June 23, 2014

By Alison Insinger

While there is evidence for what works in treatment, treatment providers know that the longer a patient can be engaged in treatment, the better the outcome. Sometimes, what keeps them engaged is simply staying in touch with them.

Phil Herschman, Ph.D., chief clinical officer with CRC Health Group, said that the next step, now that addiction is recognized as a disease, is for treatment providers to understand that patients need to be engaged in their own treatment, so that “self-management” takes over — just as physical health providers are working with patients with asthma and other chronic diseases. This means treatment has to go on for a lot longer than the traditional acute phase of a few weeks, said Herschman.

“If you can keep patients engaged in treatment for a year, you have a 90 percent retention rate,” he said. CRC started a 12-month case management program at Sierra Tucson as a pilot, giving all patients one year of continuing care. The data is just starting to come in, said Herschman.

But the difficulty is getting the insurance company to pay for this continuing care. The process includes giving the patient a robust continuing care plan, through which CRC stays in touch with the patient.

“I’ve had many conversations with the bigger insurance companies, and they like this, but they don’t want to pay for it,” Herschman said.

CRC’s next step will be to talk to employers, who take a longer view than insurance companies of their workers’ health, said Herschman.

When Barry McCaffrey was at a meeting of drug court professionals recently, he — along with other treatment program executives — were told “that if we expect to get paid by the ACA, we have to sound as if we’re providing hospital services.”

McCaffrey, who is on the board of CRC Health Group, recalled this meeting in a telephone interview with ADAW last month. “One person said, ‘We’re sure, based on a meta-analysis that somebody did, that acupuncture doesn’t work.’”

This statement was followed, said McCaffrey, by a “mini-explosion,” with some outraged treatment providers saying, “Wait a minute, we know our clients are more likely to stay in treatment when they have an array of services that don’t necessarily sound like antibiotics and manipulation of joints.”

Much of treatment for substance use disorders (SUDs) has components like acupuncture, art therapy, equine therapy, yoga and so on — components that are distrusted by insurance companies and many policymakers.

But McCaffrey is worried that the medicalization and dependence upon evidence is going to leave treatment programs that do good work behind. “I’m an engineer so I listen to objective data,” he said.

“But I also observe.” For example, McCaffrey didn’t believe that a pain management program could help patients with art therapy — but he went to observe. “I went into an art therapy session assuming it would be nonsense, but now I think it’s 100 percent effective,” he said.

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