I’m glad to see that he’s addressing palliative care models. I’ve seen similar talks from him on several occasions and this is new to me. I mentioned in an earlier (and controversial) post that his description of MMT was different from my experience.
Treatment providers have long been troubled by the psychiatricizing of addiction. The mental health system is far larger and far more powerful. Fear of being “colonized and devoured” led to a kind of hunkering down that bred unhealthy skepticism (As opposed to healthy and appropriate skepticism.) of research, new treatment models, medications and any integration of mental health in addiction services. This response may have ensured the survival of a fraction of the addiction treatment system, but it stunted growth and was unsustainable. Bill’s approach this problem was different than other treatment advocates. Rather than pile on mental health providers, he acknowledged the history and sought to engage the mental health system by offering a vision of a recovery-oriented system of behavioral health care. Offering recovery as the organizing paradigm had the potential to address what’s wrong with both systems and minimize conflict over details by focusing everyone on facilitating recovery. This process is still unfolding, so we don’t know how it will end but an attempt to maintain the status quo would have likely ended in a complete collapse of the specialty addiction treatment system.
Bill is clearly trying to do the same thing with MMT–sidestep the historic tensions by unifying drug-free and medication-assisted treatment providers around recovery. The addition of references to palliative care models seems to be a challenge to medication-assisted programs in the same manner he has challenged drug-free treatment providers to abandon acute care models.