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In the face of crisis, providers' everyday work isn't enough

October 02, 2018

Leaders who opened this week's Moments of Change conference in Palm Beach, Fla., relayed clear direction to the addiction treatment providers in the audience. Whether it is to advance what is good in the industry or to stamp out misdeeds, providers must take action beyond the essential services they provide within their own programs alone, given the deadliness of the opioid crisis.

“You must get involved when you see fraud,” said Alan Johnson, chief assistant state attorney in Palm Beach County, where efforts of a communitywide task force have started to change the landscape in a region considered a hotbed of unethical behavior within the treatment and sober home communities.

Johnson urged attendees as they return to their own communities to establish a structure similar to the Palm Beach County Sober Homes Task Force, the efforts of which were a main driver of business reform legislation adopted by state lawmakers in 2017.

Johnson's co-presenter, Caron Treatment Centers CEO Douglas Tieman, asked attendees, “How do we make our field believable?” in the face of many unflattering—and largely deserved—headlines and portrayals.

“We should be ashamed of what the public sees of us today,” Tieman said.

Following the opening talk from Tieman and Johnson was a presentation from former New Jersey Gov. Chris Christie, who gave a highly personal account of how his early years in government service and the later loss of a close friend to prescription opioid addiction fueled in him a desire for involvement—a pursuit he now calls “my evangelization.”

Now that Christie no longer is in position to promote a government executive's agenda or sign legislation, he has channeled some of his energy toward his work as executive chairman of the Beach House Center for Recovery in Juno Beach, Fla. He urged attendees not to shy away from efforts to eradicate stigma, which he considers the number one potential impediment to progress in combating the crisis.

“You are not only people involved in the treatment world. You now must become influencers,” said Christie, who chaired the Trump administration's President's Commission on Combating Drug Addiction and the Opioid Crisis. “You will get some resistance, because the stigma is there.”

Embrace involvement

While not diminishing the importance of the everyday work that addiction treatment centers and their clinicians do to save lives, Monday morning's speakers at the Foundations Recovery Network conference said it is also essential for professionals to get involved in broader initiatives.

Johnson recounted a situation in Miami-Dade County in which there was clear evidence that unscrupulous people were poaching a treatment center's patients with offers of free inducements, but prosecutors were left unable to pursue the case because the treatment facility's leaders resisted getting involved.

Christie recalled that when he attended the opening of a treatment center in a fairly affluent community as New Jersey's governor, he encountered protesters who thought the center's presence somehow would corrupt the neighborhood. Never one to cower from a potential verbal volley, Christie told members of the group that someday they'd be glad the facility was in their back yard, because chances are that one of their family members would end up needing its services.

“Talk reason to people who are being illogical,” Christie advised the Moments of Change audience. “Show strength in the face of prejudice.”

Change incentives in system

Tieman said the widespread unethical behavior within segments of the industry resembles what was seen in the late 1980s, but the influence of the Internet has helped make today's problems “so much louder and so much worse.”

He discussed numerous ongoing efforts to hold providers accountable, in areas such as investigating through the accreditation process whether a facility is truly using American Society of Addiction Medicine (ASAM) clinical criteria—a claim often made on glossy marketing materials but not applied as enthusiastically in everyday clinical practice.

Johnson said recovery/sobriety is the only component within the continuum of care with no financial incentive directly tied to it, and he believes that must change. Positive outcomes, not failure, need to be rewarded with payment, he said.

“One part of the problem that hasn't come to the table within the Sober Homes Task Force is the insurance companies,” Johnson said. “They're doing audits and they're not providing information to law enforcement when there's fraud.”

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