Connecting People with Substance Use Treatment

Last week, a report from KFF indicated that nearly three in ten U.S. adults (29%) say they or someone in their family have been addicted to opioids, including prescription painkillers and illegal opioids like heroin. Complicating matters, the same report revealed that only half of the people suffering from substance use issues are receiving the care and treatment they need. It was no surprise, at least to me, that substance use issues continue to hamper many Americans. However, I was surprised and concerned that so many people are having problems accessing treatment for substance use issues, are not aware of the treatment available, or simply refusing it. Over the past several years, health care systems, community organizations, and local, state and Federal governments have invested significant time, money, and resources into providing support for substance use and mental health issues. Given this strong commitment to treatment and support, why are so many people unable or unwilling to access it?

As a person in recovery who is interested in pursuing a post-retirement career in substance use and mental health treatment, I started thinking about the roadblocks preventing people from accessing the treatment they need, and how those barriers could be removed. Admittedly, I am a bit of a novice on all of the complex matters related to substance abuse, but nonetheless offer my ideas as a way to generate dialogue and hopefully come up with the right answers to this important public health problem. My ideas focus primarily on why so many individuals are refusing treatment or unaware it is available to them.

My first suggestion relates to the perception many people have about recovery and substance use treatment. There are many people with substance use issues who incorrectly believe their one and only option for recovery is to spend a month in a remote rehab, followed by participation in a 12-step program like NA or AA. This is what I believed before becoming more knowledgeable on recovery. As successful as these options have been for so many people, it is not always the right fit for everyone. While in-patient recovery centers and 12-step plans have saved an immeasurable number of lives, it does not work for all, nor is it the only option for recovery. Most health care systems offer a wider range of treatment options that are tailored to the individual and the respective factors leading to their substance use issues but, to this modest observer, do not always market these services and options. How recovery services are marketed could turn people off from receiving treatment because they do not fully comprehend the wide range of treatments that healthcare systems are offering. It would behoove health care systems to refresh their outreach materials to reflect the flexibility available in their substance use treatment.

I also believe that breaking the stigma of substance use issues unlocks some of the resistance that people have to receiving treatment. Many people suffering from substance use issues are afraid to receive treatment because of the perceived embarrassment it may bring them and their family. They believe, rightly or wrongly, that admitting to their problems will get them tagged as “addicts” and “nut cases.” They are concerned that receiving treatment for substance use issues will damage their career and friendships. To counteract these fears, health care officials could use testimonials from individuals who have experienced success in recovery and who are willing to share their recovery stories. Hearing first-hand accounts of individuals who received treatment and, because of it, are now able to live a satisfying life free of alcohol and drugs, could be enticing to someone on the fence about pursuing treatment. These testimonials could be printed on marketing materials, pamphlets, or posted on organization websites. Videos of these first-hand accounts could be uploaded on organization websites or even social media sites like Instagram or FaceBook. Asking people in recovery to speak about their experience to high school students, college students, churches, and local community organizations could be powerful testament and provide the motivation some people need. Even an Alumni Newsletter featuring stories of those in recovery could be helpful. A so-called “surround sound” approach of sharing personal recovery stories through as many media mediums as possible will undoubtedly have a positive effect on breaking down the substance use stigma and hopefully encourage more people to engage in treatment.

Reflecting on my own personal story, another important factor in successfully treating substance use issues is reaching people as early in their substance use journey as possible. A father or mother who has the pressure of providing for their family and believes that seeking treatment could cost them their job is certainly more likely to refuse it, thereby perpetuating their problem and increasing the likelihood of them ultimately losing everything - their family, their job, their friends. However, many health care systems offer flexible treatment programs where an individual can maintain employment and support their family while also receiving the substance use treatment they require. Intensive outpatient programs, support from a peer specialist or certified recovery specialist, and mental health/substance use counseling can many times be worked around an individual's work schedule and family duties. Adapting substance use treatment to the schedules of a working parent or an individual who values their career increases the likelihood of someone accepting treatment before hitting rock bottom.

Continuing with the theme of flexibility, I believe that offering remote treatment services (tele-health, Teams meetings, etc.) could also motivate more people to seek out the support they need. Lessons from the COVID-19 pandemic, costly as it was in the toll of human lives lost, taught us that face-to-face, in person interaction could be replaced by speaking to someone over your smartphone or laptop. Someone with constrained availability because of their work schedule, family responsibilities, or lack of transportation could conceivably receive treatment through a remote treatment option. On the surface, this option seems like an obvious solution. However, numerous legal impediments exist that limit the level of treatment someone can receive remotely and complicates the process of receiving it. For example, medically-assisted treatment (MAT) such as Methadone or Suboxone, so critical in the treatment of opioid abuse for many individuals, cannot be easily ascertained in a remote environment. While it is easy to understand why ordering controlled substances for a sustainable taper requires adequate controls, there has to be a healthy balance that provides a pathway in remote circumstances. Advocacy at the state and Federal levels is necessary to strike this balance and remove the so-called “red tape” associated with the remote treatment of substance use disorders. We need to write to our state and Federal legislators asking them to research this issue and, based on their findings, pass legislation that avails the same level of substance use treatment in a remote environment that is currently available in an in-person setting. There are many people, much smarter than myself, that could find a way to make this happen while also providing the proper “guard rails” to prevent any misuse or further abuse.

Substance use issues, ranging from illicit fentanyl to prescription benzodiazepines, have become an undeniable epidemic in our country. There is no single pathway to recovery and addressing this epidemic. It requires flexibility, adaptability, and even “out-of-the-box” thinking. It’s time to have this discussion.