I like this twitter thread a lot.
Thread:— Brandon Bergman, PhD (@brandonbphd) October 30, 2019
until the 1980s: We don’t want to treat addiction it's too hard and you're too difficult go to AA and these rehabs that'll link you to AA they can help. (1/5)
In the 80s and 90s: Ok so we are sorry about all that stigma now we got some good treatments and realize addiction is a medical condition and should be integrated into health care. (2/5)— Brandon Bergman, PhD (@brandonbphd) October 30, 2019
In the 2000s: But wait didn't you hear us we said we have good treatments?! We get it we abdicated our responsibility and we are ready to help. (3/5)— Brandon Bergman, PhD (@brandonbphd) October 30, 2019
Current: This is exasperating! Ok let's criticize as strong as we possibly can this system of care that we helped create by abdicating our responsibility -- maybe that will change things! (4/5)— Brandon Bergman, PhD (@brandonbphd) October 30, 2019
Future (hopefully): Ok we are ready to listen. We really want to help. What can we do to understand your views on addiction and recovery? How can we make it so that you'll adopt all these treatments that we have seen are really helpful?! We are all in this together. (5/5)— Brandon Bergman, PhD (@brandonbphd) October 30, 2019
I’d like it more if that last tweet was a little different.
I like the desire to learn more about the desire to understand recovering people’s views on addiction and recovery.
What I like less is that it sounds like this understanding is not an end in itself. It is sought with another end in mind–to get recovering people to “adopt all these treatments” rather than achieving understanding and then deciding upon a course together.
What might be better?
Maybe we could learn something from mental health patient advocacy.
Pat Deegan works to support mental health patients’ self-determination and pursuit of the best possible quality of life.
One of the strategies she uses is called Power Statements. What are Power Statements?
Peer staff, case managers, and therapists are trained to support clients in creating power statements in the waiting area of public mental health clinics by using a worksheet that guides users in filling out a two-part stem: “I want you to help me find a medication that will help me . . . so that I can. . . .”
Importantly, Power Statements are dynamic.
With support from peer staff, clients update their power statements prior to appointments as needed, for instance when clients’ goals for treatment have changed. Power statements—typically two or three sentences saying something about the client as a unique individual— state how she or he wants psychiatric medication to help and invite clinicians to help achieve these goals for medication treatment. These statements amplify the client’s voice and sense of control, while communicating concisely the client’s specific goals for using psychiatric medications. Toward the beginning of the appointment, psychiatric care providers often read the power statement aloud and ask, “Is this still the goal for our work together?” Clients and psychiatric care providers have reported that the process enhances communication
What do power statements sound like in real life? This table from her paper will give you a sense.
So . . . what would it be like if addiction treatment providers embraced Power Statements? What if there was real collaboration around choices about whether to use medication, to what end, how success is defined, and how to evaluate outcomes?
What would it be like if patients were encouraged to think about and share what they want from treatment? And, if providers listened to that?
What if providers and researchers started critically evaluating what goals each treatment (medication or otherwise) is effective, ineffective, or contraindicated for?
Maybe Power Statements are the way out of all these MAT battles? There are a lot of parallels. IDK. Just a thought.