Bill White on the biggest barrier to better addiction treatment in the US. Our acute care (AC) approach:
This AC model works well with acute trauma, and it can play a role for many in addiction recovery initiation and stabilization. Unfortunately, it does not work well with the treatment of addictions of high severity, complexity and chronicity–patterns that dominate admissions to specialized addiction treatment units. Brief episodes of crisis intervention do not support the transition from recovery initiation and stabilization through the stages of recovery maintenance and enhanced quality of personal and family life in long-term recovery.
Efforts to transform AC models of intervention into models of sustained recovery management analogou
s to the treatment of other life-threatening chronic health conditions require substantial changes in service practices. One such critical change is abandonment of the graduation ritual or reframing this ritual as something other than the “end” of treatment. No healthcare provider would think of providing a “graduation” ceremony marking the discharge of patients admitted for crisis care of diabetes, heart disease, asthma, chronic respiratory conditions or chronic pain because such interventions would not constitute the end of care and the service relationship. Discharging persons from primary addiction treatment should also not signal the end of care. It is time we altered practices that inadvertently convey this end of care message.