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Confronting Shortcomings of Our Field During Alcohol Awareness Month
April is Alcohol Awareness Month. Public health campaigns are launched annually to educate people on the treatment and prevention of addiction. Yet we might also use this month as a reminder that the vast majority of people with alcohol use disorders do not get our help. Tidy FAQs will not change public perceptions, and unfortunately, the public still embraces stigma and regards treatment with skepticism.
Our priority should be building confidence in our field. The problem is less our understanding of addiction or a lack of tools to help. It is more that the field is shrouded in stereotypes and care is provided by an isolated clinical specialty. Furthermore, mistrust has been earned with widely publicized cases of fraud and abuse in the treatment industry, and some of our traditions alienate people.
Our society promotes endless arguments over who merits the label “alcoholic.” As experts, we must own the confusing cultural messages stemming from the many ways people get in and out of trouble with alcohol. While the term alcoholic is still used by some in our field, most are ready to declare it an old term ready for retirement. People get addicted to alcohol in various ways. There is no classic alcoholic.
Many have identified as alcoholic on their path to recovery, but traditions change. For example, we no longer wait for “hitting bottom” nor discourage the taking of psychotropic medications. Other practices bear scrutiny. Let us start in the outpatient realm. Everyone in the behavioral healthcare field should have basic competency in addiction. SUD knowledge has grown, but it still resides in an isolated silo.
Specialized care is multifaceted when needed, starting with biological advances in addiction medicine and psychiatric care. Valuable medications help people through the pain of detoxification, cravings, and the co-occurrence of mental health and substance use disorders (SUDs). Conceptually, the American Society of Addiction Medicine’s patient placement criteria bring clarity to a field that has long struggled with how to best use each level of care.
Biological treatment targets one aspect of addiction, and yet psychosocial solutions are also critical. Clinical tools like motivational interviewing and relapse prevention help clinicians provide effective care. The biggest problem we face is not a lack of solutions. Most people needing help do not enter specialty care. Yet they are not invisible. They are hiding in plain sight in primary care and outpatient therapy.
While we might point to funding issues or the reluctance of many people to accept care, the behavioral healthcare field has internal problems that impact access. It is not that our addiction specialists are deficient. We have encouraged psychotherapists to see SUD as a specialty, and most have declined to pursue it. They have little knowledge of SUDs and their treatment, and they tend to avoid this focus.
Psychotherapists working in general practice should be able to integrate issues of mental health, substance use, and unhealthy behaviors with every client. Since people cannot easily compartmentalize these issues in their lives, therapists should be prepared to understand the whole person and not just segmented domains. Furthermore, reaching people before the later stages of addiction is critical.
The stigmatizing of addiction is arguably more intense than that of mental illness. Therapists are trained to help people with anxiety and depression, while believing a specialist must work with SUDs. Addiction care exists in a separate world. While this may be a remnant of stigma or a testament to clinical silos, it certainly should become an obsolete tradition. We need knowledgeable generalists and specialists.
A solution worth considering is to formally segment our clinicians into generalists and specialists. This is not to propose a certification process like that in medicine, but rather to establish career tracks. Some clinicians prefer intensive specialization and others general practice. A generalist would focus on addressing the early phases of clinical problems, including SUDs. They might work in primary care.
We must engage people in care well before they are addicted. We need a workforce better prepared to do this work and to guide those with severe problems to higher levels of care. The conundrum we face today is that while the public mistrusts addiction treatment, most of our licensed professionals have only a cursory knowledge of that care. We must ensure everyone in our field understands SUD.
We tend to imagine the early detection of problems as an assessment issue. However, it is better viewed as a conversation with a trusted professional. We need PCPs and outpatient therapists to be well informed and comfortable discussing a wide range of problems. Alcohol Awareness Month is a time for them to be alert to SUD issues and prepared to motivate people to seek care when needed.
Let this month of awareness be internally focused. It can be a time to remind those in our field who identify as mental health professionals that our field is actually called behavioral healthcare.
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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