While Monday's opening keynote at the Moments of Change conference offered an outsider's perspective solely focused on the future, Tuesday's opening presentation from a prominent addiction field leader advised the audience to study and not repeat mistakes of the past.
Caron Treatment Centers president and CEO Douglas Tieman said the field will fail to capitalize on unprecedented attention and consumer access to care unless it addresses shortcomings in three areas that have halted progress at other times in its history:
An inability to police itself to prevent ethical violations in the provider community.
A lack of high-profile spokespeople to share the story of recovery (at one point in his talk, Tieman said, “We have no voice”).
A shortage of cooperation and collaboration, both within the field and beyond. Tieman challenged the audience with, as one example, “Who can you partner with to do population management?”
Tieman's presentation at the conference hosted by Foundations Recovery Network and Southworth Associates offered a contrasting tone to the previous day's keynote from futurist Nicholas Webb, whose remarks conveyed that the field could be overrun by those that will step in to fulfill unmet consumer needs. Tieman offered a historical perspective that chronicled high and low periods in the field's history and suggested that the field once again could overcome challenges that it has successfully confronted in the past.
He advised that one way for the field to elevate its position will be to identify higher-profile individuals to carry the message of recovery to the public, suggesting that any provider who has access to such an individual should share him/her more widely. While crediting several individuals for their present efforts nationally, he said none of today's voices rise to the level of a Betty Ford or a Harold Hughes, who shouldered major responsibility at pivotal times for the field.
Demystifying new players
Tieman clearly knows his audience at a conference attended by many longtime leaders in the provider community, and he took time to address two entities that raise their share of suspicion in the field: pharmaceutical interests and private investors.
He said that medications such as methadone and buprenorphine offer great benefit when used as part of comprehensive care, but that government interference often limits their potential. “Methadone is a wonderful medicine,” Tieman said. “Methadone used inapproriately is a horrible medicine—just like all of our medicines.”
He said private equity's interest in the field has brought much-needed capitalization, but also a profit motive that can be dangerous when mishandled. He shared an anecdote of one privately financed facility's leader telling him that he wanted his center's spa-like amenities to be so attractive that when its patients inevitably relapsed, they would want to do nothing else but return to the same facility.
Tieman also offered some bright spots for the field, including data indicating that national spending on treatment finally is outpacing that of law enforcement. Yet he said that if the provider community doesn't produce tangible results from initiatives such as the Comprehensive Addiction and Recovery Act (CARA), the public's mindset quickly will shift from a treatment orientation back to a law-and-order approach. This is especially true given the recent emergence of a few prominent voices once again questioning the disease concept of addiction, he said.
He added that health reform is offering major opportunities for behavioral health organizations to become an integral part of accountable care organizations. He therefore advised the audience to think in terms of treating whole communities.