THE REMEDY WILL REQUIRE A RADICAL SHIFT

The remedy will require a radical shift in focus and thinking. The remedy will require some risk!

We have made some progress. What’s the next step?

The fundamental problem we have is utilization not efficacy.

We argue over what pathway to recovery is the best. In the meantime, they all have one thing in common: NO ONE USES THEM.

10% ENGAGEMENT???

Think about something: we work in an industry that has accepted “MAX 10% Engagement”.

That is na “Maximum 10%” will get help. Even the recovery support profession focuses (mainly) on the “willing 10%”.

The typical recovery coach is trained to serve the willing 10%.

But look closer. Look at other behavioral health “helping professions”. Same thing.

THE REMEDY – PROFESSIONALS???

Maybe a little higher (depression = 20 to 40%) or maybe a little lower (clinical EAP utilization = 3%)

BUT… generally speaking. We don’t even TOUCH (let alone help) the majority of people in need.

As a society we are firmly attached to the “come and get it when you want it” model of behavioral health care.

THE REMEDY – APPS

Most apps trade on that model. Every “wearable” trades on that model. The “new rehab” down the street trades on that model.

The breakthrough medication trades on that come and get it model. On and on.

In the meantime. The majority don’t want it and never, ever will come and get it.

And hence … we stand no chance.

Because we are trying to solve the wrong problem.

PROBLEM

You ever hear the joke: How many psychologists does it take to change a lightbulb?

Answer is 1 … but the lightbulb has to “WANT to CHANGE”.

It’s in our bones.

We only help people who want help… and that will never get it done.

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The Recovery Movement

At the risk of being labeled a full blown heretic, I’d like to offer an alternative view on peer support / recovery coaching and “the recovery movement”.

– Side Note: Can we agree that arguing by example is not the best way to approach a healthcare crisis.

An argument by example (also known as argument from example) is an argument in which a claim is supported by providing examples. “This the best way to recover: here are some examples “from my experience”.

A logical argument (or just argument) is a process of creating a new statement from one or more existing statements. An argument proceeds from a set of premises to a conclusion, by means of logical implication, via a procedure called logical inference.

In order to solve “problems” we must first identify the problem that needs solved.

If we identify the wrong problem (or we make up the problem) we can never solve the actual problem. You can put more gas in the car but if the ignition is faulty you will never be able to drive it…not matter how much gas you put in the tank.

WELL THEN…here we go:

The Narrative

There is a narrative in the “recovery movement” that fundamentally goes like this:

• Recovering people were working in the field.
• Things were going relatively well, overall.
• Then Insurance Companies started to play games.
• Managed Care Organizations and licensing bodies and evil regulators got involved.
• The field became “over-professionalized”.
• Recovering people were pulled out of the process.
• So we need to bring “peer recovery” back.
• Nothing about us without us. The problem is we have been left out.
• We need to advocate for peer recovery and inclusion in the process.
• Once we re-engage recovering people everything will get better.
• Recovering people will introduce better policy and better practice.
• People will rush into recovery and everything will improve.
  (FOR THE RECORD: I AGREE. WE NEED INCLUDED IN THE PROCESS.)

The Problem

The problem is… that explanation is largely mythical.

1. PRIOR TO “PROFESSIONALIZATION”:
   
   The presence of “more recovering people” in the industry did not make things better. Things were not going well.
   
   There was a punishing aspect to care. It was one size fits all.
   
   The echo chamber was established and the lines between home group and therapy group were blurred (this persists today-unfortunately).
   
   – For more information on pre-professionalization: consider the Minnesota Model and Synanon. The overwhelming majority of programs followed (and still follow) these principles (one way to recover, “confrontation” equals effective treatment etc…).
   
2. WITH “PROFESSIONALIZATION”
   
   Even with professionalization, a fair percentage of people working in the field were in recovery themselves.
   
   They became “certified addiction counselors” and/or professional therapists.
   
   Also they worked in administration. They worked in “business development”.
   
   They still work in business development…(and if you look around on FACEBOOK you will see exactly how little progress has been made in professionalizing addiction treatment marketing)….
   
   The problem wasn’t over-professionalization.
   
   The problem was confrontational, one size fits all treatment and no separation between personal recovery and professional treatment.
   
3. THE RECOVERY COACH
   
   “Mobilizing and training” recovery coaches for the sake of creating an army of recovery coaches (in and of itself) is not smart.
   
   Demanding more recovering people at the table is important; but only if they are professional in their approach and multiple pathway in their beliefs.
   
   Massive damage is done when a “certified recovery specialist” (or whatever they are called in your respective state) is simply a sponsor with a credential.
   
   There is a great deal of denial within the peer recovery support workforce. Many people who attend a training and claim to believe in multiple pathways quickly revert to their “recovery of choice” upon completion of the training. That sets the process back 50 years.
   
4. THE NEGLECT OF 90%
   
   Recovering people don’t automatically offer new ideas and/or push new models.
   
   Every “plan” is essentially some version of “more access to treatment (including M.A.T.)” ; a call for parity; a call for stigma reduction etc…
   
   For the record (again), there has been an absolute neglect of 90% of people in need. People think that the 90% “treatment gap” is due to lack of access.

Conclusion:

There is zero validity to this perspective. The gap is due to mismanagement and disregard for the most basic elements of SUD.

Including, people DO NOT seek help—the disorder produces irrational behavior and impaired judgement.

Until we solve for that reality…we make only incremental progress.

The paradigm must change from “hit bottom and want it/relapse equals patient failure” to “the professional provider bears responsibility for connection, retention and service effectiveness”.

Until that happens nothing will change…ever. No matter how much gas money you have.

The issue is not over-professionalization.

The mentality that “only a recovering person can help someone with SUD” is problematic.

If this is a healthcare issue we need to act like it is a healthcare issue. This means many people with varied backgrounds will be involved in the solution.

And there will be a need for professionalization of the peer recovery credential.

This is where things breakdown in my mind. I won’t defer to arbitrary authority. It’s basically: appointed authority versus legitimate authority.

How do we reconcile the need for professionalization with the uncomfortable reality of centralized bureaucracy overlooking said professionalization?

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What Do iPods and Recovery Coaches Have In Common?

Unsolicited advice and random observations from the front lines. We need business minded people to get in on these solutions.

The end of the “opioid money” is near. For example: The “SOR” runs out September 2020. That will be here in a blink of an eye.

When that happens all the nation-wide “special stuff” goes away. What do I mean by special stuff: emergency room peers, medication assisted tx access, increased access to narcan etc…

FAVOR Greenville funds 8 of 9 hospital programs independent of opioid money and we will fund the 9th as well if needed.

Maybe not at the same level. But we will get something figured out.

Nationwide

When the dust settles and the attention fades and the money goes away….ask yourself: What will Be left behind?

Will anything be different, in terms of helping people with SUD, be left behind? – Yes.

We will have really cool tool kits and resource websites. We will have a thousand certified peer support staff hanging out (sponsoring people I guess).

It looks like a full out return to business as usual is highly likely.

• Change paradigms to change results.
• Change funding infrastructure to change paradigms.
• Change the gatekeepers to change the infrastructure.

Or raise up a new channel… a new vertical. Invent a business model.

Maximize Impact

Do all you can with what you have in front of you. Be creative to maximize the impact of what you have.

When you invent a product or a service. You also, many times, have to invent a business model that supports the invention.

Otherwise, when you insert the new service into the existing business model, the new service will be forced to conform to the old business practice. The innovation will get rubbed off by the old expectations.

This is why peer recovery provided via clinical treatment (or in clinical treatment setting) will eventually resemble behavioral tech more than peer recovery.

The iPod

Steve Jobs and Apple invented the iPod. But the iPod is useless without music.

Jobs had to develop and disrupt the entire business model.

Artists were selling their stuff in record stores. He had to move the industry toward completely new distribution channel. Jobs had the money to get that done.

We are not capitalized at the Apple level.

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