Failing to Treat Its Afflicted Citizens
According to our US Surgeon General, Vivek Murthy, there is a huge deficit of addiction treatment facilities in America, just as our national opioid epidemic is hitting epic proportions.
It is a grave situation that is counter-productive because it’s estimated that every $1 invested in viable addiction treatment options for substance use disorders saves $4 in health care costs and $7 in criminal justice costs. That presents huge potential savings, particularly when you consider the economic impact of drug and alcohol misuse amounts to $442 billion per year (as compared to diabetes at around $250 billion per year). Then there’s the tremendous impact of social costs which include the fact that one-third of all traffic fatalities are alcohol related and that, on average, one American dies every 19 minutes from a heroin or opioid overdose. Given the dramatic costs, we should see extensive bi-partisan support from both social liberals and fiscal conservatives alike.
Congress Passes $1 Billion addiction treatment initiative…at last.
Yet, it took more than an entire year. And even then it had to be watered down and otherwise attached to a broader Food and Drug Administration bill designed to speed up drug approvals. In addition, it’s not even clear how much of that $1 billion will go towards treatment. A good portion will be spent on administrative expenses and to set up special drug courts to mimic “diversion” programs quite common under state judicial systems.
While it’s clearly a worthy goal to send fewer substance abusers to prison, that part of the program will quickly eat up a large chunk of the allocated funds. Moreover, is $1 billion even nearly enough? It’s like trying to take down an elephant with a pea shooter. The government wanted to throw $1 billion at the Zika virus, which in its entirety accounted for fewer deaths than addiction kills in a mere few hours. So my question to you is: Where’s the anger? Where’s the moral outrage? What are we missing?
Awareness is the key
The public is surely aware of the magnitude of the issue. It shows up periodically on the nightly TV news, and gets splashed into articles in local and national newspapers, online ‘zines and in social media. Most people even know a good friend or family member who is afflicted with addiction.
Yet in spite of all that, it was an issue that barely arose during this past year’s presidential election and received no attention whatsoever during the debates. Why is it that a national crisis of such immense proportions doesn’t gain more sympathy and support?
Coming to terms with the national epidemic
While there is no obvious reason for this disconnect, it seems that the main impetus might be a lack of education, from our community to the public at large. Let’s face it, it’s only relatively recently that the medical community itself has universally come to terms with classifying addiction as a chronic disease. The average American still believes that addiction stems from a personal weakness or a moral shortcoming. They believe addiction involves a lack of will power and that if the person only tried harder, only made more of an effort, he or she could overcome the substance abuse.
Many of our current treatment methods also still haven’t fully adopted the disease model, fostering belief of a quick fix program in a nurturing environment. Addicted individuals are sent to Detox, diverted to 28 day programs as an alternative to incarceration, or offered out-patient treatment to help them get better. Then, even while in treatment, most of the focus is on short term goals and getting to a point of graduation into sobriety. While treatment is surely evolving with our better understanding of addiction as a brain disorder, there is still a certain allure in trying to “solve” the problem of addiction.
After all, that’s what patients have grown accustomed to hearing for decades. It’s difficult to transition their expectations overnight. As a result, not nearly enough effort is put into after-care programs, where the truly hard, long-term work needs to be accomplished. Nonetheless, before too long, we will all be forced to cope with that reality, both for the sake of our patients and our own survival. The upcoming changes in compensation structure towards “results-oriented” care will reverberate throughout our industry as we adapt. So, since we, ourselves, have not fully implemented care conforming to the model of addiction as a chronic disease, how can we expect laymen without any experience to think any differently?
A Paradigm Shift Is Approaching
The simple reality is that we are in the midst of a compelling paradigm shift in how addiction is viewed and to be treated. Just as with any other paradigm shift, it will take time to fully take hold. Women did not get the right to vote overnight and desegregation didn’t occur in an instant. They were moral imperatives of our most basic human rights, yet they required a gradual shift before rising to the level of rightful general acceptance. It is a process akin to that we now face in getting our fellow citizens and politicians to understand that addiction is not a personal fault, but rather a multi-faceted disease, stemming from misfiring neurons in the brain.
Even within our own community, it has taken a while for this notion to gain traction. We still wrestle with finding the best mix of methodology that will have the most profound impact. As with any chronic disease, we need to initially focus on a full-frontal attack, which is now generally common practice. During that initial period the goal is to get the disease into a manageable state. From there, the patient requires structured, intensive and active maintenance for a period of 1-2 years, focused on maintaining the hard fought benefits gained by achieving sobriety.
The final phase involves general supervision and continued vigilance, of at least 2-3 years additionally, to ensure that the newly formed healthy habits remain intact. However, even then, the process is not complete. It is unfortunately never complete. As with any other chronic disease, we need to recognize that the best we can do is treat the symptoms, because at the moment there is no cure. We can quiet the cravings and euphoric recall, but never eliminate them.
Can we make a difference? Yes, we can.
So the $1 billion question is “what can we do to garner more support and make a difference?” To begin with, we need to continue the evolution of treatment within our own community. This is not only necessary given our newfound greater understanding of addiction, but a financial inevitability if we are to survive in the soon to be implemented results-oriented health care compensation model. Any treatment center with a high relapse rate, will find itself drowning in unfunded ongoing treatment requirements. The second vital step is community outreach and education. People need to understand, learn and appreciate the urgency of the issue, its excessive costs and why spending more resources on actual addiction treatment will lead to huge cost savings in the long run. The recent US Surgeon General’s report “Facing Addiction in America” is an excellent tool, but it’s also a huge publication that your average person will never read. It is therefore incumbent upon us to share that information in easy to use formats, to help educate our fellow Americans, and, when we do, we will be happily surprised by the impact we can have shaping the national dialogue on addiction.