Two decades into addiction crisis, one solution not yet tried: more comprehensive, longer care
By Jeremiah Gardner
NOTE: This was originally published for the Hazelden Betty Ford Foundation’s monthly Recovery Advocacy Update. If you’d like to receive our advocacy emails, subscribe today.
As America’s addiction crisis has progressed over 25 years, claiming millions of lives and harming hundreds of millions more, we’ve seen a dramatic increase in public dialogue and awareness and, at the same time, a rise in sober curiosity. The topic seems to get prominent mention in the President’s State of the Union address annually.
In recent years, the government has stepped up to increase related grant funding, incentivize solution-oriented special projects and startups, expand harm reduction and recovery support services, expand access to treatment through Medicaid expansion, regulatory reform, and more. But still … we have stagnant addiction rates amid an ever-more dangerous drug supply and increasing mental health concerns. It begs the question, are we missing opportunities?
One solution we haven’t tried during the entirety of the overdose epidemic and broader addiction crisis — as it relates to those with severe substance use disorders — is whether more comprehensive and longer addiction care would make a difference.
To the contrary, the nation has actually been testing — amid continued parity setbacks and a proliferation of lower-threshold solutions — whether shorter treatment and less comprehensive interventions work.
Ask the families and professionals in the middle of it all, though, and most will say their loved ones and patients need more.
For years, we have seen evidence that long-term care engagement is important to successful outcomes for those with a severe SUD diagnosis. We’ve known that pilots and physicians are required to engage in care longer than most, and that they experience better outcomes. At Hazelden Betty Ford, we know people who engage in our recovery management programs (lengthening their overall engagement) experience better outcomes. Long-term care is also a common theme in many of the most transformative stories we hear in our podcasts, articles and conversations.
It should almost go without saying: longer care=better results. The problem is, it doesn’t go without saying. It requires more and better outcomes data.
Researcher Dr. Nick Hayes, chief science officer at Cumberland Heights in Tennessee, lays out the need for better outcomes in a recent op-ed. He is helping drive better outcomes data collection through work with the National Association of Addiction Treatment Providers.
It seems to me the challenge is this: doing what’s right for people with severe substance use disorders is dauntingly expensive.
If I had a loved one right now who needed care for a severe substance use disorder, I’d want them to have comprehensive residential care that included therapy, medications, peer support, and medical and mental health care —all for several weeks until my loved one demonstrated they were ready to begin moving into lower-intensity services and community-based supports, which might look something like outpatient treatment, with sober living and a peer coach for several months followed by active monitoring and check-ins through their first five years of recovery. I’d want our family to have services too.
That ideal, though, is expensive. And the health system, starting with payers, isn’t ready for it. But how do we get there?
NAATP may be on the right track focusing on outcomes.
In the late 90s and first decade of the 2000s, recovery advocacy was focused pretty intently on the issue of parity — getting a law passed that said insurance coverage for addiction and mental health must be on par with coverage for other health conditions. It was a unifying issue, and the driving rationale for more/better coverage was fairness, with recovery stories at the foundation of advocacy efforts.
Well, we still need more and better coverage. Only this time, rather than fairness alone, the rationale for any long-term Parity 2.0 effort may need to be effectiveness. Recovery stories will continue to help — they’re always a must. But to move toward the ideal length, amount and quality of care — in a way that’s accessible to most, not just a few, and that includes both initial treatment and coordinated ongoing support for up to five years— we need to focus on research and outcomes. It’s the next logical step and could be another decade-long, unifying theme for treatment and recovery advocates.
Jeremiah Gardner is director of communications and public affairs for the nonprofit Hazelden Betty Ford Foundation.
