SECAD day two: Treatment must transform, but it will take years

Continuing the conference's theme of challenging conventional thinking, Chestnut Health Systems' William L. White on Feb. 10 offered attendees of the SECAD '09 meeting an outline for what he calls a "revolution in addiction treatment."

In his morning keynote address, White suggested that present financial distress in the field is masking fundamental change that is under way in the design of treatment. He said the change is being fueled by the emergence of a new culture of recovery-focused entities such as recovery homes, schools and ministeries. He compared the recovery movement's evolving language and values to the histories of the civil rights, women's and gay rights movements.

White, Chestnut's senior research consultant, bluntly challenged many orthodoxies in the traditional acute-care model of treatment. He called what often passes for treatment a "setup" rather than a "chance" for the client, and said programs need to intervene with clients earlier and monitor them for a significantly longer period.

He said a durable recovery tends to surface only after about four to five years, a fact that has shaped treatment of other chronic illnesses such as cancer but not addiction. "What do we do in addiction [during that extended period]? Nothing," he said.

White believes it will take years for the treatment system to make the necessary transition from acute care to recovery management, requiring an alignment of concepts, funding policy, regulatory policy and service practices. In the meantime, programs should not oversell the effectiveness of the acute-care model, he warned. That could cause a backlash among policy-makers and the public that could permanently damage addiction treatment's standing in the overall health care community, he said.