Embracing the idea of addiction management
I believe basic truths in life get repackaged in unique or creative ways throughout time, resurfacing in books, self-help strategies, stories, movies, or movements. When these things come on to our radar seemingly for the first time, we either embrace them and they become big hits, or we reject or dismiss the ideas because the timing is off - our society is not yet ready.
How to deal with addiction is one of these “basic truths.” Although mankind has behaved in excessive ways for centuries, only in the past couple-hundred years has society evolved the idea of excessive behavior being called “addiction” and requiring intervention. And, only in the past 5 to 10 years has society been ready to accept the basic truth that addictions are problems that we manage over long periods of time, similar to other chronic conditions. In 1955 the book Management of Addictions was published, offering a collection of treatment approaches for alcohol and drug abuse problems. Although the interventions outlined in the book provide significant evidence for how far we have come in our treatments, what I find most interesting is that over 50 years ago a collection of healthcare professionals embraced the idea of “management” in dealing with addiction.
Yet today, we give lip service to addiction being a chronic condition and still largely treat it as an acute problem, where average treatment stays can be measured in days or months. At an addiction treatment conference not long ago, I was frustrated by the complete lack of discussion about how to transform our current acute-based system into one that truly embraced addiction as a chronic condition. It was the elephant in the living room, yet folks went on and on about this ear and that toe…little incremental band-aid solutions to treatment - completely ignoring the opportunity to truly talk about how we might improve care for millions through systems-level change.
I don’t blame them. We have invested a lot in our current system, and many have built careers around the status quo. But the time is right to envision a new treatment enterprise that truly embraces addiction as a chronic condition and wisely utilizes resources to optimize long-term patient outcomes. Idealistic? Maybe so, but the status quo presently sees less than 10 percent of those in need of help, staff turnover in treatment programs is higher than in the fast food industry, and of those fortunate enough to have access to treatment, most do so multiple times. We can and we must do better.
What does it mean to manage addiction? We know manage is a verb that implies action. So, what actions are necessary to get us where we need to be, both with our treatment system and in helping individuals who struggle? Here are a few things to get us started:
- We know multiple treatment episodes are costly because often patients require intensive services (detox, residential, transitional housing, etc.) upon each admission. We should find creative ways to incentivize or reward treatment providers who can keep patients in treatment for years, decreasing costly hospital admissions and residential stays.
- We need to leverage technology and the fact that over 70 percent of folks in the U.S. have high-speed Internet, and many of those who don’t, can still access it now in many public places. Recent evidence suggests that computer-based treatments may be as effective as individual or group counseling. Are human counselors soon to be replaced by robots? Likely not, but there is little doubt that in the years to come computer/Internet-based interventions will play a critical role in healthcare delivery.
- Addiction treatment providers (and patients) should beg, steal (ok, maybe not steal), borrow, utilize, and adapt management interventions from diverse disciplines. Significant research has been devoted to the topic of how best to manage chronic conditions, such as the chronic care model. Let’s not reinvent the wheel, but seek out what others have done, and bring practical, useful, easy-to-implement behavioral management tools to those who need them now.
It’s your turn. What can we do to start transforming our current acute-based addiction treatment system into one that is similar to how primary care treats other chronic medical conditions? What self-management or disease-management tools do you believe are the most helpful? How might we package these tools to make them more accessible to the 90 percent who presently are on their own to deal with addiction?
No problem this big gets solved one clinician at a time. There are too many variables, too many invested parties and too much red tape. Our profession has recently just won the right to bill insurance in all 50 states…this took time. It also took a large population of professionals to join together, write letters, donate money and time to ensure that, through the legislative process, counselors received the same benefits as MSW’s. The NAADAC’s website states it supports a comprehensive approach, yet still identifies specific substance abuse without addressing overall addictive behaviors. NAADAC’s legislative committee even asks for funding that only addresses substance abuse without taking a holistic account of the disease.
$1.847 billion – Substance Abuse Prevention & Treatment Block Grant
$472 million – Center for Substance Abuse Treatment (CSAT)
$210 million – Center for Substance Abuse Prevention (CSAP)
$1.064 billion – National Institute on Drug Abuse (NIDA)
$464 million – National Institute on Alcohol Abuse and Alcoholism (NIAAA)
$441 million – Safe & Drug Free Schools/Communities
Based on this information I must assume that our society and addiction professionals are not ready for a holistic approach of addiction management. Addiction is the number one public health issue in the United States today. According to the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 22.2 million people aged 12 or older needed treatment for an alcohol or illicit drug problem in 2003. Of those 22.2 million people – almost 10% of the US population – only 1.2 million received treatment for their disorder. Unfortunately, for our society the addiction problem may only get worse. Until we truly all get on the same page our fate looks bleak.
Response to “jryan says: October 26, 2009 at 10:36 am”
Your idea of adding social skills type classes into our school system is great, great and superb! Merely training students academically is setting them up for failure. Knowing how to read the periodic table of elements will avail you nothing when you get laid off the job and someone offers to get you high to take your mind off of it. This is program that would surely be beset by attackers on all side if introduced at the next PTA meeting. “Teach my kid about crack, prostitutes and finances?! Its my kid. I’ll tell them about them when it right and proper!” is something along the lines this program would be met with. But with time and patience it can see the light of day. Training our children to not only become a great student, to nurture their emotional I.Q and skills to be a better citizen in our society will only help us all in the long run.
Shannon’s post rings true because it addresses the fact that we as humans often and in many ways do not care for each other, and at times it feels like participation in this culture is hinged upon adopting uncaring attitudes towards people. For instance, how often do we “tune out” homeless people on the street, because there are so many of them and we can’t give them all money, so we might as well pretend we are blind to their issues, and their very existence. The sad part to me is, given this world we’re in, many of us find addiction to be an adaptive way of participating in the culture. It is possible to be successful with an addiction, in fact, I’d say sometimes addictive behaviors, such as womanizing, can help facilitate the versions of extreme power we see played out by “Great Men” who rule the world, who embody what seems to be a destructive power.