composite patient look like and how do you think about approaching their care?

AYANA JORDAN, MD, PhD: The type of patient that I'm dealing with often comes from a minoritized background, meaning that they're not part of the majority in this country, oftentimes will have a language barrier—so English is not their first language. But also, not only are they dealing with a substance use disorder or problems with substances, but at the same time a psychotic illness that is impacting their ability to fully participate in recovery, and at the same time are dealing with many inequities in the social determinants. So we'll have problems with housing, we'll also have issues financially, being able to take care of themselves or fully engage in the treatment recommendations. And how this all comes together requires a lot of thought in terms of what are the treatment recommendations that we are going to put together, but also how we can engage our partners to deal with each of those barriers. So that's a broad stroke of all the different issues.

CHARLES MARMAR, MD: As you described, this kind of composite imaginary patient, they feel very real to me.

AYANA JORDAN, MD, PhD: Yeah.

CHARLES MARMAR, MD: I can think of a number of patients that we care for that would fit that kind of description perfectly. They are among, I think, the most complex patients that we as psychiatrists and doctors care for in all of the practice of medicine.

CHARLES MARMAR, MD: Absolutely. And so it sounds like you are thinking about an approach to care that can try to address all those elements?

AYANA JORDAN, MD, PhD: Absolutely. We're realizing that when we think about precision medicine, we have to be thoughtful around—precise in what areas, of course, biologically, but also understanding how the psychosocial, cultural, and spiritual factors also play into it. So we're broadening our approach not to just consider the patient-doctor interaction, but how are the things in the environment impacting the patient's ability to fully participate in our recommendations? And so we have systems in place to provide comprehensive precision medicine, and I'm really excited that we're at the forefront of doing that at NYU.

CHARLES MARMAR, MD: That represents to me the state of the art—yes—of how to empathically and strategically, medically care for the most complex patients. But I was thinking, Ayana, if we have the pleasure ten years from now of sitting down together, I can imagine that what we talk about will have changed somewhat, that there will be some important new advances or breakthroughs that will offer our patients and their families, and even their broader communities, greater hope and relief from pain and suffering. What are you most excited about that could really change the lives of our patients in your area of interest?

AYANA JORDAN, MD, PhD: Yeah, I'm excited about a few things, actually. Thinking ten years from now, that we would have really been able to integrate automated information systems into the care that we're giving. So we see the types of patients that we're dealing with, we understand a particular prototype of the barriers that they already face, and integrating AI to automatically give us some recommendations on programming that can be instituted immediately to help them be able to engage in services so we don't have to spend so much time developing those each time from scratch, but having some models already ready that we can plug in to really individualize to each of our patients. I'm also excited about training, right, through a center at the Jordan Wellness Collaborative—more people from broad, diverse backgrounds that are able to participate in this work. So thinking about advanced training and peer facilitation, right, so that we have people from lived backgrounds that are able to participate in the same way that physicians are in the care delivery. And then you'll see there's so many ways that people will be able to engage in care. We don't have to just restrict it to federally qualified health centers. Insurance will actually pay for someone to go to their community center or place of worship in order to get treatment, and doctors will be working in those places. And so it will no longer be novel. They'll say, "Oh, that's old news. Dr. Jordan developed that type of way," and I'm really excited about that.

CHARLES MARMAR, MD: What about on the science side? Are there ways that we can understand addiction and psychosis? One of the challenges—we have a unique challenge in psychiatry that's somewhat different from general medicine. As you know, I was a family doctor for a short time before I became a psychiatrist, and as a family doctor with most patients, the patient has a reasonable understanding of their diabetes or high blood pressure or cancer or whatever they're struggling with, and they're very engaged in trying to get the best care and comply with the best care and get it as quickly as possible. Because we deal with patients with psychotic illnesses and very severe mood disorders and addiction, all of which affect the organs of insight, judgment, and self-understanding, often our patients are not—it's the opposite. Instead of being desperate to get the best care, they're fearful of getting into care.

AYANA JORDAN, MD, PhD: Yeah.

CHARLES MARMAR, MD: How can we provide better care for vulnerable patients who don't necessarily have the executive function to care for themselves?

AYANA JORDAN, MD, PhD: Yeah. I think that, as you know, with the work that you're doing in your center, it's being developed to really figure out what are some markers that we can actually look at to be able to understand exactly how decision-making is being impacted, and so that's being developed—not ready for prime time yet. I am not as optimistic. I don't think we'll even have it ten years from now. But what I do think we will have is actual treatment for some of the substance use disorders that we don't have, and we're getting a lot of promising data with the GLP-1, really understanding how that's minimizing craving in alcohol use disorder and even some tobacco use disorders. Also, really looking at—I mean, we have it here at NYU—psychedelic research and seeing how there is an increase in serotonin that really allows for improved insight into decision-making that can help. So I think we'll have a lot more options in terms of treatments, but I think we're not quite there to really having the composition of understanding biologically what's happening with our patients that's limiting their ability to really engage. Some good news, right? Not great, but we'll have more tools to help us treat our needs—more tools in our toolkit.

CHARLES MARMAR, MD: And more understanding of the determinants of health also.

AYANA JORDAN, MD, PhD: Exactly.

CHARLES MARMAR, MD: And try to combine those.

AYANA JORDAN, MD, PhD: That's what it's all about.

CHARLES MARMAR, MD: It's been my great pleasure to have a conversation—too short today, so we'll, of course, have you back for this—with Dr. Ayana Jordan, the Barbara Wilson Professor of Psychiatry and an international leader in the care of historically underserved patients. And I often playfully say the hashtag line for our department is "a place where golden minds meet golden hearts," and you embody that so deeply. So thank you, and it's been a pleasure speaking with you.

AYANA JORDAN, MD, PhD: Brilliant. Thanks for having me.