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  • Scott Luetgenau MSW, LCAS

A Roadmap to Sustained Recovery

I have a daughter who cannot stop heroin. She just overdosed yesterday and died, and they had to bring her back. She is begging for help to get detoxed and get clean and straight again. She does not have any form of insurance and is homeless. If there is any way you can help us, please give us a call back.” – voicemail left by a mother desperately seeking help.

This is the type of phone call our treatment facility would receive every day, and although there are a number of comprehensive interventions for the effective treatment and remission of substance use disorders, less than 11 percent of individuals who struggle with addiction receive access to this care in the United States. Our country is facing an unprecedented substance use crisis, and the only way to end it is to change the way we engage with it.

Substance Use in the United States:

Addiction and risky substance use (engaging in addictive substances in ways that are both unhealthy and unsafe) are the sources of the United State’s largest and most costly health problems. According to the Center on Addiction, over 40 million people suffer from addiction and roughly 80 million people are classified as risky substance users. Combined, these numbers reflect a greater portion of our population compared to those suffering from other health-related diseases:


· Heart conditions (27 million people)

· Diabetes (25.8 million people)

· Cancer (19.4 million people)


Substance use disorders are responsible for one-fifth of all deaths and account for one-third of all inpatient hospital costs in the US. They are also linked to a broad range of additional devastating health and social consequences, such as automobile accidents, homelessness and domestic violence.


Addiction negatively impacts individuals, families, places of employment, congregations, schools and communities. We must work to build prevention, treatment and recovery networks for all individuals regardless of where they live or how much money they earn.


A New Direction

Although efforts have been made across the country to cope with the effects of addiction (with over $28 billion spent every year on treatment), this somewhat reactive approach is quite limited and doesn’t offer a long-term solution. Treatments that focus solely on abstinence from substance use can lead to relapse and often overlooks other underlying issues such as undiagnosed mental illness. A less widely accepted but consistently proven-successful modality is one that includes a well-structured and strategically delivered Medicated-assisted Treatment (MAT) program.


Various studies have shown that individuals who benefit from MAT show significant improvements in multiple aspects of their lives, including a decrease or abstinence of illicit substance use, a decrease in criminal activity and a general diminishment of high-risk behaviors. They also report an increase of engagement in recreational and daily life activities, employment, improved psychological stability, family functioning and physical health. It is important to note here, however, that all MAT programs are not created equal. As service providers, policymakers, healthcare administrators and communities, it is crucial that we further define our MAT approach. The distribution of medication alone can often lead to further addiction, overdose and dangerous discrimination and stigma. Research has consistently shown that the most positive outcomes are found when medication is combined with psychosocial treatments to form a comprehensive program.


By following a holistic and sustainable approach, we have the power to sharply reduce overdose deaths and facilitate long-term recovery. The importance of our roles as service providers and key stakeholders in implementing such a well-rounded, inclusive strategy that considers all facets of addiction (prevention, treatment and recovery), is paramount to ending this epidemic.


Leading with Outcomes

Moves toward a value-based healthcare reimbursement structure will bring about sweeping changes in the delivery of addiction treatment. Providers will be evaluated upon the efficacy of their programming. This will finally incentivize providers to put a premium on clinical services while allowing the opportunity to shed duplicative practices and unnecessary administrative work. Providers who are tracking their outcomes will be at a clear advantage when forging new contracts with payer sources and vetting the viability of new service lines. Systems such as ACORN can provide inexpensive software solutions that efficiently/accurately track outcomes while giving your clinical staff a powerful tool to evaluating patient outcomes and integrating into your clinical supervision regimen. Clinical trials have demonstrated that MAT treatment reduces death rates by 30 to 50 percent, yet one-third of patients treated at specialty addiction programs drop out of treatment within two weeks of initiation. Treatment providers can significantly improve patient engagement and treatment quality by tracking patient outcomes.


A Holistic Approach to Recovery

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery as “a process of change through which individuals improve their health and wellness, live self-directed lives and strive to reach their full potential. Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations and is made up of four crucial dimensions: Health, Home, Purpose and Community.” Focused MAT programming has the potential to positively impact SAMHSA’s dimensions of recovery but must include three crucial components:


Training

In the substance use treatment field, staff training is often sidelined by the immediate need to manage a crisis at hand. Yet, it is critical that we realize the impact our staff members can have on the individuals who seek our help. By investing in comprehensive training, we can better serve individuals with substance use disorders. With the right preparation, we can create treatment plans catered to our clients’ unique needs. Training and technical assistance programs, such as SAMHSA’s Opioid Response Network, are working to do just that by playing a critical role in disseminating best practices in both the urban and rural communities throughout the country.

· Research indicates 47% of Americans would turn to a health professional if someone close to them needed assistance with a substance use disorder.

· Yet, less than 6% of referrals to publicly funded addiction treatment come from health care providers.


Our knowledge around addiction has changed drastically with our evolved understanding of how the brain works. It is now time to empower providers with our most current understanding of addiction and recovery to become agents of change in their communities. Our medical, mental health and public health colleagues require additional support, so that they can offer the bandwidth for sustained, positive changes to their organizations and communities.

Realizing that the first interaction your staff members have with your clients can mean all the difference in their road to recovery. When we get bogged down with compliance, paperwork, policies and regulations, we often neglect the human being right in front of us who may be in crisis. To begin providing better care to our clients, we must start by investing in our staff.


The individuals we work with are often extremely sick, and if they sense the slightest judgement based on the exhibited symptoms of their illness, they are likely to walk away from support, treatment and the possibility of recovery. While it is easy to confuse bad behavior with “badness”, it is crucial that we equip our staff with innovative tools and techniques, along with the right language, so that they feel prepared. When they can empathize with the individuals that they interact with every day, they can better serve them. Proper staff training can positively influence the environment of your facility, the flow of operations and most importantly, the long-term recovery of your clientele.


ACE Care

Up to two-thirds of substance use disorders can be traced back to Adverse Childhood Experiences (ACEs), according to the North Carolina Medical Journal. These events – such as traumatic physical injuries, abuse, neglect, sexual assault, mental health issues and infectious or chronic diseases – can cause the body to be susceptible to a series of other illnesses and conditions. To support individuals with substance use disorders on their road to recovery, it is crucial that we focus a large part of our energy on unpacking their traumatic histories. Chronic addiction to substances, more often than not, stems from childhood issues and those can be understood and worked through with the help of a dedicated, professional and experienced counselor. By combining this work with that of an expert psychiatrist who is highly skilled at prescribing non-narcotic medications for mental illness, we can provide a more comprehensive, open and dynamic treatment that serves the unique needs of each individual. These statistics also highlight the need to invest in the children of those suffering from substance use disorders as they are likely to face similar, if not the same, health challenges without proper support and guidance.


Family Recovery

Lastly, it is crucial that we make our clients’ families part of the recovery process. Addiction is an isolating disease, but by bringing family members into the conversation, our clients can open themselves to receive positive support from their loved ones, which can strengthen their recovery and rebuild severed bonds. Through family recovery, we can examine how to heal those wounds that addiction causes, reconstruct family roles, rules and relationships, encourage forgiveness and fortify the resistance, resilience and health of all family members involved. When we look at the ultimate aim of family recovery, we must consider how to best break the intergenerational transmission of drug-related problems by providing constructive tools for growth and a positive future.


Medication-Assisted Recovery: Shifting the Narrative

"Before coming into medication-assisted treatment, I was a sad, broken shell of a person. My daughter once asked me, "Mom, how come you're always sick? You never play with me anymore." I realized then that I needed to sit back and stop driving the car; I couldn't be my own doctor anymore. Through treatment, I have been given the chance to put my life back together; the medication has been my parachute keeping me safe from relapse, and I've adored working with my counselor - she knew exactly what I needed. Today I am a confident, loyal, and dependable person and am working on tapering off my medication completely." – anonymous testimonial from a former client


Medication-assisted treatment is about long-term recovery, and if it is to be sustainably successful, it is time our society starts to treat it as such. Individuals in MAT, are in recovery. We know this modality of treatment works when the dated criteria for diagnosing opioid addiction begins to disappear and the measures change. Instead of looking for substances, our patients are seeking and acquiring gainful employment. Instead of isolating themselves from their family and friends, they are reaching out and engaging. Instead of feeling preoccupied by cravings, they are establishing new values to live by. Sustainable treatment is holistic, personalized and diverse. The largest cohort study on overdose risk to date exemplified the tragic impact of evidence-based treatment shortages, particularly when it comes to opioids. Patients who only received psychological supports for opioid dependence were twice as likely to die by overdose. Well-delivered pharmacotherapy alongside counseling, case management and identification of recovery supports within the communities they come from manages patients' cravings while facilitating access to healthcare and increasing chances of sustained recovery.


If we can shift the conversation from medication-assisted treatment to medication-assisted recovery, we will start a new narrative around sustainable outcomes, and our treatment facilities will be better equipped to combat this epidemic successfully. By incorporating recovery supports and inviting the recovery community into the treatment space, we can create a positive environment for the individuals affected by substance use disorders. When we involve the communities in which these individuals live, we can build authentic networks that encourage lasting healing. MAT programming must be more than a single offering. We must provide fiscally sustainable and comprehensive services that treat the whole person (addiction, behavioral health, physical health, spiritual, social determinants of health and the connection to a positive community).


The Role of Community

We know that medication alone increases an individual’s chances of survival in that moment of crisis, but a more comprehensive approach addresses underlying trauma and other factors contributing to the longevity of their addiction. When we add MAT into a holistic, community-centered recovery culture, we can save lives, end the epidemic and witness positive results. This means bringing key stakeholders into the conversation.


While an individual works on their own healing from a substance use disorder, the community in which they live, as well as its institutions, should be healing in conjunction. The individual affects the community, and the community affects the individual. They are inseparable from the point of view of addiction recovery. Everything must be in the healing process simultaneously. We must connect our clients back into the positive niches within the communities they came from. Individuals who suffer from substance use disorders often feel like they do not exist. By working with the communities in which our clients live, we can accelerate recovery.


To find out more about how you can implement a medication-assisted treatment program in your area, or for any other queries, please contact us at scott@gatespringconsulting.com


Sources:

Center on Addiction (www.centeronaddiction.org)

Substance Abuse and Mental Health Services Administration (SAMHSA) (www.samhsa.gov)

North Carolina Medical Journal (www.ncmedicaljournal.com)

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