**Like other chronic medical illnesses, substance use disorders have biological, social and behavioral components; and effective management of the disease requires attention to each of these pieces (similar to Type-II Diabetes).
**A recent call from a family member of a patient illustrates just how bad the situation is. This call was from a very senior level executive at a prestigious medical school, asking for advice on how to help his 26 year old son who has a serious heroin addiction. The son had been through five residential treatment programs over the past several years, at a cost to the family of over $150,000. In this case, he was literally too ashamed to contact one of his own organization’s physicians. This extraordinary degree of stigma and sense of isolation that families still experience is unjustified and incapacitating. The second thing that troubles me about this interaction is that although his son had been to five residential treatment programs, he was unaware that there were any FDA-approved medications for the treatment of opioid dependence. No treatment program had informed him or his son about these treatments, even in the face of repeated, potentially deadly relapses. This is not simply inappropriate – it is unethical.
**It is time and it is possible for individuals with emerging substance use disorders to have all available medical facts associated with the progression of addictive disease; to receive full disclosure and information about all evidence-based treatment options for their condition; and to have full access to all evidence-based therapies, medications and services. I am hopeful that the Affordable Care Act and the Parity Legislation together will create basic fairness for individuals and families affected by the disease of addiction. But if those landmark pieces of legislation are not enough, it will be time to stand together to demand the already available health benefits for the prevention and treatment of substance use.
Treatment has boxed itself into a corner. Centers have created a myth that if you send your loved one to us they will be fixed. Therefore, they charge astronomical fees essentially zapping a Families resources and then give us recovery rates as bad as only 15% getting well (number vary, but the “real” norm amongst honest Industry Therapists and Executives is between 10% & 20% don’t relapse after Treatment). If we made tires and 8 out of 10 failed new we would be out of business. It is also time to stop blaming the diseased individual and say “they were not ready” or “They didn’t do the work”. Programs need to step up to the plate and start realizing that what Treatment does is 4 things.
- Hopefully open the Patient to the notion and ability to speak about themselves in an honest fashion without wearing a mask.
- Provide a long-term Continuing Care Plan that includes Addiction Care Management.
Treatment Centers needs to lower their costs so that Families have the funds to afford other resources that are necessary for long-term recovery. Things like a Addiction Care Specialist that can assist in keeping all the pieces moving forward, provide accountability that the Addict is following through, bring in other resources such as Therapists, financial planners, Marriage Counselors etc.. as needed over the long haul.
Addiction is a Chronic Illness and like other Chronic Illnesses, like my 11 year old niece – diagnosed with Type I Diabetes since 4, there are multiple interactions with Professionals over time (it has been 7 years for her) to make sure she is accountable, the course of Treatment is working, her Parents are getting support and as she gets older she is educated more and more on what she needs to know. This is no different than the Model that needs to be developed for the Treatment of Addiction. It is already there for Diabetes and other Chronic Illnesses, all we have to do is take what works and leave the rest.
Addiction Care Management www.addictioncaremanagement.comis a step in the right direction but more needs to be done by Centers who need to take their heads out of the sand and see what is traditionally the way of doing things is not working. A Continuing Care Plan where you hands a Patient an AA Schedule, tell them to do 90 meetings in 90 days, get a Sponsor, work the steps, Help others, Trust god and maybe get a Therapist with no other help is archaic and a broken model.
**Treating addiction as a chronic disease – how do we get from here to there? July 2, 2013 by A. Thomas McLellan – Addiction Professional Magazine