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Turning uncertainties into opportunities

February 1, 2010
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Seeking out answers to unresolved questions will rally support and clear the path to the future

Over the past year, uncertainties about the economy dominated news reports, with concerns about healthcare costs and reform ready to emerge on any day that was an economy “slow news day.” Amid the uncertainty and concern that surrounds these issues, there are great opportunities that can capture our attention and imagination-and that of the public-throughout 2010.

For proof of this, one need look no further than the ongoing storm of public interest and comment on economic and healthcare issues. If we, as an organization and an industry, can help to answer just five of the “what if” questions that stand before us during the next several years, we will not only chart our own course forward, but bring vital public interest and support along as well.

What if there were 40 million more Americans with health insurance than there are today, and what if they had some minimum benefit to treat the disease of addiction?

While it is not likely that all of the 40 million Americans who reportedly lack health insurance will receive coverage as a result of any healthcare reform, it is likely that some will and that the numbers of those insured will grow over time. As a result, we have an opportunity to construct an addiction treatment system that is much more seamless than it is today. Surely those covered by health insurance will have that benefit managed, but, at the same time, as the number of insured Americans grows, the reliance on federal and state funding for addiction treatment will decrease. We need to anticipate how to respond when the lines that now define and separate the private and the public delivery systems for addiction treatment blur into greater similarity.

What if we committed to lifetime management of the disease of addiction for the individual?

While critics are fond of pointing out shortfalls in the approaches used to manage chronic diseases like diabetes and hypertension, it is now widely accepted that these and other chronic diseases must be managed through the lifetime of the individual. If they are not, our society understands that it will incur greater costs for the complex treatments that result when such chronic diseases manifest themselves in acute episodes. As addiction treatment professionals, we have become “experts” in treating the acute episodes of this disease. But we have done far too little to develop standardized protocols for managing the disease. This is an opportunity! If we commit to developing and implementing standardized protocols for lifetime management of addiction, we will position ourselves and our profession at the leading edge of any healthcare reform. We can demonstrate that we support the core tenet of any reform: cost reductions that result from practices that mean fewer acute episodes of another, very costly chronic disease.
What if all the addiction treatment providers agreed on five standardized outcomes or results of treatment?

During this past year, there have been frequent calls for “comparative analysis” of the various methods used to treat a particular illness. The goal is to identify those that offer the greatest advantages at the lowest cost. Are we employing methods and procedures which actually provide only slight documented benefits? It's a difficult question, but precisely the question we must ask about our approaches to addiction treatment. And, unless we adopt and begin to consistently measure a similar set of treatment outcomes or results, we will continue to have difficulty in identifying and proving the core procedures and methods that drive those results. Our opportunity: do our own comparative analysis before someone does it for us!

What if it was declared that the ultimate outcome of addiction treatment was to be long-term, sustained recovery? What if everyone who entered any form of treatment could access the resources needed to attain this outcome?

At some point soon, it is essential that we answer these questions. Today, due to the overwhelming numbers of people who suffer from this disease, it is easy for us to settle for something less than recovery. And, even if we adopt recovery as the goal, not everyone will achieve it, as is the case with almost any chronic illness. Nevertheless, we must set a standard for recovery and commit our resources and energies to ensure that our treatment system responds accordingly. Our opportunity is to boldly state that every person diagnosed with an addictive disorder must have access to the kind of resources that make long-term, sustained recovery likely, rather than possible.

What if we help to ensure that 42 CFR Part 2 legislation truly protects an individual's information, not just the provider that uses it?

In an alarming number of recent cases, information has been collected from individuals that has referenced or contained actual addiction diagnoses in settings that were not identified as providing addiction treatment. And, this information was placed into individual medical records without safeguards mandated by 42 CFR Part 2 being put into place. At the same time, some individuals involved in addiction treatment have presented for medical services, including pharmacology, only to find that their physician has no information or documentation regarding the treatment. In one case, the individual gets treatment, but no privacy protection. In the other, they have privacy, but no treatment. Either case represents “bad medicine.” We must revisit 42 CFR Part 2 to ensure that it does what it was intended to do in a changing environment of electronic health records: increase individual mobility and new interventions for addiction treatment.