Steal This Blog Post – Policy Considerations to Improve Our Substance Use Care System
“The only way to support a revolution is to make your own” – Abbie Hoffman
The title of the post is a thinly veiled reference to the late social activist Abbie Hoffman. It has been said that the best way to get stuff done is to not have to take credit for it. The intent in posting this is to ask readers to review the ideas, take them to add to efforts to get ideas out there into the world for consideration in a spirit of contribution.
Readers may really like the ideas, readers may like some and not all, or some may not even like any of them. To all I say wonderful! Use what you like and dispense with the rest. Take in whole, modify, or even delete and move on. Feedback welcomed – I am genuinely interested in your thoughts.
So below and ATTACHED are ideas for improving our substance use care system. As Abbie said, start your own revolution, but perhaps we may all also listen to each other and seek the common ground that will benefit all of us and avoid the toxic ego centered debates that result in a quagmire of conflict that ultimately harms us all.
While largely mine in authorship, the ideas are the culmination of a whole lot of conversations with people here in PA and beyond and influenced by some of our community’s deepest thinkers.
Guiding Principles of Consideration on Treatment & Recovery for the Biden Administration
Scope of the Problem – Addiction and its consequences are arguable our greatest domestic challenges, costing lives, breaking up families with devastating community and economic consequences across our entire society.
- The COVID-19 pandemic is exacerbating the dynamics of deaths of despair and will eventually eclipse it.
- Historically, our treatment & recovery has been acute focused and fragmented. Stigma against persons experiencing addiction has resulted in a care system built on low expectations of recovery. Even the concept of abstinence as defined as not use addictive drugs in ways not prescribed has been stigmatized by some.
- Despite the reality that 85% of persons who sustain recovery over five years remain in recovery for the rest of their lives, our care system is not designed around this overarching goal.
The Goal – Our entire social service and behavioral health system should be aligned towards a long-term recovery orientation to focus on restoring individuals, families and communities to full functioning and freedom from addiction.
Treatment and Recovery Support Services – Addiction is a bio-psycho-social-spiritual disorder impacting diverse communities. We need to equitably address all aspects of it and not solely focus on biological and medical dimensions.[1]
- We believe in and support the NIDA Principles of Effective Treatment[2]. Federal funding should follow these principles and guide who and what is funded in an equitable manner that meets actual needs.
- The five-year recovery model currently only used in professional monitoring programs, should be scaled and modified to be available to everyone with an addiction, to replicate these remarkable recovery rates for persons using MAT and non-MAT pathways in order to expand recovery opportunities for millions of Americans.[3]
- Care must address polysubstance use and not be single drug focused as this is how addiction occurs in real life.
- Study and implement Cascade of Care for OUD as a framework to bridge the divide between harm reduction, prevention, treatment, and recovery and effectively build out a comprehensive continuum of care for everyone.[4]
- Full implementation and enforcement of parity for addiction treatment with other chronic conditions is essential.
Many Paths to Recovery – Recovery is a voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship[5].
- People should receive individualized care. No single pathway is best for everyone.
- There is robust evidence to support Twelve Step Facilitation[6] and federal funding should be available to programs that utilize this as their treatment modality as well as other effective strategies including and beyond medication.
- Recovery builds resiliency to overcome trauma and as a result, we get better than well7.
Recovery in Criminal Justice While we must work towards getting people help prior to involvement with the criminal justice system, we recognize that this doesn’t always happen. As a result, addiction care should be provided before, during and after involvement with the criminal justice system, including pre-arrest diversion programs.8 9
Education & Workforce – All helping professionals must receive mandatory education on addiction care and recovery.
- The addiction professional workforce has a special skill set that needs to be recognized as a specialty with compensation to match10
- National credentialing standards need to be created by and for the addiction professionals they will guide.
Research – Published research should consider “real world” conditions such as polysubstance use and longer-term outcome measures focused on the bio-psycho-social-spiritual aspects of addiction and recovery.
Payment Reform – We need to incentivize long-term recovery and move away from our historically acute, fragmented care that yields poor outcomes such as continuum of care models such as the Addiction Recovery Medical Home Alternative Payment Model (ARMH-APM)11
[1] https://www.asam.org/asam-criteria/about
[2] NIDA. 2020, September 18. Principles of Effective Treatment. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment on 2020, December 3
[3] Dupont, R. L., Compton, W. M., & McLellan, A. T. (2015). Five-year recovery: A new standard for assessing the effectiveness of substance use disorder treatment. Journal of Substance Abuse Treatment, 58, 1-5.
[4] https://www.drugabuse.gov/news-events/news-releases/2019/01/cascade-of-care-model-recommended-for-opioid-crisis
[5] Betty Ford Institute Consensus Panel. What is recovery? A working definition from the Betty Ford Institute. J Subst Abuse Treat. 2007 Oct;33(3):221-8. doi: 10.1016/j.jsat.2007.06.001. PMID: 17889294.
6 Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880Hibbert LJ,
7 Best DW. Assessing recovery and functioning in former problem drinkers at different stages of their recovery journeys. Drug Alcohol Rev. 2011 Jan;30(1):12-20. doi: 10.1111/j.1465-3362.2010.00190.x. PMID: 21219492.
8 Butzin CA, Martin SS, Inciardi JA. Evaluating component effects of a prison-based treatment continuum. J Subst Abuse Treat. 2002 Mar;22(2):63-9. doi: 10.1016/s0740-5472(01)00216-1. PMID: 11932131.
9 https://ptaccollaborative.org/about/
10 https://aspe.hhs.gov/pdf-report/substance-use-disorder-workforce-issue-brief