Core Knowledge for All Providers Needed to Guide Consumers to Our Services

Many professionals in our field lack knowledge on core topics like substance use disorders (SUDs). It is accepted as normal based on the idea that this knowledge is specialized. This tradition is archaic and harmful to our clients. There is a difference between knowledge and expertise. Experts may treat specific problems, but other professionals in that field should have core knowledge about that work.

While our field should ideally ensure that every professional has broader expertise on issues related to mental health, substance use and health behaviors, this remains a distant goal. This is a training issue that requires basic changes at many levels. Ensuring that everyone practicing in our field has certain core knowledge is less ambitious. Yet this more modest achievement would greatly impact consumers.

Two SUD treatment examples clarify these points, namely, the use of peer support groups and the use of medication-assisted treatment (MAT) for opioid use disorders. Many working in our field are not comfortable giving any opinion on these issues. Their lack of expertise is fine, but we should no longer tolerate the idea that someone in our field lacks core knowledge on such critical topics.

Peer support or mutual-help groups are a key part of addiction recovery for many people. Various 12-Step programs are most prevalent today. While anonymity precludes research, there is wide anecdotal support and also research supporting clinician-directed attendance. Yet 12-Step dominance makes it hard for other models to thrive. Most other approaches are in short supply and yet might be quite helpful for many.

Less well-known groups have compelling conceptual elements. SMART Recovery is one. Its support groups were founded in 1994 based on key principles from cognitive behavioral therapy. It discourages labels like addict or alcoholic and encourages group discussion. It exists nationally yet has few meetings in any city. The unique needs of women and minorities are the focus of other noteworthy groups.

Based on the needs of those with substance use disorders—and nearly 90% of the 23 million people with SUDs get no treatment—it would seem wise to refer into as many support groups as possible. Some groups may be better than others, but we have little data to compare. Individuals may prefer one approach over another. Decisions are largely subjective. A 12-step referral bias seems hard to justify.

AA gained dominance long ago, and most professionals recommend it. AA enjoys word of mouth referrals, and yet it also has critics of its spiritual aspect and use of labels. Its dominance will persist if all remains the same. The reason is pure math. Routine referrals add up. Most professionals with no SUD expertise or knowledge will recommend 12-Step as the traditional path. They know little else.

The dynamic is that clinicians with low knowledge defer to specialists. Yet many specialists in SUD rely on tradition more than data or innovation. Many consumers would be better off if we followed the data and did not defer to 12-Step dominance. My opinion? Our field should endorse peer support groups generally. We need to vastly increase group participation since nonjudgmental support is powerful.

The example of MAT is quite different. The data argue for this as a critical part of treatment for opiate addiction. However, many clinicians are wary of discussing this medical treatment, especially non-physicians. Also, certain MAT controversies discourage clinicians without SUD expertise from expressing any opinion. Yet that is the power of having core knowledge. It is our field speaking with one voice.

We need everyone in our field to master this core knowledge and use their influence with consumers. We have some empirically supported treatments (like MAT) to recommend and some services with less evidence. What happens when evidence is meager, need is great and diverse resources are available? Promote all reasonable resources and bring the full force of the field behind our recommendations.

Our field needs the best general marketing message for most people in need. The goal of marketing is to increase awareness of services, and so everyone in our field is at some point a marketing person. We need agreement on the body of core knowledge for behavioral healthcare. This can be done. It means more people will get MAT, peer support and many other vital, underutilized resources.

Core knowledge is essential and practical knowledge. Establishing it may ruffle the feathers of some experts. However, our priority should be the needs of the people we serve. Core knowledge should inform all of the communication vehicles we use to reach the general public. Behavioral healthcare covers a wide range of problems, but we should act as one field and not as a collection of specialists.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.