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Communities Must Apply Proven Strategies for Engaging Patients

July 10, 2019

Enrollment in therapy continues to be a major roadblock for addiction care. Interventions and self-enrollment are still viable and critical ways of entering treatment, but statistically speaking, treatment is only as effective as the policies in place to promote it. Public policy and public outreach programs will always be more effective than any individual effort. Screening, Brief Intervention and Referral to Treatment (SBIRT) is one tool that, with government funding, has had a colossal impact on treatment. Tools such as SBIRT are available for local doctors and therapists to engage patients in rehab, and given the right atmosphere, they have the potential for major impacts on the health of local communities. While SBIRT has been one powerful program, other options are also available to local communities, if explored and funded adequately.

Community Reinforcement and Family Training (CRAFT) is a unique model that relies on a significant other of the patient to handle a large part in convincing the patient to enter rehab. These “concerned significant others” (CSOs) are coached and trained by professionals to be able to read the energy of the conversation and the emotions of the person suffering from addiction, and are given scripts on how to convince the person to enter rehab. It often comes to light that the significant other of someone with a substance use disorder (SUD) can also be suffering from either an SUD or depression, anxiety, or other mental health disorders. The relationship between an addict and the significant other is a huge part of the success of this program because it encourages the CSO to be an active part of the treatment for the partner, encouraging long-term success.

The ARISE intervention program created by Judith Landau features an emphasis on family in the intervention. By being honest and forthright from the beginning about rehab and its implications, the program starts with a soft yet honest approach at intervention. If the sufferer of the SUD refuses the initial attempt to enter rehab, the program slowly builds pressure with three different levels of engagement.

The Johnson model of intervention is one model with a much heavier emphasis on the involvement of a therapist. The therapist, in this case, trains an “intervention team” closely related to the patient. Throughout two or three meetings, the therapist gathers information about the patient, the possible negative outcomes of intervention, and the most appropriate treatment. The therapist then coaches the intervention team on how to approach the individual, as well as the potential risks or downsides to intervention, such as emotional tension. A leading feature of this program is the belief that people will only truly change when they hit rock bottom, and that the combined implication of all their loved ones will be a strong motivator to overcome their addiction. Although the program implies that the addiction is causing problems for the relationships of the family and loved ones, patients are never shamed or insulted about their addiction. They are told, forthright, the hard truths about their addiction, how it has impacted others, and the immediate consequences if left untreated.

Finally, SBIRT is a proven and effective method, where the patient is engaged with a physician who will do the initial review of the case and decide to refer to a therapist. This program is especially effective because local specialists can focus on nuanced cultural differences that wouldn’t be clear with a more rigorous program. One such program for Native Americans is the Healing of the Canoe, a story-based intervention that ties central themes of Native American culture into the narrative of overcoming addiction. One study of the Substance Abuse and Mental Health Services Administration’s (SAMHSA's) SBIRT programs found that more than 2 million people were screened via SBIRT by 2017, and 20% of those were referred to treatment. The sheer numbers show just how effective and necessary government-funded programs such as this can be in treating local communities.

Enrollment into therapy is a critical part of treating our local communities. There are a number of powerful programs with a nuanced reach that can be effective in treating a wide variety of patients. Communication and collaboration with local physicians are important, but government support is critical in making these programs effective at a massive level. With the rise of SUD-related deaths in the U.S., massive intervention is going to be essential for the future of our communities.

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