Addiction Treatment: Addressing Workforce Gaps Improves Patient Outcomes

In a session at the 2022 Rx and Illicit Drug Summit, R Corey Waller, MD, MS, managing director, HMA Institute on Addiction, presented on how to improve the treatment ecosystem by addressing addiction workforce gaps.

He reviewed his recent discussion paper, “Guide for Future Directions for the Addiction and OUD Treatment Ecosystem.”

Based on this paper, Dr Waller explained that there are “4 C’s” within the addiction treatment system, including:

• Capacity
• Competency
• Consistency
• Compensation

For capacity, Dr Waller asked, “is the system right-sized for the community it is serving?” This includes hospital-based care, such as emergency department care, [intensive care units], and [neonatal intensive care units].

Competency includes education, training, and evaluation among peers, administrators, prescribers, therapists, and counselors, according to Dr Waller.

Of note, Dr Waller asked, “Are we delivering high-quality care?” To have complete consistency, Dr Waller said the following factors are important:

• Fidelity to the American Society of Addiction Medicine levels of care
• Structural measures
• Outcome measures
• Service array

Finally, the last “C” that Dr Waller highlighted was compensation. He posed the question, “Are we paying the right amount for the right things?” Dr Waller said it is important to consider payment for evidence-based medicine vs legacy treatment, payment amount, and payment type.

Dr Waller went on to explain the challenges linked with competency in the treatment landscape.

“Most addiction treatment centers do not offer evidence-based medical treatment,” he said. Often these centers are “siloed from traditional office-based medical and psychiatric practices.”

Also linked with competency challenges is a lack of understanding how structural racism and discrimination affect the various levels of treatment. Additionally, Dr Waller said that without a baseline quality metric there is no adequate mean to standardize and improve the quality of the addiction treatment system.

“A deeper issue lies in how health practitioners and the public understand addiction as an illness.” He said they are “treated as a behavioral and moral failure rather than a medical condition with behavioral symptoms.”

Next, according to Dr Waller, the components of addiction treatment include medical care, psychoeducation, treatment milieu, and psychotherapy. He explained that the reality of addiction treatment includes a direct overlap of all these components.

Finally, Dr Waller said “where do we go from here?” He said that once providers determine what they have and what they need, the next step is to build and train staff. Once it is confirmed that it is done well, the final step is the pay an appropriate amount.

Reference

Waller RC. Addiction workforce gaps: Improving the treatment ecosystem. Presented at: Rx Abuse & Heroin Summit; April 18-21, 2022; Atlanta, Georgia.