California’s current budget crisis has led to drastic cuts in human services programs, particularly those most needed by those struggling to overcome alcoholism and drug addiction.
The crisis highlights a more basic deficiency in service delivery, namely the over-reliance on short-term and expensive treatment services. Most recovery-related (including mental health services) funding from State and county sources flows to institutions which primarily deliver short-term professional treatment services. However addiction is a chronic, rather than an acute condition. Chronic conditions require a fundamentally different approach.
Other evidence shows that the best predictor of recovery outcomes is the amount of time during which someone receives supportive services. Short-term addiction treatment has been shown to have value, but is not a good predictor of long-term recovery outcomes. When cost is considered, it’s far harder to justify our inordinate emphasis on short term treatment. Moreover, individuals in early recovery require a broad range of supportive services. Different people enter recovery with different needs, not all of which are obviously identifiable as addiction-related.
The Substance Abuse and Mental Health Services Administration (SAMHSA) published an important white paper in 2008, on the topic of Recovery Oriented Systems of Care (ROSCs).
This paragraph from the report’s introduction summarizes the problem:
“Addiction has long been recognized as a chronic disease. However, most treatment for addiction uses acute care interventions rather than a disease management approach. For many people seeking recovery, this has created a revolving door of multiple acute treatment episodes.”
“Multiple acute treatment episodes” means more crime, more homelessness, more violence, more unemployment, and perhaps most importantly from a public policy point of view, high costs incurred for generally substandard recovery outcomes. These shortcomings fail to adequately summarize the aggregate harm to individuals, to families and to communities.
The paper goes on to describe what, unfortunately, is lacking in approaches by states including California:
“Creating recovery-oriented systems of care requires a transformation of the entire service system as it shifts to becoming responsive to meet the needs of individuals and families seeking services.”
This transformation is both a challenge and an opportunity. Several of us at the Sober Living Network have been thinking about these issues in some depth. In future articles we will present some of our specific recommendations for change.