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2010 Outstanding Clinicians Awards: Joseph A. Troncale, MD

January 1, 2010
by root
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In his eight years as medical director and then senior physician at Caron Treatment Centers, Joseph Troncale, MD, was instrumental in the organization's ability to counteract a conservative image by investigating and integrating leading-edge treatments.

Position: Senior physician

Organization: At time of award, Caron Treatment Centers in Wernersville, Pa. Troncale retired from Caron at the end of December and is now working at Lancaster General Hospital.

Age: 57

Quote: “We have doctors now who are addictionologists at hospitals, but this is still an area that's woefully underserved. Some hospitals don't see it as an essential service.”

Comment from a colleague: “He is a patient's doctor,” Caron president and CEO Doug Tieman says of Troncale. “He loves spending time with patients.”

“Our first utilization of buprenorphine occurred under his watch,” recalls Caron president and CEO Doug Tieman. “We were beginning to use it off-label for heroin detox, and he helped us to do an effective job.” Tieman explains that discharges against medical advice were substantially higher for heroin addicts treated at Caron than for other groups in its patient population, but the introduction of a stabilizing medication changed that.

These kinds of accomplishments were striking for a physician who essentially fell into addiction practice. He had been in family practice until he was asked to be medical director for a dual diagnosis unit at Lancaster General Hospital in the 1990s. “I was always interested in behavioral issues,” Troncale recalls. “I thought I knew a lot about addictions, but I was wrong.”

Now he can look back on his days as a young physician, when patients with alcohol problems would receive no more than a medical detox and a trip through the revolving door of crisis treatment, and he can describe them as horrifying. “There was no real treatment involved,” Troncale says.

The Alabama native left Lancaster General when his treatment unit was about to lose its funding as a result of Medicaid cuts, and he joined Caron in 2001. He is widely credited for bringing a psychiatry base to a treatment center that historically had focused on non-medicinal ways to help clients. This was back when the AA ethic seemed to frown on a recovering person even taking an acetaminophen tablet.

“Now we have two part-time psychiatrists, and eight to ten psychologists,” Troncale said before his late December retirement from Caron. Use of buprenorphine, naltrexone and other medication treatments became more common under his watch. Six months before his departure from Caron, he moved into the role of senior physician, working largely in patient and family education, as another physician with a strong background in current medication options took over as medical director.

“He said, ‘I want to be with patients,’” Tieman says.

Some of Troncale's most memorable work with patients and families at Caron revolved around his lecture on the lizard brain, a talk that has become legendary in the organization. “He has helped families understand what their loved one was going through,” Tieman says.

Troncale now has come full circle, having returned to Lancaster General in September to work in occupational medicine. Chairman of the Family and Generational Issues Workgroup for the American Society of Addiction Medicine (ASAM), Troncale also is hoping to launch a services program through his family's church.

“What I'll miss most about Caron is the contact with patients,” he says. “When someone is 25 and on heroin, just to get them engaged in treatment, what I honestly tried to do is reframe a crisis into an opportunity.”

Addiction Professional 2010 January-February;8(1):16-17