I recently received a call from a very senior level executive at a prestigious medical school, asking for advice on how to help his 26-year-old son who has a serious heroin addiction. The son had been through five residential treatment programs over the past several years, at a cost to the family of over $150,000. The troubling thing about this call was the reason this man reached out to me. He called me because I have been public about my own son’s drug overdose – he was calling me as another affected father and had no idea that I had any familiarity with the field other than my family experience. Let’s just stop there. Consider if this high-level executive’s son had been suffering from a rare tropical disease, he would have unhesitatingly sought and received guidance from a leading medical expert – not a father who had lost his child to that disease. In this case, he was literally too ashamed to contact one of his own organization’s physicians. This extraordinary degree of stigma and sense of isolation that families still experience is unjustified and incapacitating.
So how can we get past the stigma and ensure that our children, our loved ones and everyone affected by addiction receives the appropriate care? Like other chronic medical illnesses, substance use disorders have biological, social and behavioral components; and effective management of the disease requires attention to each of these pieces (similar to Type-II Diabetes). According to the Food and Drug Administration’s standards for effectiveness, there are presently four prevention interventions, five medications and more than a dozen behavioral therapies that can be called effective in preventing, intervening early and managing substance use disorders.
We know the best outcomes are achieved when the disease is identified and intervened upon early in its trajectory. But even serious, chronic cases can be treated effectively. Self-managed, continuing recovery can, and should, be the expectable outcome from all addiction treatments.
Yet many physicians and counselors have never even heard of these medications or of many other “evidence-based” behavioral interventions and most were never trained in how to manage substance use disorders. Many specialty addiction treatment programs are not staffed to provide anything other than basic group counseling. Other programs are not licensed or funded to provide these more effective but more costly therapies and medications. And still, other programs refuse to provide them on ideological grounds. For example, there are currently three FDA-approved medications for the treatment of opioid addiction, yet less than 30 percent of addiction treatment programs offer addiction medications, and less than half of the eligible patients in those programs ever receive them.
Based on a recent review of the issue by the American Society of Addiction Medicine, the Treatment Research Institute and the Avisa Group, it appears that the most significant reasons for the lack of physician utilization are lack of training, legal and regulatory controls on the medications and, most significantly, written and unwritten insurance coverage limitations.
It is time and it is possible for individuals with emerging substance use disorders to have all available medical facts associated with the progression of addictive disease; to receive full disclosure and information about all evidence-based treatment options for their condition; and to have full access to all evidence-based therapies, medications and services.
I am hopeful that the Affordable Care Act and the Parity Legislation together will create basic fairness for individuals and families affected by the disease of addiction. But those landmark pieces of legislation are not enough to eradicate the crippling stigma still associated with this disease. We must stand together—as parents, as patients, as practitioners—to demand the already available health benefits for the prevention and treatment of substance use.
A. Thomas McLellan, Ph.D. is the CEO of the Treatment Research Institute (TRI) with more than 35 years of experience in addiction treatment research. From 2009 to 2010, he served as Science Advisor and Deputy Director of the White House Office of National Drug Control Policy (ONDCP). In 1992, he co-founded and led TRI (until his ONDCP appointment) to transform the way research is employed in the treatment of and policy making around substance use and abuse. Dr. McLellan received his B.A. from Colgate University and his M.S. and Ph.D. from Bryn Mawr College. He obtained postgraduate training in psychology at Oxford University in England.
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