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The Revolving Door of Addiction Treatment: A Response to William White

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by Dr. John Dyben, DHSc, MCAP, CMHP – Clinical Fellow

William White, renowned author of “Slaying the Dragon: The History of Addiction Treatment and Recovery in America”, recently raised valid concerns about the ongoing recycling of patients in an aptly named blog, “The Revolving Door of Addiction Treatment”.  As leaders in the addiction treatment industry, we felt compelled to respond to this article. Origins Behavioral Healthcare has consistently sought to incorporate a model of treatment that truly eliminates the “revolving door effect” and fully addresses addiction as a chronic illness. We are committed to the belief that one can truly recover from this “seemingly hopeless state of mind and body.”

 

Like other chronic health conditions, Substance Use Disorders (SUDs) present in a spectrum with mild forms of the disorder responding well to education, stabilization, and early intervention efforts.  More severe SUDs (with “addiction” being the most severe) require a more aggressive model of treatment. Though we have long identified addiction as a chronic illness, there is an industry-wide failure to implement a comprehensive approach to treatment that treats addiction as a we would treat other chronic illnesses.

The Centers for Disease Control promotes a four-domain approach for tackling chronic disease, with Health Care System Interventions (e.g. addiction treatment) serving as only one of these four components. In his article, White points out that our industry focuses almost exclusively on the one stage of “recovery initiation and stabilization” through such interventions. While primary treatment (what term do we use here?) is a vitally important for those afflicted with addiction, overemphasis on this phase alone rarely creates sustained recovery.

A model of addiction treatment that routinely recycles patients through a brief stabilization period (often 28 to 30 days), and does not adequately provide for ongoing support after that period, is an ineffective model for treating addiction.  At Origins, we walk alongside our patients through multiple levels of care, including medically managed detox, as well as varying intensities of residential treatment and outpatient treatment. Understanding that addiction treatment is not a “one size fits all” approach, incoming patients are screened for appropriateness to level of care by a multidisciplinary team.  When patients are returning to residential treatment  after having been through treatment before, this weighs into admission considerations and we integrate these factors into our patient’s treatment plan before they arrive on campus.

It is widely acknowledged that a patient’s prospects for sustained recovery are improved significantly when the family is involved in treatment. At Origins, every patient is assigned both a family counselor as well as an individual counselor and the family is involved in the treatment process from the very beginning.  Their process includes a five-day intensive program of education and treatment.  This is often an important step in breaking generational cycles of addiction, a factor of addiction treatment which is rarely mentioned. When we break these cycles, we impact future generations who may never need to experience the pain of participating in an addicted family system.

The time a patient spends at Origins is considered only one part of the treatment of their disease. For this reason, we work closely all throughout primary treatment with the professionals that send us patients so that there is no lapse in continuity of care. From the beginning of treatment, a plan is developed for linking (or returning) patients to ongoing care, often at decreasing levels of intensity to facilitate both healing and an integration back into normal life. The prime directive of treatment at Origins is to create an environment that fosters patient engagement in the time-honored 12 Step program of recovery.  This is a critical element of both stabilization and long-term care that promotes not only “maintenance” but spiritual growth and the development of a rich life, filled with service.

Despite the fact that every major medical and scientific organization in the nation asserts that addiction is a primary, chronic disease, governmental and corporate structures do not support this and instead continue to see addiction as moral failing.  This is clearly evident by the fact that very little in government funding goes to treat addiction compared to the billions spent annually to incarcerate non-violent, non-trafficking drug offenders. In conjunction with this, third-party payers continue to seek minimal treatment for addiction and fund little, insufficient care, or acute-care over chronic care services.  There remains to this day, even in the health care community, a stigma related to addiction that contributes to chasms between different disciplines of health care providers.  This makes it difficult to establish a continuum of care for addiction that incorporates health professionals across disciplines and in every corner of the community.

If we are hoping to make a radical impression on addiction as a whole, there must be a concerted effort throughout the addiction treatment industry to do more than focus on the acute crises that propel patients into treatment. Our systems and programs must begin to take a more global look at all factors contributing to this chronic, fatal illness.

In sum, the elimination of the “revolving door effect” does more than stop the vicious cycle of substance use for the afflicted individual – it nurtures overwhelming hope for the thousands of men, women, and their families who have yet to cross the invisible line into the dangerous realm of addiction.