This week I ran across a wonderful STAT News article by Dr David Eddie and Dr John Kelly “People recover from addiction. They also go on to do good things,” it was published a few days ago. One of the motivators for me writing this blog article is to draw attention to it in hopes that people read it. If you do nothing else, stop here and read the linked article above. It is an exceptionally well written piece that every policymaker in the nation should consider. I clipped out this section, with intact embedded hyperlinks to draw attention to what they are saying below:
“Around 75% of people seeking recovery from a substance use problem achieve their goal, though it may take them some time to achieve full remission. The average number of attempts before success is five, though the median number is just two, meaning that a small number of outliers — usually individuals with the greatest addiction severity and other concomitant mental health issues — who need five-plus attempts, inflate the numbers, making them look worse than they are. Along with several colleagues, we recently completed a landmark study which, for the first time, comprehensively surveyed Americans who said they had resolved an alcohol or other drug problem.”
This is incredible work, and research continues to confirm what people in recovery (who are the experts on recovery) have known for a very long time. We get better, and when we do, we are assets to society. When we recover, we also save an incredible amount of resources as we are no longer costing society resources in a myriad of ways. I figured this out about a year or so into recovery, around the time I first started working in the SUD field.
I was so excited even in those days about what research was showing us. I would share the developing body of literature with anyone who crossed my path. Around 2001, we learned that treatment resulted in a 7:1 ratio of benefits to costs. I can only imagine what it would find if we factored in recovery support services in. They didn’t exist then. At the time, I figured that all we would need to do is let the world know, policies would change and we could build a robust care system. We would not just keep people alive. In recovery we thrive. We would drastically reduce the number of persons trapped in the criminal justice system and the consequences of addiction in our hospitals and human services programs.
Of course, that is not what happened. Research did not drive the conversation in the direction of expanding access to services that even averaged the minimum threshold of effectiveness or addressed drop out in any systematic way. Services remained fragmented, lengths of stay generally did not budge and may even have decreased over the years. We failed to develop and address care that followed the person until we hit the right individualized combination to meet their needs. The stats clipped above from the article are remarkable – 75% of people seeking recovery eventually achieve their goal. Can we imagine what this would look like if we systematically engaged people earlier and stuck with them until they got better with comprehensive services? It would change our society. The question is will we ever do it?
Colleagues who have been around longer than I recount to me similar experiences in the 1980s and work they did to educate the public about the benefits of helping people who have substance use issues. The impact of these efforts and the favorable research available at that time was not enough to sway the public or policymakers. We didn’t fund care or increase access, or move things towards more comprehensive services. It just didn’t happen. Fragmented, short term care for some, but not all people who need it has been the gear we have been stuck in since before the age of Disco.
There is an immense reservoir of implicit bias across society about addiction and recovery. History shows us that we do not want to help people even if saves money and lives. We expend our resources on punishment and unending devastation. Afterall, “those people” did it to themselves. We do not want to help “those people” even if it makes sense for every other reason. People in recovery play a roll too. A person wiser than I observed a lot of us recovering people pull punches and don’t speak out nearly as much as we should given the extent of the devastation and death across our community. The most fortunate of us smile and sit at the table as tokens even as nothing changes, and we bury our family and friends. In a subconscious way, perhaps we buy into the moral model believing we don’t deserve better care. Perhaps we believe we did it to ourselves and so we don’t deserve better.
I applaud Dr Kelly and his team of researchers who have made such huge contributions to what we know. They are doing invaluable work. We are in their debt. I hope society pays attention. The truth remains:
We typically get better, and when we get better, everything else improves too.
The fundamental question is whether society is ready to focus on redesigning care around long term wellness for all of our diverse communities because it makes every bit of sense to do so. I hope this time that science wins over bias. The world would be fundamentally better place in such a sea change.