Industry Insider - October 2016

Sept/Oct 2016

Vol. 2 No. 5

Dr. Gabor Maté on Trauma pg. 2

NAATP Faces “Critical Times” pg. 4

Responding to First Responders pg. 7

CCAPP National Advocacy Update pg. 9

Recovery and the Community Health System pg. 11

Mark Gold Heads Scientific Advisory Board at RiverMend Health pg. 5

Cottonwood Tucson and The Essence of Resilience pg. 8

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AmericanAddictionCenters.com

Sept/Oct 2016

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Letter from the Editor

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fforts to curb opioid addiction in the United States made news again this summer when the US House of Representatives adopted the Comprehensive Addiction and Recovery Act (CARA) on July 14 with 407 votes in favor and 5 against. CARA gives the Attorney General and Secretary of Health and Human Services the power to award grants to stem the tide of the opioid epidemic, one that claims over seventy lives every day in the United States. CARA has since been hailed as the most comprehensive reform of addiction in decades and the first to treat addiction as a disease rather than a crime. But the questions remain as to what the Act might really do for our industry and what its realistic implications are.

Beyond that deluge, I started to think of all the contributors to this publication who’ve served as compasses for historical understanding of the treatment and recovery space: Bill White, Dr. Bob Ackerman, and two who blessedly feature in this issue of the Insider, Dr. Mark Gold and Dr. Gabor Maté.

for outcomes can answer the question of not just whether, but which treatment, and for whom, does treatment work.

There was much in the CARA bill to reflect the work of this groundbreaking researcher, father of medication-assisted treatment, and real mentor to the next generation of addiction researchers and clinicians. The Act makes several pivotal cultural and policy shifts in how addiction is viewed and how it should be treated. First, the law emphasizes the treatment of addiction as a disease and not a crime.

It is, to its authors’ credit, legislation providing grants that use treatment as an alternative to incarceration. Additionally, echoing our subjects in these forthcoming pages, the law emphasizes and requires that addiction treatment be evidence-based and specifically includes medication-assisted treatment as a necessary treatment option. The grants therein would go towards forming an interagency task force to “review, modify, and update best practices for pain management and prescribing pain medication,” according to the bill’s authors (CARA, 2016).

Informed by scholars such as the good doctors who’ve seen much of this before, one is hesitant to express reservations. CARA will expand access to the lifesaving overdose reversal drug naloxone. It’s truly multifaceted and hopefully will have a serious impact in saving lives and helping people get the addiction treatment they desperately require during this national epidemic. However, it’s surely unlikely that CARA goes far enough to address the current opioid crisis.

There isn’t any actual funding for the law at this time and no guarantee of funding in the future. After passage, my inbox was immediately filled not only with the collective outpouring of relief that something was being done, but also from constituencies who began their bleat with a regional or industry-specific take of: •“That’s • right—$0.00 new dollars of a 7 BILLION dollar budget allocated to this local/state/national, CDC-declared epidemic.

In his galvanizing presentation to five hundred professionals at US Journal Training’s 29th Annual Northwest Conference on Behavioral Health and Addictive Disorders (June 1–3) in Seattle, Dr. Maté applied his scientific knowledge with the usual compassion to make his essential point: both substance-related addictions and problematic behaviors are manifestations or symptoms of underlying issues that inevitably relate to childhood trauma.

“We’re really addicted to the quick fix solutions,” Dr. Maté says on page 2. “If you look at the treatment industry, and the whole law enforcement apparatus around addictions, there are decades upon decades upon decades of bitter failure and minimal success. Perhaps the reason we’re not succeeding so well is because we’re not looking at it from the right perspective,” he adds.

Similarly, Dr. Gold (featured on page 5) was one of the first pioneers to suggest use of clonidine and naloxone in rapid detoxification and sequential use of clonidine and naltrexone. Gold demonstrated successful treatment of physician and business executive addicts using detoxification, monitored therapy, and naltrexone in the early 1980s— outcomes-based research without which naltrexone would not have been approved by the FDA after the failed NIDA trial.

As Dr. Gold has always maintained, using PHP research and outcomes as the “gold standard” and five years as the desired follow-up

•“The • ___ is asking for your help in getting real funding for this opioid epidemic (naloxone/treatment/needle exchange/diversion programs/ prevention/education/etc.). $7 billion for opioids and we in [insert state or name of organization here] got $0.”

Meanwhile, provider organizations should keep an eye on the legislation, but also should not expect CARA to make major changes to how addiction and mental health provider organizations pay for services or receive funding until Congress acts in the autumn—after a considerable summer recess—to see if any meaningful funding will be provided for the Act. Meanwhile, enjoy in these pages the stellar interviews and presentations of these giants in that historical context. n Sincerely,

Stephen Cooke Editor, Treatment & Recovery Industry Insider References S. 524 — 114th Congress: Comprehensive Addiction and Recovery Act of 2016. (2016).

Retrieved from https://www.congress.gov/bill/114th-congress/senate-bill/524/text

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Dr. Gabor Maté Speaks Out on Early Childhood Trauma Gary Seidler

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ver the past few years, few voices have resonated so insightfully and powerfully as that of Gabor Maté, MD, a Hungarian-born, Canadian physician and bestseller of the award-winning In the Realm of Hungry Ghosts (2010).

Dr. Maté’s knowledge, passion, and perspective have educated and enthralled both lay audiences (his TED Talks have attracted over one million viewers) and addiction and mental health professionals (he has spoken internationally to thousands of frontline practitioners at various behavioral health conferences).

Speaking to five hundred professionals at US Journal Training’s 29th Annual Northwest Conference on Behavioral Health and Addictive Disorders (June 1–3) in Seattle, Dr. Maté combined his scientific knowledge with compassion to make his essential point: that both substance-related addictions and problematic behaviors are manifestations or symptoms of underlying issues that inevitably relate to childhood trauma.

Addiction, Dr. Maté insists, is not the primary problem. Mental illness, physical illness, and addictions are all manifestations of a lack of love and the basic human need for attachment, meaning the “drive to be close to someone else.”

Dr. Maté explains: So attachment and love, in that sense, that instinctual drive to be close to somebody, to be taken care of or to take care of, is part of our inherent wiring. They’re not luxuries, they are life necessities. That is true even for little birds, who don’t survive without the attachment relationship with the parents. And so when I say that afflictions or addictions of all kinds reflect ultimately a failure of love, I’m not talking about the sentiment of love or the feeling of love. I’m talking about something happening in that attachment relationship that does not allow for the healthy development of the young. And that failure of development, then, is what manifests in mental illness, in addiction, and, I’m bold enough to say, in physical illness as well.

Dr. Gabor Maté

When discussing addiction, the first question needs to be “not why the addiction, but why the pain?” Dr. Maté insists. “And if you want to understand that one, don’t look at people’s genes, look at people’s lives. What happened to them? Why do they have so much pain?” he added.

According to Dr. Maté, how we look at or understand the problem, perceive the problem of drug addiction has everything to do with how we deal with it. As he continues to describe, In North America we’re really addicted to the quick fix solutions. If you look at the treatment industry, and the whole law enforcement apparatus around

addictions, there are decades upon decades upon decades of bitter failure and minimal success. Perhaps the reason we’re not succeeding so well is because we’re not looking at it from the right perspective. So, the mainstream view is really two pronged: addiction is basically a bad choice, an unacceptable behavior that, to be a deterrent, will be punished.

People will be jailed, ostracized, judged, and excluded.

The other approach, Dr. Maté continues, is the medical approach in which he includes the Twelve Step model, which assumes the fundamental belief that addiction is a disease. Dr. Maté states, “. . . one has this disease of the

Sept/Oct 2016 brain called addiction; you are born with this disease through an unfortunate set of genes that you inherited.”

While Dr. Maté favors the Twelve Steps and believes they are essential to healing for a lot of people, he advocates broader understanding which goes even beyond the American Society of Addiction Medicine’s definition of addiction as a primary brain disease. Dr. Maté asks that we consider addiction from the point of view of human experience. And here, he points out, there are three ways of knowing: intellectual knowledge, experiential knowledge, and intuitive knowledge.

Dr. Maté describes his own definition of addiction: A complex, physiological, and psychological phenomenon, manifested in any behavior that a person finds pleasure in, finds relief in, in the short term craves—so pleasure, relief, craving—but suffers negative consequences as the result of and still continues to do the behavior despite the negative consequences. So, craving, pleasure, relief, negative consequences, inability to give it up.

Dr. Maté uses the same definition to describe process addictions including gambling, food, shopping, trolling the Internet, pornography, sex or any number of human activities.

“It’s the same process, the same brain circuits, the same emotional dynamics, and the same causes,” he adds.

By this definition, most of us—including the vast majority of the Seattle audience—relate to having engaged in addictive behavior at some time or another to feel a sense of control, to experience pleasure, to get relief from pain, and to shut off painful feelings.

In other words, Dr. Maté says, “Addiction isn’t the primary problem; your addiction was the intent to solve a problem; the primary problem was that you were in your life, but yet you didn’t feel in charge, you had no control.”

Dr. Maté suggests that, Addiction is actually a normal response to an abnormal situation. In our society, it is very normal for people to have a lot of pain; it is very normal for people to have a loss of control; it’s very normal for people to be shut down emotionally; it’s very normal for people to lack pleasure. But what is normal in society is completely unnatural. In other words, there is a huge distinction between normal and natural. Normal is just a statistic; if everybody in Seattle tortured their pets, it

would be abnormal not to. But it wouldn’t be natural.

So when that I say that addiction is a normal response in an abnormal situation, I mean it’s a normal response to an unnatural situation. And then you have to say, “Well what actually happened here?”

When discussing addiction, the first question needs to be “not why the addiction, but why the pain?”

Returning to his original thesis, Dr. Maté points to California’s Adverse Childhood Experience (ACE) studies, which showed the greater amount of adversity in early childhood, the greater the risk of addiction. He explained, So an adverse childhood experience includes physical, sexual or emotional abuse; a parent beating another; addiction in the family; a parent in jail; a divorce; a parent dying; or a mental illness in a parent.

For each of these ACEs, the risk of addiction goes up exponentially, they multiply each other, and they rarely come alone. That’s the basis of addiction.

Dr. Maté continues, However, you might look at your life or the life of one of your clients and say, “Well, okay none of that happened, but addiction is still happening.” That’s because there’s another kind of trauma that’s more subtle, and we call that “developmental trauma.” And developmental trauma is not when something bad happens, but

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when something good doesn’t happen.

And that something good is something I call, or something the Harvard Center called, “the mutual responsiveness of adult-child relationships.” So children can be traumatized, especially if they’re very sensitive (and there might be some sensitivities that are genetic obviously), but that doesn’t mean they inherited a disease, it just means they’re more sensitive, so whatever happens affects them more.

Dr. Maté also presents his understanding of trauma and its relevance to addictive behavior: We think about trauma as terrible things happening. That’s not the trauma . . . that’s the traumatic event that triggers the trauma.

The trauma is actually what happens inside the individual; it happens in the body and in the psyche. And the essence of trauma is a disconnection from oneself.

These disconnections are protective in the sense that if you’re suffering a lot of pain, emotional or physical, and you can’t escape from it, and you can’t change it, then one way that the body or the brain protects you is to disconnect. Now you can endure it. That disconnection becomes a problem later on, but at the time it’s happening it’s actually protecting you from more pain than you can bear.

So when you’re traumatized early in life, the world you’re going to live in is going to be dangerous. In the world you live in, you’re going to be all alone; caregivers cannot be trusted because they hurt you. You have to manipulate and cheat in order to get your needs met, because the world will not meet your needs. That’s the world of the addict. In short, whether we’re looking at the physiology of addiction in the brain, whether we’re looking at the psychology of addiction, whether we’re looking at the emotional base of addiction, whether we look at the spiritual emptiness that’s at the heart of addiction, we’re looking at the impact of early childhood trauma.

And that means that without a traumainformed approach, how can we possibly succeed in really helping people overcome their addictive drives? n References Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. New York, NY: Penguin.

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NAATP: Conference, Leadership Addresses Health Care Crisis, Recent Criticism

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AATP is mobilizing to meet new and powerful forces that threaten an effective treatment model,” says Marvin Ventrell, CEO of the National Association of Addiction Treatment Providers (NAATP).

Referring to what he deems to be a “critical time when we have both significant interest in addressing addiction as a health care crisis and criticism from the public and policy makers about how we do our work,” Ventrell’s remarks came on the heels of the association’s 38th annual leadership conference, which drew nearly eight hundred attendees to Fort Lauderdale, FL in May. Ventrell celebrated his first year as head of NAATP by cementing the association’s presence with new offices in Denver and overseeing a successful leadership conference which reestablishes the association among all groups as a major force and “values-based professional society.”

Also writing in the new Addiction Leader publication and participating in the rebranding that accompanied the event, Ventrell acknowledged some criticism of how NAATP has responded to “The Addiction Industry at a Crossroads,” as the Florida conference was titled:

singer-songwriter John Hiatt in that state and, on the occasion of its centenary, Rosecrance board member Peg Wilkerson was honored with Caron’s prestigious awards. Wilkerson helped navigate a merger between Rosecrance and another addiction treatment center she’d been a board member for since 1984. She is the senior vice president of business banking at Alpine Bank in Rockford and uses her financial expertise by serving as the Rosecrance Health Network board treasurer and finance committee chairman, and also served as a 100th Anniversary Committee member.

The Michael Q. Ford Journalism Award was received by Alison Knopf, editor of Alcoholism & Drug Abuse Weekly, and the Nelson J. Bradley Career Achievement Award was presented in absentia to Dr. Nora Volkow, director of the

National Institute of Drug Abuse. The awards were emceed by Caron’s CCO David Rotenberg.

Ventrell looked ahead to how important this assembly will continue to be after nearly forty years as the addiction service profession’s most conspicuous North American leadership society:

Peg Wilkerson, Rosecrance board member.

John Hiatt, singer-songwriter.

The Leadership at the National Association was particularly pleased with our 38th National Addiction Leadership Conference.

We feel it was a considerable success for all the usual reasons: attendance, quality of program, this kind of thing. But more importantly, we feel, and the field is confirming this, that the conference reestablished NAATP as a major force in our work and with relevance and value added to our members. n

It seems we do not always know what evidence-based practice or medical model means on the one hand and what a psychosocial-spiritual model looks like on the other.

Without that understanding, we are hard pressed to develop policy and implement services that synthesize the best of both worlds. But that is our charge as addiction professionals, and now is the time to use our best thinking.

Three days of presentations were followed by the annual Dr. Jasper Chen See Volunteer Awards to individuals who have provided exceptional leadership in the area of addiction treatment through board membership and philanthropy. A Cumberland Heights, TN contingent described the extraordinary work of

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Dr. Mark Gold and RiverMend Health

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ark S. Gold, MD, is a translational researcher, author, and inventor best known for his work on the brain systems underlying the effects of opiate drugs, cocaine, and food. He has published over one thousand peerreviewed scientific articles, texts, and practice guidelines. His work is widely cited by his peers and includes citation classics in cocaine neurobiology, opioid addiction neurobiology and treatment, and food and process addictions. He has been called a groundbreaking researcher, father of medication-assisted recovery, the first to translate rat experiments into theory and treatments for human addicts, and mentor of the next generation of addiction researchers and clinicians.

After working on state dependency of memory, amphetamines, and sleep neurobiology, Dr. Gold proposed a novel model for opiate action, dependence, and withdrawal changing the way opiate action was understood. This locus coeruDr. Mark Gold leus theory of opiate and drug withdrawal is a mainstay of 2016 theory and practice, even though he proposed it in 1978. Dr. Gold is the senior author on the discovery paper and was awarded a patent for the discovery of new uses for clonidine which remains widely used for opiate withdrawal and pain management. Drs. Gold and Herbert Kleber were the first to suggest use of clonidine and naloxone in rapid detoxification and sequential use of clonidine and naltrexone. Dr. Gold demonstrated successful treatment of physician and business executive addicts using detoxification, monitored therapy, and naltrexone in the early 1980s, which was pivotal to naltrexone’s approval by the FDA after the failed NIDA trial.

During the 1980s Drs. Gold and Dackis developed a new theory for cocaine action, dependence, and withdrawal based on his understanding of the neuroscience of dopaminerich areas of the brain. While most at the time did not consider cocaine addictive because of the lack of a classic withdrawal syndrome, Dr.

Last year, Dr. Gold became chairman of the scientific advisory boards for RiverMend Health, a national provider of addiction, eating disorders, and obesity evaluation and treatment.

INTERVIEW

Gold proposed a dopamine theory of pathological attachment, loss of control, and addiction.

This work not only helped to reclassify cocaine as addicting, but reduced the importance of withdrawal to the nosology of addiction.

Dr. Gold has also worked for over thirty years trying to understand overeating as related to drug of abuse or addiction models. He described food addiction in several classic papers and texts, and this work has stimulated the field and is summarized in Brownell & Gold’s Oxford University text Food Addiction (2012).

Dr. Gold is a distinguished alumnus of Washington University, the University of Florida, and Yale University. He was a professor, eminent scholar, distinguished professor, and distinguished alumni professor during his twenty-five years at the University of Florida and one of the directors of the McKnight Brain Institute. He has served as a consultant to the ONDCP, NIDA, the State Department and other governmental agencies, professional sports, and CASA-Columbia.

Counselor Consulting Executive Editor Gary Seidler recently posed the following questions to Dr. Gold.

Gary Seidler: What are the most important lessons we’ve learned about addiction in the last four decades?

Dr. Gold: I started doing neurobiological research on drugs of abuse and addiction in 1972. We had limited understanding of the brain, the messenger-receptor systems, and few treatment options at that time.

But our Yale group made considerable progress discovering the noradrenergic neuroanatomy of opioid addiction and withdrawal (Gold, Redmond, & Kleber, 1978).

Shortly thereafter, we invented the use of clonidine in acute withdrawal, rapid detoxification, and naltrexone induction. Unfortunately, treating withdrawal does not treat the disease of addiction. That was a lesson in the limitations of research and medically assisted therapy. Giving a detoxified addict a medication like naltrexone, that completely eliminates the possibility of an opioid relapse or addiction, did not mean that the disease of addiction was in a remission or the addict cured. Most patients stopped taking naltrexone and relapsed. The only exception were executive health providers and pilots who had care case managers and job jeopardy to help them take their medications and follow their long-term treatment program.

In the 1980s we focused on dopamine and pleasure. In our studies with cocaine and amphetamines we learned that addiction was more about pathological attraction and desire and less about abstinence and the dramatic withdrawal syndrome (Dackis & Gold, 1985).

While most disagreed, we showed that cocaine was highly addicting and that dopamine was central to cocaine addiction, abstinence, dys-

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phoria, and craving.

In the 1990s we started working on cigarette and second-hand smoke, smoking, and how smoking was addicting because of rapid brain delivery—injection without a needle. Dopaminerelated drive for the drug reinforcement rather than the withdrawal symptoms drove relapse (DuPont & Gold, 1995).

On and off for nearly thirty years I was studying the relationship between drug intoxication and eating as well as addiction withdrawal and anorexia-hyperphagia. I made some progress, but mostly failed to understand drug-like reinforcement and obesity. I summarized my thirty years of failure in this research at one time (Gold, 2011), but in the end this work led to a clearer understanding of the role of dopamine in process addictions, especially gambling, sugar, and food addictions.

Gary Seidler: Does addiction treatment work?

How do we reasonably answer this question?

Dr. Gold: Addiction treatment clearly works for impaired health professionals. Drs. Bob DuPont, Tom McLellan, and our group first studied five-year outcomes for physician addicts in Florida and then extended this study to a national sample of physician addicts. Addiction treatment works very well in this population as nearly 80 percent of the addicts return to practice and are drug free with clearly positive and cost-effective five-year outcomes.

We published this five-year outcome study in JSAT (DuPont, McLellan, White, Merlo, & Gold, 2009). Similar outcomes have been reported for pilots and business executives. Why physicians do so very well has been attributed to having their treatment monitored by random urine testing and managed by physician health programs. It may also be important that physicians have good premorbid function, start using drugs late in their lives, and succeed enough to get into medical school.

It is also true that if you compare outcomes of a thirty-year-old physician using opioids intravenously and a thirty-year-old unemployed person using opioids intravenously, one would be prescribed detoxification, abstinence-based therapy, and physician health program monitoring, and the other methadone or suboxone.

Using PHP research and outcomes as the “gold standard” and five years as the desired follow up for outcomes can answer the question of not just whether, but which treatment, and for whom, does treatment work.

Gary Seidler: What have you been doing after twenty-five years as distinguished professor and chairman at the University of Florida?

Dr. Gold: I have been busy continuing my research, writing, mentoring, and teaching as

an adjunct professor at Washington University. I have been giving a Grand Rounds most months and teaching at medical schools across the USA from Yale to Stanford to Emory and the Medical College of Georgia to UMass, UConn, and Tulane Medical School. I am the chairman of the scientific advisory boards for RiverMend Health—both addiction and psychiatry, as well as eating disorders and obesity. It has been great to have a faculty of great researchers and clinicians to work with to develop new academic partnerships, treatment programs, and evidence- and outcome-based treatments.

The academic partnership between RiverMend and the Medical College of Georgia has been a model and led to the development of a new Division of Addiction Medicine, new ASAM-ABAM training program, and training of MCG students, faculty, and psychiatry and other fellows. In addition, the full range of treatment from evaluation, intervention, detoxification, drug-free and medication-assisted treatment and a beautiful new treatment campus on the river, Bluff Plantation in Augusta, GA. RiverMend has started national educational forums, web-based educational programs, and CME programs. There are also new physician expert-led addiction programs on Lakeshore Drive, Positive Sobriety Institute in Chicago with Northwestern Faculty and Malibu Beach Recovery Centers with USC Faculty. These have become major regional treatment programs, and source of medical clinician education as well as important community and training resources. I have also enjoyed spending time teaching, working with the physicians, and speaking at RiverMend’s programs in eating disorders at Rosewood Ranch and programs in Arizona and Santa Monica too. In my “spare” time I have also started research and the study of treatment, interventions, and outcomes at RiverMend and working on the second edition of our Oxford Press book.

RIVERMEND HEALTH

RiverMend Health provides scientifically driven, specialty behavioral health services to those suffering from alcohol and/or drug dependency, dual disorders, obesity, and chronic pain. Founded on the belief that addiction and obesity are the nation’s most pressing health care challenges, the company brings together many of the world’s experts and a national network of rehabilitation facilities to conduct evidence-based treatment, research, and education.

RiverMend’s scientific advisory board(s), chaired by Dr. Mark Gold, and the company’s leadership team, reads like a “who’s who” of preeminent researchers, scientists, and clini-

cians who have made significant contributions to the field of addiction and behavioral health: • •Daniel Angres, MD, adjunct associate professor of psychiatry at Northwestern Feinberg School of Medicine.

Dr. Angres is also CMO at RiverMend Health.

• •D avid Baron, DO, MEd, professor at University of Southern California and director of USC’s sports medicine division. Dr. Baron is CMO of Health and Wellness at RiverMend Health.

• •Stacy Seikel, MD, CMO of RiverMend’s integrated recovery program and medical director of RiverMend’s Health Center in Georgia.

Other scientific board members include Kenneth Blum, PhD, chairman of the board and CSO of LifeGen Inc.; William Alder, former chief of the DEA’s Education Foundation; and Robert DuPont, MD, founding director of NIDA and former drug czar.

RiverMend Health’s campuses include: • •Bluff Plantation on 178 acres on the Savannah River in the heart of Augusta, GA •Malibu • Beach Recovery Centers in CA • •Positive Sobriety Institute on Lake Michigan in downtown Chicago, IL • •RiverMend Health Centers, Atlanta.

• •Rosewood Centers for Eating Disorders in AZ and CA • •Wellspring Camps (weight-loss camps for kids, teens, and young adults) n References Brownell, K. D., & Gold, M. S. (Eds.). (2012) Food and addiction: A comprehensive handbook.

New York, NY: Oxford University Press.

Dackis, C. A., & Gold, M. S. (1985). New concepts in cocaine addiction: The dopamine depletion hypothesis.

Neuroscience and Biobehavioral Reviews, 9(3), 469–77.

DuPont, R. L., & Gold, M. S. (1995). Withdrawal and reward: Implications for detoxification and relapse prevention. Psychiatric Annals, 25(11), 663–8.

DuPont, R. L., McLellan, A. T., White, W. L., Merlo, L. J., & Gold, M. S. (2009). Setting the standard for recovery: Physicians’ health programs. Journal of Substance Abuse Treatment, 36(2), 159–71.

Gold, M. S. (2011). From bedside to bench and back again: A thirty-year saga. Physiology & Behavior, 104(1), 157–61.

Gold, M. S., Redmond, D. E. Jr., & Kleber, H. D. (1978).

Clonidine blocks acute opiate-withdrawal symptoms. Lancet, 2(8090), 599–602.

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Responding to the Responder: Dr. Todd Langus Develops Frontline Therapy for Emergency Personnel at Champion Center Stephen Cooke

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his year has seen a renewed interest, for good or bad, in the unique elements of stress, grief, and loss that workers in public safety jobs often come across in the line of duty. It should come as no surprise after events of 2016 that many public safety or military personnel members often turn to self-medication with pain pills or alcohol instead of asking for help.

“These people see the worst of the worst every day,” says Todd Langus, PsyD, MFT-I, who is well-poised to know after serving for almost twenty years as a California police officer himself.

Dr. Langus spearheads an innovative program to treat first responders at Champion Center in Lompoc (pronounced lom-poke) in the heart of Santa Barbara County, Dr. Todd Langus nine miles east of the Pacific Ocean.

Champion Center is forging, under his direction, a nationwide reputation as the leading chemical dependency treatment facility for specializing in military and public safety officer treatment.

“At Champion Center, like police work, it’s never a dull moment; you never know what issues are going to come up or what ‘fires’ you’ll have to put out,” says Dr. Langus.

Dr. Langus has become an in-demand public speaker and is frequently featured at US Journal Training (USJT) conferences around the country. He is sought after for his clinical agility in delivering the experience most clinicians lack in relating to the impact of trauma to those who serve on the frontlines of menace and danger.

Dr. Todd Langus received his doctoral degree while serving as a police officer and sergeant during a distinguished law enforcement career that encompassed assignments ranging from patrol, canine unit, field training officer, investigations, hostage negotiator, SWAT, jail operations, and court operations. He has since dedicated his career to treating public safety and military personnel, including responses to national emergencies such as 9/11 and Hurricane Katrina, and has led responses to countless officer-involved shootings, line-of-duty deaths, and critical incidents throughout California as well as other states while treating

veterans from the wars in Afghanistan and Iraq.

Not only has he seen the direct effects of trauma to others, he has a perspective missing in many American clinicians that he has seen trauma first-hand on multiple visceral occasions and is a trauma survivor himself.

“I see a population that, especially with current media ignorance of its role, can be deeply misunderstood with terrible consequences,” said Dr. Langus as more news reports came in from a combustible summer for first responders in Baton Rouge, LA and indeed across the United States. “I’m trying to train therapists to connect and understand that there’s a big difference in treating the responders,” added Dr. Langus. “If we miss that, we can actually harm them more than heal them.”

The gestation of Champion Center’s pioneering first responders program began when Officer Langus was called into the local Hemet hospital to do an intervention on a fellow officer. While there, one of his colleagues told the nurses that he was actively doing therapy of this nature from a private practice for frontline emergency personnel.

Enter Steve Collier, RN, one of the cofounders of The Hemet Valley Recovery Center and Addiction Medicine Services, Inc. (AMS) who had served as a drug exemption officer in the US Navy.

With Lompoc’s proximity to Vandenberg Air Force Base, Collier brought in Dr. Langus to do a lecture, and immediately saw with his AMS team the potential to forge a first responders program with his expertise at the helm. He allowed Dr. Langus to design the program and establish a curriculum that has, over the last few years, become well-known to military, police, and fire units across the United States.

Champion Center’s incarnation was as a partnership between AMS and the Lompoc Healthcare District as The Lompoc Valley Medical Center, the first operating health care district to be established in California. Ironically, the City of Lompoc was first founded as a temperance colony in the 1880s. AMS prides itself on partnering with hospitals to deliver chemical de-

pendency and behavioral health care services, and entered new trauma territory with its faith in the program designed by Dr. Langus.

Not only has he seen the direct effects of trauma to others, Dr. Langus has a perspective missing in many American clinicians in that he has experienced trauma first-hand on multiple visceral occasions and is a trauma survivor himself; as an officer, Dr. Langus was involved in officer-involved shootings and has lost friends and partners in the line of duty and to occupational suicide.

“First responders unequivocally get into the career with a singular mindset to help people.

When they have to inflict deadly force or take a life in order to assist others, it goes deeply against that mindset of helping the public,” Dr. Langus explains. His team is also active in helping responders’ families in accompanying areas of depression, grief, anxiety, relationship issues, and anger management. “The damage comes when these personnel feel that they’re ineffective and somehow unable to save others or, at worse, provide positive outcomes for victims,” he adds.

Dr. Langus continues to deliver training and lectures to numerous law enforcement agencies and corporations throughout the United States. The field in general has taken notice of his ability to help clinicians identify personality traits and behaviors that are unique to the post of successfully handling emergency situations that later often preclude responders from coping with their personal lives.

There’s another irony for the officers that value this inspirational leader; that learned occupational traits so often lead to negative defense mechanisms and self-defeating behaviors specific to the first responder that commonly are left unidentified. “There were not too many resources or knowledge to help me with my own PTSD when I lost my partner, and that really began my crusade to help responders,” affirmed Dr. Langus.

With the unique challenges that have been rendered all the more poignant by what police departments and emergency personnel have faced during 2016, Langus is a man on a mission and championing a novel new paradigm in providing behavioral health treatment to what has been an underserved community of need. n

8 Industry Insider

Sept/Oct 2016

Cottonwood Tucson Team Affirms “Essence of Resilience” in Treating Trauma Stephen Cooke

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he word “resilience” is often overused in recovery circles at this time; many are the mutual help gatherings and treatment centers that incorporate it into their messaging or literature. But the fortitude of real resilience is there for all to see in the work of Kathleen Parrish, MA, LPC, and Tanya Lauer, MA, LPC, both professional counselors at the internationally renowned residential treatment center Cottonwood Tucson in AZ’s Sonoran Desert.

On a scenic thirty-five-acre campus in the foothills overlooking Tucson, Cottonwood and its stellar clinical team are gaining international renown for their safe clinical strategies to promote trauma healing, emphasizing mindfulness, self-compassion, and what they deem to be the transformative power of story.

They are now sharing some of those inspiring tales of success in meeting suffering with healing for a new book that these prolific presenters and writers have coauthored entitled The Essence of Resilience: Stories of Triumph over Trauma (2016).

“In our years of work in the area of trauma recovery, we have been honored to share in the journey of many courageous beings,” said Parrish, who serves as clinical director at the residential facility.

Acutely aware of chemical dependency so often being coupled with a psychiatric or emotional illness, Parish and Lauer lead an outstanding rehab staff well-trained to manage co-occurring disorders (dual diagnosis) by designing individualized treatment programs for each client. There are few teams better qualified in the United States to address the precious resource of resilience to provide important and urgent answers to trauma, this all-too-common interloper. On that spacious campus, evidencebased practices support clients in discovering their strengths and their resilience.

And they do deem it to be a precious resource, alternatively described as “the gift” or “the gold in the wound.” The book is a primer for therapists transforming a story of trauma into a story of resilience.

A prolific author, Parrish’s expertise has been instrumental in shaping a Cottonwood clinical team that has won international acclaim for its treatment of co-occurring

“When trauma enters the lives of the unsuspecting, it steals from their very soul. It not only robs them of peace and joy, it can take years and decades from their lives while they desperately try to fill the hole in their heart, pretending that their soul isn’t leaking out of it. No one is ever prepared for trauma and no one is ever left unchanged by traumatic events.”

Kathleen Parrish, MA, LPC, and Tanya Lauer, MA, LPC, will be presenting “Resilience and the Healing Power of Story” at the US Journal Training (USJT) 22nd Annual Counseling Skills Conference in Dallas, TX on September 22–24, 2016. disorders. She has a master’s degree in marriage and family therapy, has worked in private practice, and also has over twenty years of providing counseling and intervention services for trauma survivors.

With over forty years of combined experience helping survivors find the “gift” or the “gold,” Lauer and Parrish are well-qualified

to understand the narratives that shape each traumatic incident. Thus stories play a big part not only in their work in the desert, but also in their new book.

“Our book is dedicated to those trauma survivors who have inspired us,” said Lauer, who has presented at conferences throughout the United States and Europe, “not only with their stories of suffering and healing, but with the true essence of their resilience.”

With a master’s degree in counseling and psychotherapy, Lauer has applied her healing to psychiatric hospitals, in-home therapy services, and outpatient trauma centers, and her expertise has helped Cottonwood Tucson establish itself as one of the most innovative and evidence-based holistic behavioral health treatment centers in the world for treating that “gift in the wound.”

“Traumatic wounding is a powerful source of suffering,” added Lauer. She explains, “Many trauma survivors continue to feel trapped long after the trauma has occurred by their physiological symptoms of stress response, along with a potent and entrenched shame-based narrative that echoes through their internal dialogue.”

There’s no doubt that Parrish and Lauer will continue to address the potential for that reprieve in their life’s work through stories, compassion, and outcomes-based understanding of the eternal question of what allows people to find untapped resources of resilience in their wounds while another might suffer endlessly in the face of such adversity.

“In an effort to survive and break free from these patterns, clients often develop myriad maladaptive coping behaviors that perpetuate the traumatic wounding instead of offering a reprieve,” Lauer added.

It resonates not only in the vivid narratives of the face of such adversity but now in a book for trauma survivors to find the gift in their narrative, as simply affirmed by the center’s clinical director: “At Cottonwood, we shall simply continue to provide the same steady, evidenced-based course of treatment with our patients.” n References Lauer, T., & Parrish, K. (2016). The essence of resilience: Stories of triumph over trauma. Deerfield Beach, FL: Health Communications.

Sept/Oct 2016

Industry Insider

9

CCAPP National Advocacy Update Andrew Kessler, JD

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n September of 2013, I was a presenter at the National Conference on Addiction Disorders in Anaheim, CA. I gave a talk to the attendees on a very important subject: how to make the treatment and prevention of substance use disorders (SUDs) a relevant topic in politics. SUDs are often misunderstood by policy makers, and come with a stigma we are all too familiar with.

What made the subject so difficult, I explained to the audience, was the nature of politics.

Members of Congress work diligently on issues that they perceive to be of great importance to their constituencies. SUDs, while widespread and a problem in almost every congressional district, simply did not generate enough constituent interest. So I said something that day that, at the time, I believed to be 100 percent accurate: “No politician will ever get elected by making drugs and addiction a centerpiece of their campaign.”

Three years later, however, I’m thrilled to say that I can no longer make such a claim.

Not only is opioid abuse and addiction—especially overdose—a campaign issue, for this 2016 election year it is very close to being the top issue. Not the top health issue, not the top crime issue, not the top issue impacting youth— the top issue. In national, state, and local races, candidates are citing the issue as a high priority, either touting their accomplishments or promoting their plans for action.

It is a situation that would have been unthinkable a decade ago, but some House and Senate Republicans are basing part of their reelection strategies on sponsoring and passing bills to help addicts and those with other SUDs. In The Wall Street Journal, Rep. Hal Rogers, chair of the House Appropriations Committee and perhaps the strongest advocate for prevention and treatment in Congress, observed that the problem is “demanding that candidates for president put it on their front burner” (Campo-Flores, 2016).

Amongst presidential candidates in 2016, almost every candidate from a major party addressed the issue. Because NH has been hit particularly hard by heroin, and given its importance in the primary season, opioid abuse was a major theme on the campaign trail. Jeb Bush and Sen. Ted Cruz both talked about their personal experience with SUDs, as both witnessed family members struggle with addiction. At a

January 5, 2016 forum on addiction policy in New Hampshire, Jeb Bush, Gov. Chris Christie, Carly Fiorina, and Gov. John Kasich all shared deeply personal connections to addiction, and went on the record in support of reducing stigma and increasing access to care. According to The Hill newspaper, “In this unprecedented presidential policy forum with hundreds impacted by addiction in attendance they all came out for one reason - to court the recovery voter” (Levenson, Williams, & Thorne, 2016).

Sen. Marco Rubio called NH an eye-opener.

“What happened in New Hampshire was I met a lot of families that had been impacted by the epidemic. I mean, people who lost children or had children going through rehab and trying to recover from this terrible disease,” he said in Roll Call (Lesniewski, 2016).

Secretary Clinton has introduced a detailed plan for combatting opioid abuse. It calls for investing in prevention, treatment, recovery, greater access to naloxone, prescriber education, and criminal justice reform. Also proposed is $7.5 billion in funding to build federal and state partnerships over ten years. In addition, Clinton has voiced support for Sen. Joe Manchin’s bill which would tax prescription opioids in order to better fund treatment, via the SAMHSA block grant.

Mr. Trump has commented that his proposed border wall will stem the flow of illicit opioids into the United States. He has not put forth any specific plans other than to “help” those addicted to opioids.

While the national media focuses most of their attention on the presidential contest, opioid abuse and overdose are incredibly hot topics on the state level, especially in several high profile Senate races. In NH, incumbent Sen. Kelly Ayotte and challenger Gov. Maggie Hassan have made opioid abuse and misuse the central issue in their campaign. Sen. Ayotte has spent the last few years as a champion of the issue in Washington, authoring and cosponsoring legislation that would seek to expand treatment and recovery services. Another key Senate race is in OH, where incumbent Sen. Rob Portman, another Senate champion on the issue, faces a ferocious challenge from former Gov. Ted Strickland.

Sen. Portman has been one of our greatest champions on Capitol Hill by coauthoring the CARA act and doing literally everything within his power

to advance and pass it. His campaign to persuade the House to act on the Senate’s legislation to combat opioid abuse became of his reelection campaign, too. His campaign team produced a web ad in an outreach to voters that features a message from Wayne Campbell, a constituent who lost his son Tyler to an overdose of prescription painkillers.

Yet as Sen. Portman touted his record, his Democratic challenger, former Ohio Gov. Ted Strickland, is attacking Portman on the same issue. Strickland called Portman “hypocritical,” with claims the Senator has supported cuts to substance abuse funding. The exchange between the aides for the two candidates, as well as the paid advertising of the campaigns, is revolving around this one issue.

Opioid abuse has become a large enough political issue that, according to Politico, the Karl Rove-backed group One Nation spent $1.12 million in March on an ad touting New Hampshire Sen. Kelly Ayotte’s role in passing bipartisan Senate CARA legislation (Cook, 2016).

The opioid epidemic our country currently faces is most certainly a game-changer. What remains to be seen is how much attention policy makers will dedicate to the issue once the campaigns are over. n Andrew D. Kessler, JD, is founder and principal of Slingshot Solutions LLC, a consulting firm that specializes in behavioral health policy and Federal Policy Liaison for IC&RC. IC&RC promotes public protection by setting standards and developing examinations for credentialing prevention, substance use treatment, and recovery professionals.

References Campo-Flores, A. (2016). Advocacy groups, lawmakers redouble efforts to make drug abuse key campaign 2016 issue. The Wall Street Journal. Retrieved from http:// blogs.wsj.com/washwire/2016/03/31/why-drug-abusecould-receive-more-attention-on-2016-campaign-trail/ Cook, N. (2016). Vulnerable GOP Senate incumbents talk up their record fighting opioid abuse. Retrieved from http:// www.politico.com/story/2016/05/vulnerable-gop-senateincumbents-talk-up-their-record-fighting-opioid-abuse-223006 Lesniewski, N. (2016). What Rubio learned on the campaign trail about the heroin crisis. Retrieved from http://www.rollcall.com/news/policy/rememberingnew-hampshire-rubio-calls-hearing-heroin-crisis Levenson, J., Williams, G., Thorne, G. (2016). Courting the addiction recovery vote. The Hill. Retrieved from http://thehill.com/blogs/congress-blog/presidentialcampaign/265159-courting-the-addiction-recovery-vote

10 Industry Insider

Sept/Oct 2016

Industry Trends A Blessing and a Curse Michael Walsh, MS, CAP, BRI-I

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et’s face it—the addiction treatment industry is changing, and that’s a blessing and a curse. There are so many programs that have opened in the last few years and yet beds are still desperately needed in so many places in our country and around the world. There are some saturated markets—Southeast FL, Southern CA, parts of AZ, and now TX—and some areas where it appears the market is heading in the same direction.

Competition should be a good thing; free-market economies and all but sometimes there appears to be an inverse relationship between high-level marketing and quality clinical products. This isn’t an absolute, but I’ve learned in practice that almost anyone can do either great clinical work or great business.

Doing both is extremely difficult!

Add to this conundrum a payer mix that appears disinterested, indifferent, and/or just uninformed as to what constitutes quality treatment and you have a growth industry in all likelihood headed for a market correction. Like all market corrections, there will be opportunities.

Many people say we need outside help policing addiction treatment while others have called for self-monitoring of the industry. I see problems and opportunities with both of these movements.

What I would recommend is the education of the consumer and some sensible standards.

The fact that we need more beds is quite disconcerting on so many levels. This isn’t rocket science, and we have data on the brain science.

Treatment works, recovery is possible. We are misusing alcohol and drugs in this country at astounding rates, yet in many regards we don’t

acknowledge it and many don’t understand it. Codependency appears to be a close second in prevalence and severity. Clients in some cases go in and out of a revolving door and do not follow the simplest of treatment recommendations upon discharge, which results in relapse, which makes clients and families say that “treatment doesn’t work.”

It’s astounding how many families refuse to encourage loved ones to follow aftercare/continuing care plans when we know that without follow-up this fatal and progressive disease gets worse. They go to family programs and many times hear

Quality treatment, aftercare/ continuing care compliance, and monitoring should be the rule, not the exception. It’s time for the treatment community, recovering community, family, friends, loved ones, and everyone to decide that hundreds of Americans dying every day is newsworthy and that it’s time for action.

Unfortunately this message will probably go no further than you who have chosen to read it. If you do care, talk about it and make some noise. We need a movement similar to the action in response to the 1980s AIDS epidemic.

…you have a growth industry in all likelihood headed for a market correction. invaluable messages they either cannot or will not follow through on.

Treatment shouldn’t end when someone is discharged from an inpatient stay or a detox; in this context treatment is something that should continue for months if not years. When someone gets to the point of meeting criteria for a progressive and fatal disease such as this, a Band-Aid typically will not work.

I’ve been quoted as saying people spend more time picking out a pair of shoes or a purse than a treatment center. If you had cancer, would you ignore the recommendations of the oncologist over and over or, from the family’s perspective, sit idly by while your loved one dies?

Despite the headlines some unethical treatment providers and criminals have gotten in the last year, the majority of people in the treatment profession are hard-working, ethical professionals in one of the most important industries in our nation. Why isn’t that news?

Why are the hundreds of addicts who die every day in this country less newsworthy than those dying in other ways?

Their numbers pale in comparison, and I’m not minimizing the tragedy, but our disease gets relatively little coverage for the constant damage being done every day. It affects every aspect of our society, yet we are misunderstood and only get press when it suits someone

politically or a high-profile celebrity dies. The rest of the societal carnage continues to be swept under the proverbial rug.

Big Pharma made its money and will continue to, but they can’t cure the social effects of this disease even though the bandwagon is being filled and financed in DC as we speak. I’m not against medication-assisted treatment; as I’ve said before, I believe in the sensible use of medication.

We need more quality treatment, but we also need to address the habilitation (not rehabilitation) of a generation of young adults that has grown up through this carnage and has little chance of changing the course of their lives in thirty days.

Insurance companies won’t pay for “social services,” I get it. The criminal justice system isn’t the answer.

The effects of not treating addiction competently and successfully will be felt for generations to come.

How many more children have to grow up being raised by addicted parents, by overwhelmed grandparents or in the foster system before we admit this is our problem?

Thank you for caring enough to read this. Please share this with a friend and write your politicians and media outlets. n Michael Walsh, MS, CAP, BRI-I, is currently executive director and COO at HARP Treatment Center on Singer Island, FL. Former president/CEO of The National Association of Addiction Treatment Providers (NAATP), he holds a master’s degree in substance abuse counseling and is a certified intervention professional. He has extensive knowledge, experience, and understanding of the treatment industry from preadmission through the intervention, admissions process, case management, referent relations, client services, and aftercare coordination for patients.

Sept/Oct 2016

Industry Insider 11

Testing Matters Integrating Treatment and Recovery into the Community Health System Brian P. Crowley

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ith the creation of certified community behavioral health clinic (CCBHC) programs, the Excellence in Mental Health Act will begin to pioneer a universal model of care in behavioral health (BH) that will most likely in some shape or form transition, in time, to the commercial payer marketplace. Although we have a long way to go, this seems like a step in the right direction for providers and patients in that it recognizes BH as an “equally valuable member of the community safety net” (NCBH, 2015).

As twenty-four states and SAMHSA work to figure this out over the next two years, it’s important for the private sector to be thinking about how this may impact their business and way of life in the workplace. Given that this column’s secondary objective is to discuss issues that will test the industry, the concept of greater integration of treatment services into the community health system is worth some thought.

Why now? Why at all?

Well, because it’s going to take a lot of work to get it right. It will take one to three years of planning, modeling, and testing to effectively implement a viable local-state solution. Instead of reacting, some providers are already proactively researching this and engaging with payers on pilot programs.

Here’s a short list of what needs to come together for integration of BH into the community health system: •Communications • and consensus building •Pilot • programs and testing •Operational • accountability •Benchmarking • infrastructures • •Establishment of collaborative governing bodies All this to have a model that defines allowable and nonallowable costs, paying provides reimbursements based on real anticipated costs (not what payers think it should be), and that allows providers to expand services in innovative ways to deliver comprehensive care where patients live and work.

The recovery movement plays a significant role in the larger picture of integrated health care and will continue to grow in prominence due to the staggering numbers of people struggling with addiction. Such an enormous problem requires collaboration between multiple stakeholders to include physical and mental health care providers and payers in order to effectively treat this epidemic. The opportunity exists in that there is a patient/provider gap between physical and mental health patients and providers.

This article will attempt to address the essential elements needed within the industry to achieve this level of integration, which ultimately provides quality, effective treatment, and fairly disbursed reimbursements across a wide spectrum of care and information networks. We will focus on a local care delivery scenario and the Internet work arrangements that must exist between stakeholders. Once proven, this model could theoretically be expanded nationally. We will “imagineer,” as Walt Disney said, what the best case scenario could look like and what would need to be in place for it to be effective, taking into consideration

current and future care delivery, human capital, technology, and financial environments.

Imagine if you will, a forty-four-year-old woman addicted to opioids and alcohol due to a chronic back pain from a car accident and on the job stress. Over the course of five plus years she has been in the ER eight times, rehab in four treatment centers, one month in jail, and several months on probation and community service.

She earned a postgraduate degree in mechanical engineering and held an executive-level job earning over six figures. She’s still married with two kids, both under the age of sixteen. She’s currently in an IOP program, living in a recovery residence, still has insurance (thanks to her union), and is three months clean.

We all know this story and the parts that are currently broken. So let’s allow ourselves to “imagineer” a utopian scenario. From the moment of her first admission into the ER, a physician trained to detect possible addiction behaviors notes her record for a follow-up visit with her PCP, who in turn refers her to a BH clinician, who determines she may not only have a chemical addiction issue, but also an

12 Industry Insider

Sept/Oct 2016

eating disorder and codependency issues that may have originated from a childhood trauma of emotional and possible sexual abuse. We may now be dealing with chemical dependency, psychological trauma, and the emotional effects that have evolved into adulthood. Even though this is a utopian scenario for care delivery, experience has shown that the patient herself most likely will require significant time and multiple varieties of treatment in a supportive environment to improve her odds of abstinence over the first two years.

Today in the private sector, very little of this infrastructure of pertinent information is shared between public and private agencies, payers, and/or providers. Public health systems are leading with the sharing of PHI. For example, in Florida the state health information exchange (HIE) shares patients’ demographic information, source facility, and primary complaint with providers, payers, and their affiliated users to query medical records of other providers for patients’ data to facilitate case management. In order for the private sectors to achieve a similar goal, it will require a number of essential elements to be in place.

TRAINING AND EDUCATION

This includes state and regional collaborative BH outreach programs whereby payers, hospital networks, and physician groups are presented with the clinical and business case in partnering with local treatment centers.

In addition, training of staff at these facilities should include identifying behaviors and or placement of BH specialists, who are “on call” within a defined geographical area to determine initial diagnosis and select a local treatment provider. A centralized BH manager for each area acts as placement agent for the local co-op of providers, who then select treatment providers and recovery residences based on insurance coverage, historical treatment outcomes for specific diagnosis, and patients’ experience feedback ratings.

All of this information is accessed through a centralized, industry-wide enterprise data warehouse (EDW) type ecosystem. This is not one super computer, but more like an ecosystem of interconnectedness between stakeholders who share virtual private access that is authorized only by patients who get alerts (if they so choose) when third parties access the data.

This is a patient-centric encrypted data ecosystem that can be not only used for data sharing and research on patient outcomes, treatment effectiveness, and stakeholder performance.

The system can then integrate all our industry data with other patient data such as lifestyle,

disease, environmental issues, and long-term medication cross reactivity data. Using artificial cognitive intelligence, we can really begin to connect the dots and solve some significant health puzzles. That’s real, powerful, twenty-firstcentury health care!

Yes, there are valid concerns about PHI security and Big Brother manipulating care and reimbursements. This is exactly why providers need to engage more on a larger collaborative scale to influence and cocreate this next-generation care model. Before all this happens, payers and providers need to agree on how care delivery is reimbursed in this all-inclusive market and how providers can be recognized for their role at each particular stage of the patient recovery capital lifecycle. This will be especially important as payers are beginning to pursue all-inclusive payment models.

By beginning to track patient life cycles now and over the next five-year care continuum, we can start to identify the care gaps. By 2021 we will have the data, the leadership, and the collaborative organizational ability to more accurately pinpoint weaknesses in the system and fix them faster and more effectively on a larger scale. Currently, we don’t have access to the level of data that will allow us to analyze these trends, benchmark best practices, and hold stakeholders accountable to deliver on multiple fronts.

The question still remains: Why do this from a business perspective and who’s paying for it?

What are we getting? On the front end, patients are accountable to taking better care of themselves by being proactive in using the rewards programs payers promote. On the back end, if patients go through treatment and are actively working their recovery, they get rewarded through a credit system, earning them points— think air miles and shopping reward programs.

Engaging gamification tools delivered through mobile apps will exercise the brain and body, while simultaneously gathering valuable data that is aggregated and analyzed to help stakeholders improve care and cost to keep patients connected to the support community.

Providers will then have the capability to prove to stakeholders that their treatment programs work, and if not, why not. Payers can see what providers are doing and providers can see what payers are doing or not doing to ensure that patients get the level of care necessary for whatever time it takes. Under an all-inclusive or partial carve-out rate, providers are incentivized to deliver quality, personalized care and ensure that patients are prepared to plug into the aftercare system once discharged. Given that there are multiple providers involved in the

care continuum, a weighting system can determine who is responsible if and when patients relapse in certain stages and timeframes. Consequences such as financial penalties will be due back to payers and resets established at that particular stage of the recovery cycle. Government can incentivize stakeholders by offering taxation credits for best practices achieved and make available lucrative grants to study opportunistic concepts and tools to test.

So who pays for this? In short, we all do.

Get over it. It’s the cost of innovation and a better way of health care and doing business.

Patients, payers, providers, and the public are engaged under an agreed form of incentives for cost savings and accountable improvements. If accessing such an extensive level of data is not prohibitive due to cost, then it will get used. If we all play and pay our fair part, everybody uses it and we all win. Knowledge is power and this is the knowledge age.

HOW DO WE GET THERE?

We need to start thinking bigger. Providers in BH seem to think short term and on the problems of today without giving much thought or resources to the problems of tomorrow. When tomorrow comes, we go through the same cycle of insanity in complaining and expense to fight what is now today’s problem. Yes, these are bigger issues that any one single provider or network cannot fix alone. This is exactly why we must actively engage, as a collaborative group of stakeholders, to where we can conceptualize the steps, develop some pilot models, and test the tools, people, and processes on a smaller scale.

If you are interested in hearing more and getting engaged, you can e-mail me for more details at brian.crowley@integraenterprizes.com.

We are seeking payers, providers, and subject matter experts to contribute to the “Testing Matters” best practices platform (currently in development), where we will begin to break this topic down into a bite-size workshop learning series. We invite you to be a part of defining and create your future in behavioral health. n Brian P. Crowley is the founder of Integra Enterprizes. He has experience in the business of behavioral health, specifically drug testing, strategic business, and leadership development.

He is chairman of the FBHA Committee on Laboratory Services.

References National Council for Behavioral Health (NCBH). (2015).

CCBHC: Certified community behavioral health clinics.

Retrieved from http://www.thenationalcouncil.org/ wp-content/uploads/2015/11/Fact-Sheet_CCBHCimplications-and-opportunities-FINAL.pdf