The business model for addiction treatment in the United States fails to reach the success measures for other chronic illness. This is true of publicly financed, safety-net providers as well as private-pay residential providers. It is no surprise to researchers that our field has a reputation for recycling treatment events. Public opinion polls show that 68% of Americans believe someone in “recovery” means they have less than a month without using alcohol or other drugs. Few people understand recovery as a long-term, life re-building experience.
For more than 25 years, I have studied how our society responds to addiction. My point of view includes experiences as a successful businessman, operations chief of DC’s mental health system, and six years as President of the Johnson Institute – a leading national agency concerned with addiction. I found that the critical factors depressing positive outcomes in our current business models are:
- Short treatment engagements – nearly always less than the 90 days suggested in researched best practices.
- Lack of post-treatment supports for individuals adjusting to a recovery-focused life.
- Depressed rewards for front line professionals. Our field ranks poorly in salaries, career incentives, and benefits.
I also found, however, that the traditional message of recovery and the application of evidence-based best practices are sound and effective principles that work in thousands of lives. Our inability to bring recovery “to scale” with the huge demand is a failure of business practice – not because we don’t know what to do. Challenged by several colleagues two years ago, I stopped complaining about these poor business practices and began to design and implement a model that is faithful to sound practices and effective delivery of these practices.
Aquila Recovery Clinic in Washington, DC, is the result – a medical specialty clinic designed as an element of primary health care, equipped to serve individuals when symptoms are first identified by medical professionals, counselors, and employee assistance programs. We offer a three-stage engagement that lasts one year plus one day: Intensive Outpatient, Extended Outpatient, and Recovery Support. We include a psychiatric examination, one-on-one counselor relationships, evening group therapy, and education, random verification of compliance, peer-to-peer recovery supports, and linkages to recovery and community supports and life-skill assistance.
Our linkage to prospects is guided by motivational interviewing technology, reaching folks in that state of ambivalence, who are struggling to determine the costs versus the benefits of using substances to change the mood or entering the transformative path of recovery. I am grateful to so many helpers who have made this effort possible. My experience as the only non-professional member of the National Quality Forum panel on best practices was invaluable. NIAAA scientist Mark Willenbring, MD; Eric Goplerud, Ph.D.; George Kolodner, MD; Hal Urschel, MD, and Cynthia Moreno, NCAC II, CCDC III, SAP; have all been so valuable to this work. My Board and business partners include friends and supporters of many years, including Bill Lucy, retired AFSCME leader; Steve Steury, MD, retired medical director of DC DMH; Max Berry, Warren Graves, Judy Ramey, Wally Clinton, Robert Coffey.