“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.
I just wanted to bring it to your attention there is a pic of NA key tags i believe this is against our traditions #10 ,,~ NA has no opinion on outside issues; hence the NA name ought never be drawn into public controversy~ i think by showing the tags its giving the impression that we are linked to you ….. and there`s a copyright on NA … i`m not speaking for NA i`m just saying of what i know of the program ,,I think this would be different if it just showed the 1 year clean side and not the other tag in the hand that shows NA, thank you for your time
From your lips to God’s ear
Try to find treatment for my grandson has been difficult. Most rehab centers in North Carolina is very limited. The waiting list is long and requirements are hard to accomplish while the person is waiting. Waiting is hard on addicts. North Carolina needs more help available if we are to beat this crisis.
Thank you Bill.
I would love to be part of a policy change for greater than 90 days of recovery treatment be mandatory.
Please look me up on Linked In. lets connect …….
Lisa C (Restaino)Flaherty
Thanks, Bill. You’ve nailed it, as you always do. Keep fighting the good fight. Please also be aware we are having a MARTI conference in July at IUP. I hope you can attend. There might be opportunities to speak.
@Ronnette
Yes, that is correct.
One of my friends was offered a MONTH’S supply of Oxycontin for a dental procedure.
Luckily, he recoiled in horror and refused.
Apparently the current medical practice is to give you opioids until you are addicted, then abruptly stop prescribing them on the grounds that you’re an addict.
So then you have to descend into the criminal underworld to feed your habit.
———–
On the other hand, does anyone know what percent of addictions are iatrogenic and what percent are self-inflicted recreational uses?
According to the following article, Psychiatr Serv. 2014 Jun 1; 65(6): 718–726,
“Substance Abuse Intensive Outpatient Programs: Assessing the Evidence,”
Dennis McCarty, Ph.D. et al concluded: “Multiple randomized trials and naturalistic analyses compared IOPs with inpatient or residential care; these types of services had comparable outcomes. All studies reported substantial reductions in alcohol and drug use between baseline and follow-up.”
Dr. Stauffer’s article is an opinion piece that doesn’t offer clear evidence for his stance. While there are benefits to short-term residential care for a certain subset of patients (including those for whom unsupervised detox may be dangerous), there are also many drawbacks to prolonged lengths of inpatient stay. These include separation from family and friends, lost productivity at work, and the inability to confront, in the real world, those triggers for substance abuse that the individual must learn to deal with. Then there’s the cost. Dr. Stauffer may also have a financial interest in residential treatment for 90 days being the standard of care. In my experience, the money would be better spent in intensive outpatient programs that provide surveillance and support for as long as the patient needs it but keeps them integrated with their community. While I agree that “Addiction Treatment is Broken” I take strong issue with Dr. Stouffer’s solution.
Anne Phelan-Adams
According to the following article, Psychiatr Serv. 2014 Jun 1; 65(6): 718–726,
“Substance Abuse Intensive Outpatient Programs: Assessing the Evidence,”
Dennis McCarty, Ph.D.,et all concluded: “Multiple randomized trials and naturalistic analyses compared IOPs with inpatient or residential care; these types of services had comparable outcomes. All studies reported substantial reductions in alcohol and drug use between baseline and follow-up.”
Dr. Stauffer’s article is an opinion piece that doesn’t offer clear evidence for his stance. While there are benefits to short-term residential care for a certain subset of patients (including those for whom unsupervised detox may be dangerous), there are also many drawbacks to prolonged lengths of inpatient stay. These include separation from family and friends, lost productivity at work, and the inability to confront, in the real world, those triggers for substance abuse that the individual must learn to deal with. Then there’s the cost. Dr. Stauffer, who works in residential care settings, may have a financial interest in residential treatment for 90 days being the standard of care. In my experience, the money would be better spent in intensive outpatient programs that provide surveillance and support for as long as the patient needs it but keeps them integrated with their community. While I agree that “Addiction Treatment is Broken” I take strong issue with Dr. Stouffer’s solution.
Anne Phelan-Adams
What’s you evidence that he works in a residential setting and has a financial interest in residential?
He writes that his vision “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.”
He references the NIDA principles of effective treatment, which is explicitly *not* referencing inpatient or residential treatment for 90 days.
He goes on to advocate for recovery community centers and collegiate recovery programs as well as access to medical services, psychiatric services, and social support.
I am amazed every day the ignorance of people about drug addiction. Do you know how many people are addicted to drugs because of dr.s careless prescribing of opioids ? High school athletes that were smart,happy, with dreams of a college education, careers, and families that were destroyed because of an injury that was fixed with opioids by greedy drs for kickbacks and sales reps looking for nice incentives. Everyone is one accident away from addiction. If you don’t think it could happen to you or someone you love you need to pull your head out of the sand. I truly hope that you never have to live with an addicted loved one. We are loosing a whole generation of children to this epidemic.
Who will pay for this expensive, extremely long and elaborate treatment when so many law abiding productive citizens do not receive needed medical care for conditions which they themselves have not caused? I received a permanent injury ( 40 years ago ) which causes more medical issues and greater financial costs as I age. A hit and run driver who made the decision to use illegal drugs and drive rammed my vehicle. Why should the perpetrators be given excessive benefits while the victims of these criminals are left with chronic injuries which causes lower quality of life and financial expenditures for the remainder of their lives? Who will pay for their healthcare and make them whole again? It seems again that the victims’ needs are ignored while the criminals are given excessive care and life long benefits. The drug addicts make the decision to use illegal drugs and carelessly and deliberately place innocent citizens at risk. Too many drug addicts do not fear any consequences for their actions. If they overdose they are repeatedly treated and pay no bills. The massive financial burden caused by these drug addicts are causing higher healthcare premiums for the rest of us and they overburden our emergency services and hospitals. They must be responsible for their actions and their bills. I am only one of the millions that are injured by drunk drivers or drug addicts. Drug addicts will do anything for money to feed their habit whether it be robbing a citizen, shoplifting, carjacking, etc which causes more financial burdens for citizens. I have seen the results of their actions while working at a level 1 trauma center and seen how a relative refused treatment paid for by his family and how he continued to use illegal drugs for decades before he died of cancer. Unfortunately we can not force people to be responsible citizens when they have no desire to do so.
You are 100% correct.
Addicts elect to become mortally wounded, and then spend the rest of their lives injuring others — their victims, their families, the general citizens who pick up their costs.
Sometimes the injuries that addicts inflict are fatal.
But what can we do?
We can’t just let them roam the earth carjacking and breaking in to people’s homes.
I suggest “harm mitigation” instead of useless attempts to fix them.
We could assign them to an agency to pay for their costs of living in a cheap apartment.
Then they can consume drugs in controlled conditions as much as they like.
We’d save a fortune — all of which could go directly to their many victims.