Move away from the `program` approach to care

I recently posted this on social media:

“We don’t need to create programs. We need to do treatment. There’s a difference, a big difference.

A program exists on its own. It doesn’t need patients. The program will always be there. A long time from now an archeologist will come across one of the Policy and Procedure Manuals that we use today and conclude “this is how they treated people with substance use disorders 200 years ago.”

Have we come to plug patients into programs rather than planning treatment for patients?

It’s worth thinking about!”

It was really nice to see so many "likes" and "comments" on this post. It was unexpected. I typed it out during a moment of frustration. It wasn't frustration at insurance companies. Providers and insurance companies have both played a role in the dysfunctional dance we do today.

To some extent, recommending “programs’ has become easier than making “treatment” recommendations.

For example, it has become commonplace for residential “programs” to recommend that a patient engage in an “intensive outpatient program” once the objectives of the residential level of care are met. It’s easy for the therapist, the case manager and the insurance provider. It doesn’t take a lot of thought or legwork to make this happen. It takes more of an effort to look at all six ASAM dimensions and recommend what is needed at the next level of care.

Most people will agree that this makes sense. It’s also more work. But it’s likely to be less expensive.

From this point on I would like to call this a “program model” and a “case management model.” The program model takes us away from making treatment recommendations based upon clinical information toward recommendations made from a menu.

I have people coming into my office saying things such as, “I need to get into an intensive outpatient program.” The reason could be along the lines of, “I was arrested for DUI and my attorney said that I should enroll in an IOP.”

Or it could be, “Some people tell me that I need to go somewhere for 28 days, but I would prefer outpatient.” Chances are that both of these people will wind up in an IOP. And that's a very big problem!

When treatment recommendations are made so that a person gets well, rather than as a consequence of bad behavior, maybe the stigma that clings to the disorder will go away.