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Tackle the Access Crisis in Addiction Care with New Messaging
Social stigmas have real-world consequences. They infect everyone, not only individuals with the shamed attributes. Addiction is the most highly stigmatized condition in our field. It is not surprising that care access rates for it are among the lowest in healthcare. SAMHSA’s annual surveys continually show that only 10% of people needing care for substance use disorders get professional help.
Since many of these people did not think they needed treatment, we focus on how to fix their outlook. Some clinicians want to confront their denial while others prefer to enhance motivation. However, these are treatment strategies when the larger problem to be solved is access to care. The messages we are sending the public to defeat stigma and increase access are not working.
Our persistent access crisis requires a new model. We must strategize better ways to attract substance users to care. The medical model has not worked, not due to any deficiencies in medical care. In fact, we have fine detox regimens for various addictions, but the right message is not necessarily about medications and disease. It is time to reframe our messaging with the recovery model in the lead role.
A Message That Is Relatable, Activating, and Hopeful
No one owns the overhaul of our field’s communication strategy. Therefore, every behavioral executive should claim a piece of a new strategy to attract more consumers into care.
The disease model has long been our primary message for encouraging access and reducing stigma. We are losing on both fronts. Access rates have been stalled, and addiction’s stigma seems impenetrable. The disease concept may be poorly suited as a primary response to addiction. People decide to drink. By contrast, diseases seem to be involuntary afflictions people get. This argument is never-ending.
What is next if it is ill-advised to argue with the perception that substance users create their own problems? Recovery is a more inviting model that avoids questions of why addiction exists and leads with an optimism that we can change the thoughts, feelings, and behaviors sustaining it. Accepting one has a disease means becoming a patient. This is a role traditionally marked by passivity and compliance.
The recovery model aligns more closely with the concept of “patient activation,” which seems to drive improved health outcomes. Activated clients take ownership of their health status, and this means steps toward self-care and judicious use of healthcare services. Recovery is also relatable. Everyone understands it. We all recover from loss, failure, illness, injury, and other life circumstances.
We may be moving puzzle pieces—placing recovery in the foreground and the disease model in the background—but we should not minimize how cultural beliefs impact us. It seems heretical to treat recovery as primary and disease as secondary because we are used to the reverse. In reality, both are essential. One should not be reduced to the other. Yet again, this is about messaging, not treatment.
Access to care is more a consumer marketing issue than a clinical one. Access solutions need not pay homage to the medical model, however vital it might be. The problem of vast unmet needs must be addressed. Our field needs the dominant message on addiction to be relatable, activating, and hopeful.
Messaging to Increase Access
How does this unfold in practical terms? We could take the next celebrity disclosure of addiction not as a time to reinforce the disease model but as an opportunity to normalize recovery. The headline should be that treatment works and people recover, usually with relapses along the way, but with lessons learned from each episode of using substances.
The public does not know we have effective medications, validated counseling tools, and diverse options for recovery group support meetings. Making this common knowledge helps people in need make good choices when it is time to consider treatment. If we want the “B4Stage4 Philosophy” to be understood, we will give the media more stories of timely treatment and fewer sagas about interventions.
Every behavioral professional must take the lead in promoting this model. The day is hopefully approaching when suspicions of incompetence are raised whenever licensed therapists claim these issues lie outside their area of specialty. Also, timely care is only possible on a wide scale if it starts routinely in primary care. This will take more therapists working with primary care physicians in that setting.
The premise here will seem odd to many—that we should change how we present our field to boost access to care. It would be nice to sit back like in other medical fields, waiting for patients to request services in well-appointed surroundings. Yet ours is a stigmatized, underfunded field needing to find ways to be wanted. Our access rates are a prolonged crisis demanding urgent, exceptional action.
Ed Jones, PhD, is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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