“If you build it, they will come” doesn’t apply just to a baseball stadium in a cornfield. I believe that the same principle will work for creating affordable, effective treatment for addiction in the United States.
Despite well-meaning rhetoric and funding from sources both public and private, the U.S. has an appalling dearth of person-centered care for the millions of Americans living with addiction, the biggest public health crisis of our time.
I have worked in the recovery field for more than 30 years. I have seen individuals with addiction recover because they got the care they needed. Sadly, they are the minority, since our country does not have the treatment and recovery support infrastructure it so desperately needs. Five years of sustained recovery from substance use is the benchmark: 85% of people who achieve that remain in recovery for life. So it makes no sense to me that we aren’t designing our care systems around this goal.
According to the National Institute on Drug Abuse, treatment “for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommend for maintaining positive outcomes.”
But few Americans get anywhere near 90 days of care. Within the confines of existing insurance networks, short-term treatment of 28 days or less is all that most Americans are offered — if they can get any help at all. This ultimately reflects the soft bigotry of low expectations: an inadequate care system designed to deliver less than what people need because we still moralize addiction and do not value people who have substance use disorders.
Here’s my vision for what substance use treatment should look like: Generally, it starts with a minimum of 90 days in a professionally staffed, licensed program providing evidence-based care. For some, but not all, this would be a residential program. It should also include the establishment of recovery centers in every community — places where people in recovery can support each other. A viable treatment system would also include ongoing peer support services for individuals and families affected by addiction for at least five years that help sustain recovery.
Consider a young woman with an addiction problem. Getting help for her is hard to do. In Pennsylvania, where I live and work, 11 adolescent treatment facilities have been shuttered over the last decade even as overdose has become a leading cause of death for young people in the state.
I envision a system in which she could access residential care without delays or intricate authorization processes, stay there for the time she needs, then return to the community to participate in age-appropriate treatment and education. She would attend a high school designed to provide a safe, recovery-oriented environment that would include alternative peer groups that support the social and recreational needs of youths in recovery. Once she is ready for college, this young person could attend a school with a collegiate recovery program, which is set up to provide support for students in recovery nestled in the larger academic community.
By achieving recovery with help from a system like this, she would avoid the medical, social, and criminal costs that come with addiction, not to mention experience the benefits of recovery. This is what we all want for our own families, and it is what we should expect from our care systems.
An adult with an addiction also needs 90 days of evidence-based care in a professionally staffed, licensed program. This should be the minimum standard for treatment offered by every insurance policy in the nation; they also need to include family services. Treatment must address the individual’s co-occurring medical, psychiatric, relational, and other needs in a holistic fashion.
Care should include services to help individuals reorient themselves to living in recovery with the support they need to heal. The services needed generally diminish in intensity over time based on an individual’s needs.
In the event of a relapse, more intensive services should be resumed without arbitrary limits from insurers.
People in early recovery should have access to active recovery resources like the one in my community, Sync Recovery Community, where I once was a volunteer. It provides opportunities to hike, bowl, kayak, and develop new social connections with others in recovery, which is critically important.
Once an individual achieves stable recovery, she or he should still be provided with an annual recovery check-up at least through the five-year mark, when the research tells us that return to active addiction is unlikely.
Addiction is pervasive, and help is elusive. It is past time to make recovery pervasive so we can protect our family members, friends, neighbors, and countrymen from the corrosive impact of addiction. It would cost a fraction of what not helping people costs us.
According to the U.S. Surgeon General, the cost of not helping individuals with opioid addictions was around $440 billion. The cost also includes lost productivity, as well as addiction-related costs associated with the criminal justice, health care, and human service systems.
Roughly 40% of people who have substance abuse problems also have mental health issues, yet fewer than half receive treatment for either disorder. Closing this treatment gap and spending money to help people recover would save both money and lives.
Sadly, even when individuals find treatment today, they often experience significant barriers to entry, including complicated insurance requirements, high out-of-pocket costs, and out-of-network providers that can make treatment unaffordable for most people. This status quo continues despite increasing evidence of its inadequacy: study after study has revealed that very short term care is minimally effective.
Many policy makers, and even many Americans, see people with addictions as “those people.” But they are really our people and, given the proper treatment and support, recovery is the likely outcome for them.
William Stauffer is the executive director of the Pennsylvania Recovery Organizations Alliance and an adjunct faculty member at Misericordia University in Dallas, Pennsylvania.