the revolving door


Points has an interview with Bill White. He makes several points that his followers will be very familiar with, but I don’t remember him putting it together so concisely. I’ve also heard him discuss recovery capital and acute care models, but never heard him frame the acute care model as working well for low to moderate severity with high recovery capital. It puts a different frame on the the persistence of the model and cultural barriers to changing it.

. . . the cultural fate of addiction treatment may well be dictated by a more fundamental flaw in the very design of addiction treatment and the field’s capacity or incapacity to respond to that design flaw. Modern addiction treatment emerged as an acute care model of intervention focused on biopsychosocial stabilization. This model can work quite well for people with low to moderate addiction severity and substantial recovery capital, but it is horribly ill-suited for those entering treatment with high problem severity, chronicity, and complexity and low recovery capital. With the majority of people currently entering specialized addiction treatment with the latter profile, the acute care model’s weaknesses are revealed through data reporting limited treatment attraction and access, weak engagement, narrow service menus, ever-briefer service durations, weak linkages to indigenous recovery support services, the marked absence of sustained post-treatment recovery checkups, and the resulting high rates of post-treatment addiction recurrence and treatment readmission. Addiction treatment was developed in part to stop the revolving doors of hospital emergency rooms, jails and prisons. For far too many, it has become its own revolving door. Slaying the Dragon documents these weaknesses and current efforts to extend the design of addiction treatment toward models of sustained recovery management nested within larger recovery-oriented systems of care—with the “system” being the mobilization of recovery supports within the larger community.

I’m grateful to work in a program that provides long term care and support.