ADDICTION TREATMENT MUST REUNITE WITH MEDICAL CARE

I applaud the Journal Star for running the series on "Silent
Treatment, Addiction in America." The five articles strongly pointed
out the need for effective addiction treatment.

If I walked into most addiction treatment programs in the U.S. today,
I would, unfortunately, find few changes in the treatment approaches
used 30 years ago when I entered the field.

In the 1970s, the addiction treatment industry fought against being
dominated by physicians and a traditional medical approach. And we
won, to the detriment of those in need.

The medical field dismissed addiction treatment as ineffective. What
a victory. A recent study from Columbia University indicated that
only 2.1 percent of physicians think drug treatment is very
effective. Addiction is an afterthought, at best, in primary care.

There are new medications for addiction treatment available and many
more in development. Further, a very high percentage of people
receiving drug treatment have mental health and physical health
disorders as well. So the reunion of addiction treatment and medical
care is long overdue.

If treatment followed by continual abstinence is the criteria,
addiction treatment is not usually "successful." Most people who have
participated in treatment return to using. The same experience is
prevalent in the treatment of other chronic disorders, such as
diabetes. Few would condemn a person fighting diabetes for failing to
continue to faithfully follow a strict daily diet or weight-loss
program. Yet we blame people who are addicted if they do not
immediately overcome their addiction.

By definition, a chronic disorder implies that short-term treatment
should not be expected to produce immediate and lasting positive
outcomes. Standard addiction treatment follows an admit, treat and
discharge model.

We must implement a system that supports ongoing recovery and allows
rapid assistance if a person does return to using drugs or alcohol.
This method is being developed in several places, including Arizona
and Connecticut.

Recovery should be the focus, not treatment. Some people require
treatment to achieve recovery while others do not. Last year, the
Substance Abuse and Mental Health Services Administration held a
meeting that solely focused on addiction recovery. I was honored to
be invited to attend along with many people featured in the Journal
Star series.

A common theme emerged: "There are many pathways to recovery and all
should be valued." Whether a person chooses formal treatment, a
12-step program, faith-based support, secular support or simply
experiences a personal decision for change, the importance is not the
means, but the results. There is no one way that works for all.

That said, when people choose treatment, we have an obligation to
give them the best we have to offer. Unfortunately, that is usually
not the case. Studies have shown the techniques with the greatest
scientific evidence are the least used. A recent RAND study on the
quality of health care in America showed only a 10.5 percent chance
of receiving alcoholism treatment based on scientific recommendations.

So what can be done?

Funding entities must start paying for performance. It is really that
simple. In the existing payment system, there is often a perverse
incentive. For example, if my organization repeatedly detoxifies an
individual, we get paid for each day. Thus, recidivism is rewarded.

What if we were paid more if detoxification was followed by
participation in treatment? What if we were paid more if we retained
people in treatment rather than simply filling a vacant bed or
outpatient slot with a new person? And what if we were paid less for
failure to achieve these objectives? Would change occur? You bet, and fast.

Some funders have started to experiment with such changes on the East
Coast. Providers will change if their funding is at risk. Change can
be accomplished with existing dollars by realigning the payment system.

The Robert Wood Johnson Foundation is spearheading another initiative
called the Network for the Improvement of Addiction Treatment. This
collaboration of 50 providers, including five states, seeks to
improve access to and retention in treatment. After only three years
the results have been dramatic. Participants have found ways to
dramatically reduce the time between a call for help and admission to
treatment. They have significantly increased continuation in
treatment by teaching providers to use proven techniques of process
improvement.

The most important element is very simple: Listen to your customer
and design your systems to meet his or her wants and needs.

Indeed, those offering addiction treatment can do better.