This was first published in National Council, a publication of the National Council for Behavioral Health
Sam knew he was out of second chances when he checked into the clinic. He had already graduated from four 30-day inpatient programs, and every time he swore he'd never go back. Every time, the need for drugs outweighed his good intentions. He was in the chronic cycle of rehabilitation and relapse that is all too familiar to many people with addictions.
With the right combination of intensive outpatient, medication and recovery supports, Sam broke the cycle and remains drug-free and living in recovery. But he'll never forget the sense of failure and hopelessness he felt.
The National Institute on Drug Abuse estimates that nearly three-quarters of people like Sam will experience these setbacks or "relapses" after treatment.
No one expects someone with a chronic disease like diabetes to stay in a hospital for 30 days and come out cured. Yet that's how we have treated people with another chronic condition - addictions to drugs or alcohol. You have no doubt seen the data on the impact addictions have on this country. As many as 25 million Americans are thought to have an addiction. According to the National Institute on Drug Abuse, the disease costs $700 billion annually in treatment costs, crime and lost productivity.
And it costs us in lives. Deaths from heroin overdose alone jumped fivefold between 2001 and 2013. Yet only a tenth or so of those 25 million people get any help.
Companies owned by large investors aiming for big returns are stampeding into this gap now that the Affordable Care Act ensures that more Americans have health insurance that pays for addiction treatment.
However, many of these firms are investing in the outmoded model of a month of residential rehab with little follow-up.
In short, this was never a simple problem... and new players mean it's only going to get more complex.
No Quick Cure
In the 19th-century, we solved the problem of the town drunkard by putting him or her in the stocks. Until recently, most towns of any size still had a "drunk tank" in their jail; a bare tile room where the inebriated "slept it off."
Now science has taught us that addiction is a disease, like diabetes or hypertension. It can kill its victims slowly and painfully and affects everyone around the sick person - family, friends and colleagues.
Things are finally changing for the better and National Council members are leading the way.
Member organizations have embraced the science, delivering interventions in an array of community settings with far better outcomes than a one-shot stay in rehab. More and more we understand that the solution isn't easy or quick.
Take medications, recovery coaches and technology.
Medications offer hope that patients in early recovery can get relief from what are often overwhelming cravings, and National Council members were among the first organizations to embrace medication-assisted therapies. Barriers to access are gradually being eliminated and pharmacological interventions are increasingly viewed as critical to a patient's management plan.
"Recovery coach is an oldish phrase with a new twist," said Tom Moroney of Bloomberg News. "They're counselors, cheerleaders, scolds, and they just might represent the best weapon yet against killer opiates, especially heroin and its seductive cousin, Oxycontin."
Recovery coaches connect people in recovery to the services that will help keep them away from alcohol or other drugs. They help with finding medical care, getting into school or reestablishing family connections, providing long-term solutions that are more effective than simply "graduating" them from a hospital bed in rehab.
In addition to recovery coaches and medications, technology will play an increasingly prominent role in the successful treatment of addictions.
Technology solutions are transforming almost all aspects of our lives -- think Uber, Amazon Prime and Airbnb. Now health care is the darling of tech companies.
Tele-psychiatry programs bring addiction treatment into mainstream medicine, including primary care offices, improving access to services currently in short supply. Smartphone apps that offer group discussion and crisis response give patients "real time" support. Online assessments, appointments and treatment bring services to patients where and when they prefer. Electronic medical records and the application of data analytics give patients and families desperately needed information about the effectiveness of programs.
The kind of care provided through innovations like technology, coaches and medications obviously takes money and skill. Fortunately, the Affordable Care Act ensures that more people have insurance. In addition, the Mental Health Parity and Addiction Equity Act requires insurers that pay benefits for mental health and addiction treatment to make those benefits equal to their reimbursement for medical and surgical care.
The Coming Boom
According to Harris Williams & Co., an investment bank, more than two dozen private companies are actively investing in mental health facilities. They report that four giants -- UHS, Acadia, CRC and Magellan -- are "most likely" to be "consolidators in a highly fragmented space."
In other words, these four companies and others like them are likely to buy up a lot of small centers and combine them into large chains like newspapers or supermarkets did in the past.
Larger companies have already bought dozens of smaller facilities in the last decade, according to Harris Williams. Last year, acquisitions of health care and life sciences companies more than doubled, to $237 billion.
The bigger issue is, where does the addictions field fit in? Investment bank McGuireWoods called rehabilitation and addiction treatment, "a tremendous growth area" and described it as "something consumers actually want ... treatment is needed by a significant portion of the population."
Preparing for the Future
As treatment becomes more corporatized, it's important to ensure that business cares as much about its patients as it does its bottom line.
Years of painstaking work by experts and the support of high-visibility people like Robert Downey Jr. and Samuel L. Jackson have made it easier and more acceptable for people to seek treatment.
The fact that more people are more willing to seek treatment and more able to get treatment is terrific. But now we have to make sure patients can and do get effective long-term follow-up measures and have access to comprehensive continuing services.
As the system consolidates into large corporations fixed on the bottom line, we need to keep an eye on whether they do a good job treating patients. And we must continue to take evidence- and science-based approaches to treating addiction and approach setbacks as part of the recovery process.
The Gosnold Treatment Center, a National Council member, reports that in its home state of Massachusetts, 87 percent of patients admitted to detox units have been there before. Of the 215,000 days patients spent annually in detox, half were accounted for by patients with five or more previous stays. "Despite this knowledge, the system remains heavily weighted toward inpatient care and most current initiatives are centered on expanding access to inpatient detox and rehab programs," says Gosnold's CEO Raymond V. Tamasi.
"The current opiate crisis and the fear it generates are driving this growth and while the system surely is suffering from a temporary dearth of capacity, we believe the greatly underemphasized problem is the absence of substantial and comprehensive community-based continuing care and the paucity of prevention, early identification and intervention efforts."
In other words, the short-term solution doesn't work. We need more. Comprehensive community-based care is a vision shared by our members, and the National Council is determined to help make the vision a reality.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.