Happy Spring to everyone.
I love when the air outside feels fresh and is breezy – it is a time of renewal and rededication to our growth, both physical and spiritual.
I am also excited and humbled to have been asked to be a sponsored lecturer at next week’s Innovations in Recovery conference in San Diego. The positive impact we are making in the lives of those in recovery here in Delray Beach is being recognized across the country, and it’s all good!
And now, when I am finding the fire in the belly kindle itself anew, I am lucky to stumble across an entirely amazing article from The Atlantic entitled: “The Irrationality of Alcoholics Anonymous” by Ms. Gabrielle Glaser.
I love articles like this, and hate them at the same time.
I love them because they are so comprehensive and capture, like a snapshot in time, where we are in the Recovery Community movement.
I also hate these articles because, well, I wasn’t the one who wrote it. J
All joking aside, I have written in the past about the internal struggle that the Recovery Community has faced between the old guard, who have obtained achievable and sustainable sobriety, and helped others do the same, though Fellowship, and the modern reality that healthcare insurance reimbursement models are focusing more on the advances that MAT (Medication Assisted Treatment) has made in combatting physical addiction to substances.
On one hand, there is the concept of sustainable sobriety for those who elect to find a “life of purpose” to fill their personal “hole in the soul.” [Isn’t this true for all of us? Read Holocaust survivor Victor Frakl’s book Man’s Search for Meaning and prepare to be humbled].
On the other hand, there is the recognition (if not mandate) to use science to effectuate change in substance abuse treatment, which is more easily said than done. If we are in the adolescence of the “science” of mental health treatment, then substance abuse treatment is still in its infancy.
And here is where self-determination and science bump heads: “Patients on naltrexone have to be motivated to keep taking the pill.” Are you motivated if you are hanging out at “Club Rehab” in Delray Beach, living off your parent’s insurance benefits, and getting either great treatment or shoddy treatment, depending upon how and who lured you to South Florida?
There has to be a reason to remain sober. Life, not surprisingly, is filled with pain and suffering, until we give it meaning. Add in successive generations of young Americans who have lost the ideal of “lifting oneself up by the bootstraps” and we have a recipe for disaster awaiting us as a country.
That said, there is hope and optimism that, as a nation, we are finally coming together to effectuate change, albeit with some bumps in the road. Here are a few snippets from the article:
Regarding the use of modern Medication Assisted Treatment:
The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work.
Regarding the impact of the ACA on the treatment of Substance Use Disorders:
The debate over the efficacy of 12-step programs has been quietly bubbling for decades among addiction specialists. But it has taken on new urgency with the passage of the Affordable Care Act, which requires all insurers and state Medicaid programs to pay for alcohol- and substance-abuse treatment, extending coverage to 32 million Americans who did not previously have it and providing a higher level of coverage for an additional 30 million.
Regarding the disparity in care between physicians who treat “patients” and treatment counselors who treat “clients”:
Nowhere in the field of medicine is treatment less grounded in modern science. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools. The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. (The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. Many counselors are in recovery themselves. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” …. Countless others had put their faith in a system they had been led to believe was effective—even though finding treatment centers’ success rates is next to impossible: facilities rarely publish their data or even track their patients after discharging them. “Many will tell you that those who complete the program have a ‘great success rate,’ meaning that most are abstaining from drugs and alcohol while enrolled there,” says Bankole Johnson, an alcohol researcher and the chair of the psychiatry department at the University of Maryland School of Medicine. “Well, no kidding.”
Regarding the economic impact of ineffective treatment models for Substance Abuse Disorder in the U.S.:
The United States already spends about $35 billion a year on alcohol- and substance-abuse treatment, yet heavy drinking causes 88,000 deaths a year—including deaths from car accidents and diseases linked to alcohol. It also costs the country hundreds of billions of dollars in expenses related to health care, criminal justice, motor-vehicle crashes, and lost workplace productivity, according to the CDC. With the Affordable Care Act’s expansion of coverage, it’s time to ask some important questions: Which treatments should we be willing to pay for? Have they been proved effective? And for whom—only those at the extreme end of the spectrum? Or also those in the vast, long-overlooked middle?
As with most feature articles, the last paragraph tends to be the “ take away” and Ms. Glaser doesn’t disappoint, when she concludes with the following quote from University of Pennsylvania psychologist Tom McLellan, who lost a son to a drug overdose in 2008:.
“If I didn’t know what to do for my kid, when I know this stuff and am surrounded by experts, how the hell is a schoolteacher or a construction worker going to know?” he asks. Americans need to demand better, McLellan says, just as they did with breast cancer, HIV, and mental illness. “This is going to be a mandated benefit, and insurance companies are going to want to pay for things that work,” he says. “Change is within reach.”
Keep the faith.