How the Opioid Crisis Affects Addiction Treatment Centers

Published in The Doctor Weighs In, November 20, 2017. View the Article Here

The opioid epidemic is getting worse

The terrifying power of the opioid epidemic is one factor that has increased the need for treatment- and recovery-related services. The opioid epidemic is not getting better but is actually getting worse over time. There are more and more people impacted by the epidemic through death, overdose, addiction, and abuse.1

Multiple pathways of recovery

Another factor increasing the demand and need for more treatment is the treatment and recovery field embracing more pathways of recovery. Individuals and their families who suffer from the chronic brain disease of addiction are seeing an ever-increasing variety of pathways to choose from and those pathways are becoming more and more accepted within recovery environments.

As evidenced of the increase, and the acceptance, of multiple pathways of recovery, in 2010, the Substance Abuse and Mental Health Services Administration (SAMHSA), as well as the Center for Substance Abuse Treatment (CSAT), conducted a qualitative study with 33 participants with a history of alcohol and other drug problems.2 Within the focus groups, the participants reported utilizing both traditional and non-traditional pathways to facilitate the development of recovery capital and wellness.

Broadly stated, recovery capital is the internal and external resources that people draw upon to not only begin the recovery journey but sustain it over time. The building of recovery capital is naturally attached to a strength-based approach and the pursuit of resiliency and recovery protection.3

The participants in the study above described the variety of different pathways of recovery they utilized. They included the following:

• Natural recovery
• Mutual aid groups – 12-step based programs including Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)
• Mutual aid groups – non-12-step based programs such as Women for Sobriety and SMART Recovery
• Faith-based recovery
• Cultural recovery including traditional Native American sweat lodges
• Criminal justice including incarceration and drug court
• Outpatient treatment
• Inpatient treatment
• Bodywork including yoga, traditional Chinese medicine, and Addiction Energy Healing
• Other therapies including art or music therapy

Most of the participants stressed that they utilized not just one of the pathways listed above, but instead utilized two or more pathways on the journey to find recovery and wellness. They also indicated that their journey to find the right pathway for them took several years to discover.

Barrier to services

Even with the demand for services increasing and providers attempting the meet the demand for these services, participants of the study identified the barriers to finding adequate services. The barriers discussed included the lack of services provided and support options available. We also know that cost of services for many is a significant barrier to meaningful help.

Medicated-assisted treatment

One of the pathways of recovery in ever-increasing demand due to the opioid crisis is medication-assisted treatment or MAT. From SAMSHA:

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies>, to provide a “whole-patient” approach to the treatment of substance use disorders. Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery.
MAT is primarily used for the treatment of addiction to opioids such as heroin and prescription pain relievers that contain opiates. The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug.4

Opioid-related services are in ever-increasing demand

One example of the increase in demand for opioid-related services can be found in Hartford, Connecticut. In an article published at HartfordBusiness.com, the authors reported that nearly 15,000 people sought help from their opioid addiction in the area last year. The number of people seeking services for opioid addiction has increased 25% since 2012. The article reports that the recovery pathway in most demand and the fastest growing is MAT.5 MAT, as described above, is often argued as a less intrusive pathway than other pathways of recovery. By reducing cravings, MAT potentially allows more people to embrace less intrusive pathways, such as an outpatient environment versus inpatient. Being able to embrace a less intrusive pathway immediately or more quickly may provide the option for individuals to maintain their employment and/or continue with their education.

The authors of the article further point out that most of the treatment in Hartford is being conducted by non-profit agencies including state-run facilities. However, when there is demand for services, then for-profit organizations will always come into play. For-profit businesses are a natural player within the treatment and recovery field and have been for a long time.

It is a misnomer to believe that all for-profits do not offer good services or have improper motivations when providing addiction treatment. Yes, for-profits are in the business of making money but must to do so by providing good quality treatment at reasonable costs based on demand.

A big concern is that the demand for service within this opioid epidemic far outweighs the ability for non-profits, state-run agencies, and even cost-effective for-profit organizations to provide.

Such is the case in Arizona, where an article published earlier this year reported a huge increase of treatment providers offering services as the opioid epidemic is in full swing in the state. When there is an increase of demand, for-profits naturally increase the price. For example, the article reports that in Arizona:6

• A non-profit sober living environment costs around $400.00 a month.
• A non-profit inpatient environment around $15,000 a month.
• A for-profit inpatient environment around $40,000 a month.
• A for-profit inpatient opioid treatment can cost as much as $80,000 a month.

Someone is making a lot of money on the current opioid epidemic.

Supply and demand in the opioid crisis

It seems clear that there will continue to be an increase of demand for treatment- and recovery-related services. The opioid crisis we are currently seeing is a huge factor in fueling this demand. We must find ways to increase access to multiple pathways of recovery for individuals and families who suffer. We cannot tackle addiction and the current opioid epidemic in acute ways as we have done in the past. If we do so then the current epidemic will continue to spiral. A continued exploration of the impact of providing long-term recovery support through more cost-effective mechanisms (e.g., recovery peers) and utilizing adaptive engagement mechanism of support (e.g., technology-based engagement) is vital to this continued effort.

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References

1. USA Today (October, 2017). Opioid Epidemic getting worse instead of better, public health warning. https://www.usatoday.com/story/news/politics/2017/10/05/opioid-epidemic-getting-worse-instead-better-public-health-officials-warn/732192001/

2. The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Substance Abuse Treatment (CSAT) (201). Pathways to Healing and Recovery: Perspectives from Individuals with Histories of Alcohol and Other Drug Problems. http://www.naadac.org/assets/1959/pathways_to_healing_and_recovery.pdf

3. White, W., Cloud, W. (2008). Recovery capital: A primer for addictions professionals. Counselor, 9(5), 22-27. http://www.naadac.org/assets/1959/whitewlcloudw2008_recovery_capital_a_primer.pdf

4. SAMHSA. https://www.samhsa.gov/medication-assisted-treatment/treatment

5. Hartfordbusiness.com (August, 2017). Opioid Addiction Treatment Industry Grows as Epidemic Spreads. http://www.hartfordbusiness.com/article/20170828/PRINTEDITION/308249903/1043

6. Columbus, C. (January, 2017). Substance-Abuse Treatment Industry Grow to Keep Up With the Demand. Cronkite News. https://cronkitenews.azpbs.org/hookedrx/opioid-drug-abuse-treatment-rehab-industry-growth-az/

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