The Cure

I’ve been thinking a lot about Greg Williams’ recent blog post and my experiences with cures for behavioral patterns. Turns out, it is quite difficult to make a change with the same thinking and approach that helped to create the problem. Shocking, yes.

“Doing The Same Things Over and Expecting Different Results… While The Numbers Keep Rising,” is a clear-eyed indictment of the overall approach to care for people affected by substance use.

The whole thing is on point. To me, it demonstrates the parallel process between the nearly universal experience of human change and how difficult it is to change our systems. It’s a lot easier to tweak, exert, and blame external forces than it is to regroup, reimagine and assume the risk and accountability demanded by innovation.

The specialty, acute-care, residential-focused and abstinence-only model will never achieve the results we all want for our communities. Our current crises demand a reimagining of our approach, and like Williams’ work has defined over the past few years — will require a foundational shift in our payment methodologies.

“The financing mechanisms that lie behind treatment service options available in communities remain the decisive drivers of primarily acute care service models that require individuals to make significant time and life commitments – they can enroll in residential services where they need to live somewhere, not work, and be away from home for a month or more, or they can engage in intensive out-patient models that often require upwards of a 20+ hour/week commitment. These acute-focused models persist as almost the only care options in the market, despite all of the research supporting the chronic nature of addiction and the long-term recovery-oriented approaches for combating the illness.”
- Greg Williams

This is as near a bulletproof statement as we can get when it comes to SUD care. Everyone seems to think this makes sense, and yet the models persist to the detriment of all involved parties.

Payers continue to hemorrhage money on care that is both expensive and ineffective. Individuals and families continue to suffer. Providers continue to be at the mercy of outdated reimbursement models and a system defined by inertia and tradition.

The heartbreaking irony of all this is that the status quo is just so incredibly expensive.

The vast majority of our patients here at YourPath have cycled through repeated acute care episodes. Many have claims in the six months preceding engagement with YourPath that are well into the six figures. Referring someone (for the 9th time) to a siloed, non-evidence-based, $13k residential treatment would be approved by the payer. A visit to the ED (for the 9th time in the last calendar year) would be covered. And yet, a simple $97 visit that has a large body of evidence to support its efficacy is somehow a bridge too far.

This is just one of several daily examples of the Kafkaesque fever dream that is our “system of care” for people with issues related to substance use.

As the federal dollars continue to flow into SUD services and the opioid settlements join them, the architects of our existing systems will be courted by those who have always reaped the benefits of our systems. Those most able to affect change will have less and less incentive to change. Those who stand to reap the benefits of inertia will continue to determine the Overton window for acceptable discourse.

And ultimately, those who have experienced disproportionate historical suffering will continue to bear the heavy cost of our failure. Unless…

Unless the growing chorus of affected individuals, the recovery and harm reduction advocates who have been in the fight for decades, recovery groups, providers of all sorts, tech orgs, families affected by substance use, and those who represent this massive, massive constituency realize the power of our consensus. We are the overwhelming majority.

Yet the inertia persists…

The foundations of a new system, defined as much by compassion and responsiveness to human suffering as by science, data and our ever-evolving philosophical and practical alignment and integration, is within view.

I feel like we have been working on a mechanical contraption that has been left out in the elements to rust. We haven’t seen much movement yet, but I feel like we are getting close. More oil! Bust it loose!