I recently read a great article by Jacob Lynch, associate partner with merger and acquisition advisory firm Stoneridge Partners. In it, he describes why mergers, acquisitions, investments and partnerships in the addiction treatment space are positive things because they develop a competitive market and can allow the consumer to get a better experience. This is true and necessary as any industry grows and matures.
For decades, the treatment of substance use disorders had been orphaned from the rest of healthcare. We didn’t have to deliver proven effective services, or document or bill for those services like the rest of healthcare (of course, we were not paid like the rest of healthcare, either). The Parity and Affordable Care Acts led to great changes in our industry, more than any other area of healthcare. As a result, for the first time, people were willing to invest in our field - new players emerged, established players expanded. And like every other field, some were motivated by greed (example: $1,500 drug screens) and others by a new opportunity to provide great care to more patients.
If growth and investment are good for the patient, are we as a field welcoming new capital investment to improve our offerings? The answer is, unfortunately, no. Growing companies with significant capital investment underpinnings routinely get the cold shoulder from their industry peers or openly chastised as was the case recently when I sat on a panel at the National Conference on Alcohol & Addiction Disorders.
I’ve been profoundly dedicated to this field since 1986. Much of my career of more than 30 years in this field has centered around trying to eradicate the stigma surrounding substance use disorders, individuals who struggle with this disease and treatment. This has included working to make sure addiction, treatment and recovery are portrayed honestly and accurately in the media, film, TV, etc. In fact, I taught the actors on Martin Scorsese’s “Wolf of Wall Street” how to act under the influence of Quaaludes and cocaine for the sake of truthful depiction. I’ve also been open about my own struggles with drugs as a young adult and about my recovery.
Now I’m saddened by the stigma I see within, not just outside, our field. Either you work for a long-established not-for-profit or you’ve “sold out” or, worse still, you are greedy and you don’t care about the patient. Ironically, so many of us fight every day to erase the stigma of addiction and spread awareness and education about this disease, that it amazes me to see it within the field. We know stigma is one of the biggest reasons why people who agree they have a substance use disorder and need treatment do not seek it.
And yet established industry players throw stigma around each other like nobody’s business. It gives a whole new meaning to “not in my back yard” (NIMBY). Well, the stigma’s not only in our backyard, it’s at our conferences, our associations, within our recovery communities, and more. MAT providers get judged by those who only believe in a total abstinence model, and long-established treatment providers try to block additional providers from opening new or expanding current treatment facilities. The not-for-profit disparages the for-profit, even though in my 25 years of experience working in not-fir-profits and now five years working in for-profits, I haven’t seen much difference. We are all working to help people get well. Neither can stay in business without some margin. In any business, there are good and bad players.
All this is to ask: Why can’t the industry collaborate more to better understand and treat addiction and get more patients to the best treatment programs for them? The field should be working together, encouraging everyone to be their best and to get to the best evidence-based, effective treatment outcomes for those we serve. Unfortunately, we can’t even agree on what “success” is.
We should be supporting important legislation to address stigma, decrease long wait times for treatment, and address the lack of treatment on demand for our veterans. Many of us proudly thank our veterans for their service, but what about when they need our service? The collective power of the treatment community, individuals in recovery and their families could be formidable. Why aren’t we working together, making sure we offer services that more than 10% of people diagnosed with the illness want? That’s right, we have about a 10% penetration rate (the percentage of people with the disorder who received treatment, not cured). Interestingly, stigma significantly decreased for cancer, TB and other disorders when their penetration rates hit about 30%. I would love to see that in our industry in my lifetime, and the country needs all of us to succeed to get there.
There are some much needed activities that investment capital can help support. At RCA, we developed a set of amendments to federal bills and presented them to numerous congressional representatives and senators. Dubbed “Plan A” by Patrick Kennedy (because, as he said, there is no Plan B), the objectives are to amend 22 federal laws to increase availability and quality of substance use disorder treatment and decrease the death rate. It includes amendments that would expand Medicaid and Medicare treatment coverage, facilitate compliance with parity laws, improve access to evidence-based quality care, and ensure that services are provided only by licensed and accredited facilities.
Of note is that several of the amendments in Plan A would not benefit RCA, and none of the amendments in Plan A would benefit RCA exclusively. They would benefit the industry overall and, more importantly, those struggling with substance use disorders who need our help. We were able to get this legislation researched, written and presented to those who could push it forward simply because of the capital investment in our company.
To be clear, I don’t think bigger is always better. Small, single-site programs can also provide exceptional treatment and do extremely well for clients and their families. My point is that so many Americans – our families, friends, coworkers and neighbors – are struggling with addiction (23 million to be more exact) that we all need to work together and support this field that is breaking apart from very real and concerning ethical and legal battles. Let’s bring together the 12-Steppers and the MAT folks, the large treatment companies and the smaller owner-operated programs, the not-for-profits and the for-profits, and unite against addiction, not ourselves.
The bottom line is this: Would you rather achieve profound success in your business and for your patients because you badmouthed another program or stopped it from opening, or because you are a great treatment provider that is a huge service to the field and its patients? I really hope that answer is easy for you because I’ll bet it’s easy for all of our patients.
Deni Carise, PhD, is nationally recognized as an addiction, treatment and recovery expert. With decades in the field, she is currently chief scientific officer for Recovery Centers of America and adjunct assistant clinical professor at the University of Pennsylvania.