Back when he worked in an addiction treatment organization, David K. Mineta guesses he may have offered a blank stare when someone from outside the agency would come in to talk about all the exciting changes happening in the healthcare industry. He often sees the same look now from providers from his vantage point on the other side, as deputy director of demand reduction at the Office of National Drug Control Policy (ONDCP).
“It’s because you’re so worried about the day-to-day,” says Mineta in explaining the reaction to news about the bigger picture. “Someone’s talking to you and you’re just thinking about making payroll.” Yet with major legislation such as the federal parity law and the Patient Protection and Accountable Care Act signaling major shifts in how addiction treatment services are likely to be delivered in the coming years, Mineta insists addiction treatment centers have no choice but to overcome internal challenges and become students of the changing landscape. “You have to find people on your staff who can be tracking these developments,” says Mineta, interviewed last week by Addiction Professional. “The worst part would involve the field watching the ship from the dock as it disappears into the distance.” The Senate confirmed Mineta for his new role last June. Since 2007 he had served as deputy director of the treatment organization Asian American Recovery Services in the San Francisco Bay Area, having started with the agency as manager of a youth prevention program in the mid-1990s. He has addiction counseling experience in multiple agencies. Mineta says his new position has led him to appreciate the level of collaboration that exists among federal agencies in efforts on behalf of individuals who need treatment. He cited his office’s close work with the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA) on issues related to benefits structures under the Affordable Care Act.
The future workforce
Mineta says he believes that the body of comprehensive health legislation that Congress has adopted in recent years will help to improve the status of addiction counselors. Commenting on fears expressed by some in the field that health reform will move the industry exclusively toward career-track counselors at the expense of individuals without advanced degrees, Mineta indicates that he considers that discussion somewhat misplaced.
“The linchpin really looks to be the physician,” says Mineta. Going forward, “Having medical supervision will be critical. Who does the work on the face-to-face basis can be a wide range of individuals. We would like a fairly robust and wide-ranging career ladder.” Mineta says the field should be on the lookout for an upcoming announcement of workforce training grant opportunities to assist clinicians in the transition to the health reform era. The money will be available to institutions that employ counselors, not to counselors directly, he says.
Mineta says that with the current emphasis on more alcohol and drug screening and brief intervention activities in primary care offices, addiction professionals would be wise to initiate discussions with the generalist physicians in their community. “Doctors need to learn about better screening and assessment tools, but where there’s a will there may not be a way,” he says, given the time pressures physicians already face. “If someone else besides a physician could do this [screening], that would be great.” Mineta points out that another important trend involves ONDCP’s addition of recovery to a demand reduction agenda that also encompasses prevention, intervention and treatment. “We’ve included recovery for the first time, with a branch, a branch chief, and analysts,” he says.