Why stigma interferes with business growth

The chief clinical officer of Recovery Centers of America (RCA) warned an audience at the Cape Cod Symposium on Addictive Disorders (CCSAD) of numerous obstacles to success in what she otherwise termed a period of unprecedented opportunity in addiction treatment. Saying “it's never been our time before,” Deni Carise, PhD, emphasized that the industry must overcome opposition to new facilities—sometimes from within its own ranks—and treatment models that have typically resulted in some patients falling through the cracks.

Carise, who is shaping the clinical program for the new and much-watched Northeast and Middle Atlantic treatment organization, related a personal experience of referring a 70-year-old patient with dementia to a nationally renowned treatment program. The facility eventually ended up scheduling the man for continuing care at a day program located 90 minutes from his residence—not accounting for the fact that he no longer drove and could not access other convenient transportation. Absent the  transitional care tailored to his life circumstances, the man overdosed and died.

“The residential to outpatient transition is a key breakpoint,” Carise said in her Sept. 9 presentation.

RCA's philosophy has been one of establishing a full continuum of care in communities where residents generally have had to resort to receiving treatment far from home. Carise reiterated her distaste for the “fly-away model,” under which patients are not able to build relationships in early recovery with people and organizations near where they live and work.

She said RCA's model will be tested first with adult insured populations, though she added that the company hopes to be able to serve adolescents and the Medicaid population in the future. She pointed frequently to the company's efforts at a 207-bed center in Danvers, Mass., where she said RCA will maintain a 1-to-8 therapist-to-client ratio and will operate dedicated floors for opioid-dependent young adults.

She urged developers of new programs to offer high-quality services at multiple levels of care that each can be sustainable from a business perspective. She advised the audience that evidence-based practices should constitute “at least half of what you do.”

Stigma persists

Carise related to the workshop audience some of the “not in my back yard” experiences RCA has endured through its process of siting facilities. Comments such as “How can you sleep knowing that something could happen to my first grader because some addict was high?” have become commonplace in local public hearings that the company has attended, she said.

She offered several items of advice in dealing with prevalent stigma around the establishment of new treatment centers:

• Be prepared to fight. “Get the gloves out,” she said. And to increase one's chances for success, it probably makes sense to avoid trying to locate a facility near a school.
• Enlist supporters. Carise mentioned that the Legal Action Center has become her go-to source on matters involving legal rights.
• Beware of other treatment programs' reaction. “Other treatment programs may oppose you,” she said. In an environment in which 90% of those in need of services do not even receive treatment, this defies logic, she believes. But it's out there.
• Be aware of the specific requirements of the certificate of need process. Demonstrating to regulators the need for a new facility becomes a highly labor-intensive process, involving weeks of completing detailed reports, Carise said.