A look at some of the main problems with addiction treatment, and how some are being addressed.
Failure to use medication
Many treatment programs were founded on a philosophy of total abstinence, insisting that sobriety means being free of all drugs. That attitude has filtered down to patients, who sometimes decline medications.
Massachusetts regulations prohibit facilities from rejecting patients because they’re on medication, but reportedly some programs then urge these patients to get off their meds.
But the evidence is clear that methadone, buprenorphine, and Vivitrol work. The urgency surrounding opioid overdoses is breaking down the stigma against medications and they are becoming more available, said Vic DiGravio, head of the trade group for Massachusetts treatment providers.
Failure to address mental illness
Many people who develop addiction also have mental illnesses, yet addiction programs are ill-equipped to address them. DiGravio, who is president and CEO of the Association for Behavioral Healthcare, said this remains the system’s biggest gap, but one that is slowly being addressed.
Massachusetts is redirecting federal money to fund beds for people with both mental illness and addiction disorders. Spectrum Health Systems, a large Central Massachusetts treatment provider, has hired psychiatrists and has added mental health counselors to most of its locations. SSTAR, a Fall River treatment provider, recently received a federal grant to better address mental health issues.
The big challenge: Psychiatrists and other mental health professionals are in short supply.
Kicking people out of treatment
At one time, it was commonplace for providers to discharge people who resumed drug use, even though relapses are a symptom of their disorder. Today, DiGravio said, the best providers work with patients to bring them back from relapse or refer them to a higher level of care.
But there are other rules. Some are necessary for safety, such as prohibitions against smoking indoors, selling drugs to fellow patients, or violence. Others, such as banning cellphones or conversations with members of the opposite sex, have little to do with safety or recovery. Critics say they reflect the old view of addiction as a moral failing.
Patients bounce from one treatment program to another, with no one organizing or overseeing their care. To address this problem, MassHealth, the state’s Medicaid program, has established a behavioral health consortium that will coordinate the care of a limited group of enrollees, 60,000 people with a mental health disorder or addiction.
Some providers offer care coordinators and recovery coaches to help people navigate what remains a disjointed system.
Variability in quality
The vast majority of addiction treatment centers are not accredited by a standard-setting organization, in contrast with hospitals, nursing homes, and other providers.
The Commission on Accreditation of Rehabilitation Facilities has recently joined forces with the American Society of Addiction Medicine to define three levels of inpatient addiction care, specifying what services should be provided at each level.
Consumers will be able to seek out certified programs, knowing what services to expect. That program is expected to start this year.
Separately, the national advocacy group Shatterproof is working with Massachusetts and other states to develop a rating system for addiction treatment, expected to launch in 2020.