The Surgeon General's "Facing Addiction in America" report raises much-needed attention, but also many questions about the future of addiction treatment.
The Surgeon General's November 17th Report, "Facing Addiction in America," is a clarion call. The report shines a light on the addiction epidemic at a crucial time of need, and its focus on prevention, early detection, stigma-reduction and holistic care promises hope for all Americans. However, some of the report's conclusions raise significant questions about the future of the addiction treatment field.
Many of the findings within the report's more than 400 pages could be polarizing. Some treatment professionals might find the assertions a welcome acknowledgement, others might find them anathema to their experience and beliefs about what works and why. Chief among these potentially controversial findings are:
- Strong support for medically assisted treatment (MAT)
- The definitive description and language used to define the disease state of addiction
- 12-Step as support rather than treatment
- The idea that mild and moderate substance use disorders could be treated by general medical practitioners
- The call for full integration of addiction treatment into the mainstream of general healthcare practice
Regardless of where your program stands on these issues, the fact that they may become part of the public dialog about addiction treatment is important to every addiction treatment professional and organization.
The recommendations made in this report, if implemented, could reshape the treatment of substance use disorders and addiction. But important questions are when and how these recommendations may become part of mainstream healthcare, how and when patients and families will be exposed to these ideas, and how this report's assertions might affect their decisions in seeking care.
Another important aspect of this report is how its recommendations may inform which treatments insurers are willing to cover and for whom.
What might this report mean for addiction treatment marketing?
In addition to affecting the way treatment is delivered in the future, the findings and recommendations in this report may also directly affect the marketing of addition treatment. The findings of this report and news discussion of them are likely to alter consumer perceptions. While few lay people are likely to consume the full text of this report, it will become part of the news cycle. In fact, the report has already been the focus of multiple national and international stories since its release last week. As discussion and interpretation of this report grows and unfolds, people may begin to change the way they think about the issues of substance use, misuse, addiction, and treatment.
Some consumers, for example, might begin to seek out medically-assisted treatments instead of abstinence-based approaches. They may begin looking to general care practitioners for initial intervention instead of seeking specialty addiction treatment care. And some may want medical record sharing or integration with their primary care doctors. Others might begin to question the treatment efficacy of 12-Step-based programs. There are many ways in which the findings of this report could reshape the way people think about this disease and its treatment.
Language is also a notable aspect of the report. The Surgeon General's terminology aligns closely with the DSM-5 and its description of substance use and misuse disorders. Interestingly, he labels the most severe level of substance use disorder "addiction". Here, word choice underscores a larger theme - deeper patient segmentation. While many of the people seeking addiction treatment today certainly meet the DSM-5's definition for 'severe substance use disorder' (displaying more than 6 of its symptom criteria), some others may be affected by 'moderate' or 'mild' substance use disorder. This report suggests that only those with 'addiction' (severe substance use disorder) may require specialty treatment, whereas mild and moderate use disorders may be adequately treated by general care practitioners. This may mean that eventually, fewer individuals would attend specialty treatment programs such as residential treatment centers. This may be a welcome change for patients and insurers, but may indicate fewer patients for addiction treatment organizations in the future.
Integration is an important theme of the report and one that promises change. On page 6-28 (page 28 of section 6), the Surgeon General asserts that "The move toward integrated care is therefore likely to accelerate the consolidation of substance use disorder programs, which may hasten the adoption of new technologies and processes among sophisticated providers." Certainly, the Surgeon General sees a significant change in the future - one toward addiction treatment being folded into the medical mainstream. One immediate implication of this vision, at least for some, could be its influence on mergers and acquisitions. Will buyers weigh EHR, MAT, and ROSC sophistication more heavily than they do today? Will the physical location of a facility and its proximity to general medical campuses play a role?
No matter what a center's views of the Surgeon General's positions may be, it will become increasingly important to respond to its assertions. For programs opposed to medically-assisted treatment, positioning 12-Steps as treatment, and promoting the value of leaving the home environment, responding to the report's findings probably makes good sense. It is also likely that this report becomes the topic of many presentations and discussions throughout the treatment conference circuit and preparing to participate in this discussion could benefit those who take a leading role.
In all cases, developing an understanding of the report's conclusions and how they relate to your treatment program is an important step in remaining relevant and proactive.
What to do...
This report benefits people in need by bringing much-needed awareness and recommends additional investment and focus on the issue. However, some may see this report as painting the field of addiction treatment in an unfairly dim light. Of note is the finding on page 6-2 that "Well-supported evidence shows that the current substance use disorder workforce does not have the capacity to meet the existing need for integrated health care...". Here, the word "capacity" could be understood to mean "size", but perhaps also to mean "ability". The idea that addiction treatment has existed outside of the medical mainstream is a recurring theme throughout the report. To some in the addiction treatment field this idea may seem innocuous, to others it may seem inflammatory. The addiction treatment field employs many talented, experienced and passionate health care providers and helps untold scores of individuals overcome one of life's most complex challenges. They deserve a seat at the table and their experience should be respected and leveraged.
There are several immediate steps addiction treatment programs can take to use the Surgeon General's call-to-action as a means of positioning themselves for relevance and change.
1) Understand and Interpret: Read the report and review its findings with your clinicians, executives, marketers, and key stakeholders. Develop points-of-view related to the topics most germane to your program and decide how to present these to your prospective clients, referring professionals, and others in the field. Write a position paper that addresses the inferences and recommendations in the report and your view of how they relate to your experience.
2) Invite Discussion: This is a significant proposal worthy of discussion. Invite colleagues, friends, and those in your recovery communities to weigh in on the ideas proposed in the report. This is a chance to engage in fresh discussions around the potential roles and efficacies of medications, to inform your alumni and other groups about this disease and the future of care. Use social media to express your views and invite conversations.
3) Contemporize Your Content: Review your websites and collateral materials. Now is a good time to ensure that the information you're presenting is fresh, represents your latest clinical thinking, and perhaps reflects some of the ideas presented in this report.
4) Say Something: As front-line care providers your voice matters. Your local communities care deeply about the issue of misuse and addiction and welcome the experience, knowledge and hope you represent. Responding to your thoughts on the Surgeon General's report is one way to engage your community and raise awareness of the issues and of your program.
5) Contribute Professionally: From NCAAD, to WCSAD, to CORE and beyond, this field offers many excellent professional conferences. Speaking at these events is one of the best ways to increase awareness of your program, spark new and important relationships with other programs and professionals, and of attracting talented employees. Once you've formulated your views on this report and its potential implications, propose a talk at upcoming conferences to become part of the conversation.
We look forward to hearing the discussion that arises from this report and to the change it suggests. If you wish to discuss how this report affects your marketing and opportunities for growth, please call us at any time at (781) 937-0667.
Download the Complete Surgeon General's Report.Source: US Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America - The Surgeon General's Report on Alcohol, Drugs, and Health, Washington, DC: HHS, November 2016