In November the Surgeon General came out with a comprehensive report titled Facing Addiction in America. Much of the content won’t come as a surprise to ACT clinicians. For example in the executive summary it notes that:
“Our health care system has not given the same level of attention to substance use disorders as it has to other health concerns that affect similar numbers of people. Substance use disorder treatment in the United States remains largely segregated from the rest of health care and serves only a fraction of those in need of treatment. Only about 10 percent of people with a substance use disorder receive any type of specialty treatment. Further, over 40 percent of people with a substance use disorder also have a mental health condition, yet fewer than half (48.0 percent) receive treatment for either disorder.”
It’s a definite step forward when the Surgeon General, Dr. Vivek Murthy is making the rounds of various media outlets trying to get the message out on the need for change. Watch his interview on PBS Newshour (click to view)
When I was a young psychiatrist I had a simple solution for patients who had substance use problems – “you have to go to AA (or CA or NA or GA or …)”. I did my patients no good.
Two years ago I wrote a blog titled RUCCIS (click to view) pointing out how Ken Minkoff has, for years, been calling on mental health programs to provide Comprehensive, Continuous, Integrated System of Care (CCISC). He writes how
“In a CCISC process, every program and every person delivering clinical care engages … to become welcoming, recovery- or resiliency-oriented, and co-occurring capable. Further, every aspect of clinical service delivery is organized on the assumption that the next person or family entering service will have multiple co-occurring conditions, and will need to be welcomed for care, inspired with hope, and engaged in a partnership to address each and every one of those conditions in order to achieve the vision and hope of recovery.”
In that blog I commented how “on Minkoff’s webpage, the word ‘chronic’ appears only once! That word has a pernicious, disempowering effect on clients and care providers. It should be expunged from our vocabularies. Long lasting, long term, long-standing – I’m okay with all of these, but chronic – NO!”. The Surgeon General’s report does use the ‘C’ word and I appreciate that the authors have their reasons for this. I do think we need to see these problems realistically but we also have to leave room for that mysterious element of recovery. Tony Bennett just celebrated his 90th birthday and I just recently learned that he went through years of addiction and nearly died of a cocaine overdose. Meeting him at that time in his life could anyone have seen where he would be 35 years later, what with having a ‘chronic’ condition?
There are no simple answers. ACT teams should, as always, focus on delivering the best services possible.
With the holiday season upon us, Roman, Kevin and I want to wish you and yours all the best of the season and a happy and healthy New Year!