This past spring and early summer we have seen a flurry of activity that has energized and engaged the addiction treatment community in considerable discussion. The HBO special broadcast on addiction in March and the activity in both the Senate and House to establish parity for addiction and mental health treatment are among the events that have motivated discussions at meetings, on conference calls, and in newsletters and e-mail blasts.
But there is a downside to some of this activity. Both the HBO special and many of the parity developments have been driven by forces other than the addiction treatment community. Because of this we need to resist simply blending in and accepting whatever direction the winds blow. It is time to draw lines in the sand and refuse to go beyond them. After all, some issues are nonnegotiable!
For example, we need to refuse to support parity legislation that includes preemption language (when a federal law supersedes existing, good state laws), is vague on the definition of medical necessity, and/or allows payers to define covered conditions without publishing the standardized criteria used to make those decisions. Parity legislation that includes those conditions does not offer parity at all. We must have a fair bill at the national level that recognizes addictive disease disorders as equal to any other disease covered by health insurance.
We need to refuse to use the term abuse. Whenever we use abuse, we paint ourselves into a corner of working with a condition considered voluntary with an element of willfulness. We never hear heart disease called heart abuse, so why should we use abuse to describe addictive disease disorders? This change of thinking means that several government agencies must change their names, such as the Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism. We should refuse to use abuse in our publications, and we should educate the popular press whenever we see abuse used. As a beginning, perhaps we all could agree to use addictive disease disorders as the “monikeR&Rdquo; for these diseases.
We need to refuse “reduced drinking” or “using days per month” as an acceptable way to define addiction treatment outcomes. We are dealing with a disease that causes premature death if untreated, so why would it be acceptable to only reduce the number of drinking or using days per month? We have a much more acceptable and noble outcome to offer—recovery. The goal of addiction treatment is not to reduce the harm that someone does to himself or others. The goal is to provide an opportunity for people to “live life more fully” so they can replenish their souls. By not embracing recovery we dismiss the important contributions of the past 60+ years.
We must refuse to see addiction simply as a brain disease. Slick marketing and glitzy headlines produced by the popular press clearly tempt us to understand addiction as only a brain disease that can be addressed through pharmacologic interventions and rewiring of the brain. Advances in brain science are to be applauded, but they do not represent the entire picture. We must never make the mistake of thinking that addiction, which affects body, mind, and spirit, can be isolated simply to the brain.
We need to refuse “medical stabilization” as the definition of addiction treatment. For too long we have allowed payers to use a nebulous and never fully defined concept of medical necessity to be the benchmark of whether someone needs addiction treatment and, if so, at what level. If we give in to this, we doom untold millions to either no treatment or to treatment with little chance of helping them move toward recovery. Instead of becoming fixated on medical necessity, we must ask what it will take to make it more likely that a person will experience, obtain, and continue in recovery.
Drawing lines may be the easy part—refusing to cross them, taking a stand, is harder. Telling patients there is no shortcut to recovery is hard work, as is taking a stand, but both allow us to remain faithful to who we are, what we are, and who we treat.
Ronald J. Hunsicker DMin, is President and CEO of the National Association of Addiction Treatment Providers. He is also a member of Behavioral Healthcare's Editorial Board.