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Review commissioned by frustrated treatment executives will cover full continuum of care

November 14, 2012
by Gary A. Enos, Editor
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McLellan clarifies scope of paper he is preparing



The review paper that Treatment Research Institute (TRI) CEO A. Thomas McLellan, PhD is preparing for addiction treatment center executives who are frustrated over what they consider a dearth of support for residential care will encompass the entire continuum of addiction treatment services, not just one element.

Addiction Professional reported earlier this month that a group of private facility administrators who met at the Cumberland Heights facility last month had commissioned a white paper that would highlight the evidence basis for residential, abstinence-based services. But McLellan confirmed to Addiction Professional on Nov. 14 that the review document he will present to the group will outline “a modern continuum of care and reasonable expectations for that,” adding that “it also will be presented in the context of chronic care management in the rest of medicine, as that in itself is consistently being updated.”

McLellan, who will not be paid to produce a document that he expects to deliver by Christmas, says all research in the field points to the need for a strong continuum of care that includes elements of therapy, 12-Step work, recovery support and medications, and the importance of not relying on one approach to treatment alone.

Just as prescribing medications and offering no other support won’t address the psychological needs of an individual battling a substance use disorder, McLellan indicates, so too does traditional abstinence-based treatment often fall short in not assisting clients with the intense cravings that medications such as Suboxone (buprenorphine) can help to combat.

To McLellan, embracing any one strategy to the exclusion of all others will pretty much guarantee an unacceptably high relapse rate. “I told [the leaders] that I think they’ve got an important component, but it’s got to fit into a continuum of care,” he says.

McLellan adds that the document he is preparing, which will be heavily referenced, could prove useful to the field because “it has been a while since something of this nature has been done.”

Several of the leaders participating in the October meeting represent organizations that are prominent members of the National Association of Addiction Treatment Providers (NAATP), and the group is working on drafting a set of shared principles that it might consider forwarding to the NAATP board for its consideration as a policy statement. Yet there is by no means unanimous consensus within the NAATP board about preferred tools for treatment.

And even within the group that met last month, there are numerous centers that use medication-assisted treatment to a significant degree. One participant, Hazelden, even unveiled this month a major revamping of its opiate addiction treatment protocols that for the first time in the organization will use maintenance dosing of buprenorphine among its approaches.

For his part, McLellan grows increasingly frustrated with any “either-or” discussions about approaches to treatment, no matter what the source.

“Is what they are doing working so well that they don’t need any new tools?” he says. “It is not recovery or medications—that is wrongheaded thinking.”