Addiction isn’t just an issue for the health care field. The headlines in just the past few weeks have popped off the page – How Aggressive Tactics By The Makers Of OxyContin Helped Create A Crisis, Mayor Seeking To Sue Maker Of OxyContin Over Opioid Epidemic, and Overdoses Force Coroner To Use Funeral Home To Store Bodies.
The question is: What’s the best way to tackle the situation? In my article last week, How Much Residential Addiction Treatment Capacity Do We Need?, I asked about the rush to build residential addiction treatment beds. I’m not dismissing the need for residential treatment, but rather trying to gauge the relative level of investment needed.
In response to that article, I got great feedback from many readers including David Mee-Lee, M.D., senior vice president at The Change Companies and Train for Change. He wrote:
We need more feedback informed treatment; not necessarily more beds in which to lock people up and “cure” their addiction. We need a much broader continuum of outpatient and community resources like Assertive Community Treatment (ACT) and intensive care management (ICM). As with severe mental illness, the resources should be long-term for people with addiction who need chronic disease management. In addition, we need many more housing and community supports like wet, damp, and dry housing and Housing First initiatives to engage those with addiction.
The rush to residential beds is an old model of intensive treatment (and then aftercare) when we need a much more flexible and overlapping continuum of care and levels of care. The ASAM Criteria has five levels of residential and inpatient treatment and three levels of outpatient services, but the inpatient and residential beds need to be for stabilization, engagement, and linking people to ongoing addiction treatment — not the old exclusively Therapeutic Community (TC) model of the total personality makeover, “complete the program,” “graduation” model of care (see The Market Impact Of The New Medicaid Addiction Treatment Benefits and The Changing Medicaid Addiction Landscape – What The California Experience Can Teach Us).
When the public and the treatment field accepts addiction as an illness needing engagement strategies, then we will see residential treatment as just one part of the continuum of disease management services. These strategies include “discovery, dropout prevention” for those in pre-contemplation and early stages of change; and “recovery, relapse prevention” services for those further along in recovery.
The old “going off to rehab” model does not fit addiction and its service needs. It creates waiting lists; poor access to services; inefficient use of resources; and unrealistic expectations for success by mandating long lengths of stay in residential treatment. (As if we can force people into recovery instead of attracting them into recovery using evidence-based practices like motivational interviewing, stages of change work, CBT and Interactive Journaling.)
We need person-centered, individualized treatment based on careful multidimensional assessment and then collaborative, shared-decision making with patients and clients that empowers and attracts people with addiction into recovery. We need more real-time, outcomes-driven, measurement-based practice.
I think Dr. Mee-Lee’s comments are a call to action at many levels – the policy level, for health plans, and for provider organizations. How do we change the treatment paradigm to match both the changing needs of consumers and to leverage the “new science”? As a critical first step, we need policy clarity on exactly what that new paradigm is. And, we need to determine how to finance a system that incorporates that paradigm while creating a new value-based reimbursement model that offers good outcomes for consumers and financial sustainability for provider organizations.
For more, check out these recent resources from OPEN MINDS – An Update On States With Medicaid 1115 Waivers For Addiction Treatment, The Addiction Treatment Market: $36 Billion In Spending In 2015, and What State Medicaid Plans Carve-Out Addiction Treatment Services?: An OPEN MINDS Market Intelligence Report. And, to continue the discussion on the appropriate level of residential addiction treatment services, be sure to join us on June 6, 2017, at The OPEN MINDS Strategy & Innovation Institute for the session, “The Shift From Residential: Keeping Up With The Changing Addiction Treatment Landscape.”