Pubdate: Sun, 20 Aug 2006
Source: Peoria Journal Star (IL)
Copyright: 2006sPeoria Journal Star
Contact:  http://pjstar.com/
Details: http://www.mapinc.org/media/338
Note: Does not publish letters from outside our circulation area.
Author: Michael G. Boyle
Note: Michael G. Boyle is president and CEO of the Fayette Companies, 
a Peoria-based not-for-profit firm that provides services dealing 
with mental health, drug and alcohol treatment, employee assistance 
programs and management consultation.
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

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.
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MAP posted-by: Beth Wehrman