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Why values and ethics are good for business

September 25, 2017
by Doug Tieman
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It is a privilege to be a trusted and integral part of a person’s recovery from addiction. Most of us in the behavioral health and addiction treatment field take this responsibility seriously, and we are fully invested in the recovery of patients and their families. So, I am deeply troubled when I see facilities cutting corners and bending the rules to increase revenue or profit. These actions are not only short-sighted from a business standpoint, but also highly unethical and potentially dangerous to those who have entrusted us to help them recover.

Frankly, the addiction treatment field lacks a consistent set of regulations, recognized best practices or outcomes—which leaves a lot of room for unethical practices such as patient brokering, purchasing of patients, or overbilling. Caron and other leaders in the industry are working with National Association of Addiction Treatment Providers (NAATP) to establish appropriate standards for ethically appropriate treatment, marketing and billing.

Money-making gimmicks are not treatment, nor are they sustainable in the long run. Businesses that depend on loopholes or lax enforcement to keep themselves solvent are ultimately doomed to fail, no matter how much “good work” they feel they provide to the community.

Of course, every organization, whether for-profit or not-for-profit, must be in good shape financially to produce its product or offer its service effectively. But there must always be an appropriate balance between the mission of the work and an expected financial performance. The mission must always come first, and the focus should always be on quality treatment.

Efforts pay off

Taking an ethical approach and putting best practices and standards in place may not always appear financially beneficial to addiction treatment organizations in the short term, but the effort will pay off by sustaining the business for the long run. It does not matter if the business is for-profit or not-for-profit, the emphasis must be on empowering individuals and their families to recover from addiction and begin the life-long journey of recovery. However, one of the benefits of being a not-for-profit, is that we don’t answer to investors. Therefore, we can engage in treatment, research, prevention, and charity care.

If we want the addiction treatment industry to be recognized as a legitimate healthcare sector, then we need to act like one. That means becoming patient-centric rather than customer-service-centric. Patient-centric treatment focuses on always doing what is right for a person’s long-term health, even if it causes dissatisfaction or affects profit margins.

A business that emphasizes ethics and values will ultimately be stronger. People want to participate in an organization that is making a difference. It starts with attracting and retaining the right people as staff members, but it spreads to volunteers, donors, investors and referring physicians, and extends to patients and their families.

I’ve heard story after story of someone who came to us because, in their moment of need, one of our alumni stepped in and directed them to us. None of that would be possible if our alumni didn’t trust us, and that comes down to living our values and ethics and always putting the needs of the patient first.

All of us, both for-profit and not-for-profit, are medical providers, treating a disease. We should never lose sight of that. Someone suffering from the chronic disease of addiction should have the same opportunity for high quality, transparent healthcare that other illnesses have. Treatment can be profitable, of course, but quality of care comes first.



Doug Tieman is president and CEO of Caron Treatment Centers.









Prior to my 45 years experience in the addiction field, I worked at UCLA's Neuropsychiatric Institute. I was privileged to work with and participate in workshops with leaders in mental health treatment including Carl Rogers. It was from Dr. Rogers that I learned what patient-centered treatment means. It most assuredly does NOT mean "...always doing what is right for a person’s long-term health." This assumes we know what is "right" and is exactly the opposite of patient centered care.

When I started in the addiction field in 1972 I immediately understood that the dominant treatment philosophy was based on "knowing what was right" for every patient, irrespective of severity, complexity, motivation to change, recovery capital, mental health co-morbidity etc. The goal was lifelong abstinence from ALL mood altering chemicals which at the time, as you no doubt know, included psychotropics. That was what was "right" for their long-term health, assuming they lived long enough to realize it!

There is always a good reason to educate patients about addiction as a chronic health problem, the value of abstinence (which is often easier than moderation), the resources to support positive change like AA, NA and so forth. Unfortunately, even in Minnesota only about 50% of patients entering a treatment program "complete" the program. To me, this is unacceptably low and indicates the failure of a one-size-fits-all approach.

I am certain you are not promoting a one-size-fits-all approach. However, since we (Center for Alcohol & Drug Treatment) embraced individualized care 15 years ago we have found it is far more resource intensive. Our rates, which are set by the State, are based on the old model of care. On the other hand, our "completion rate," which honestly has no operational definition, has exceed the State average consistently. Because we are a community-based non-profit, we work with patients who are in active addiction at every stage of the disorder including terminally ill. We believe engagement and a positive therapeutic alliance are the best predictors of long-term outcomes whether or not sobriety (a personal commitment to abstinence) is or is not the patient's goal.