U.S. Surgeon General’s Groundbreaking Report Sets the Stage for Eliminating Stigma, Preventing and Treating Substance Use Disorders

More than 20 million people across the nation have substance use disorders (SUDs) and the numbers of overdose deaths from several types of drugs have, on average, tripled between 2001 and 2014, according to the National Institute on Drug Abuse. Although treatments for all types of SUDs have been proven to be effective, only about 10 percent of individuals receive any type of specialty treatment. These statistics reinforce the timeliness and importance of the groundbreaking report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, which Vivek H. Murthy, MD, MBA, Vice Admiral, U.S. Public Health Service Surgeon General, released on November 17, 2016.

Dr. Murthy’s statement that addiction is not a character flaw or a moral failing is powerful and will help foster progress in the ongoing battle against stigma, which, along with lack of insurance, is the most common reason why people do not seek treatment when they need it. The details on the neurological framework of addiction in the Report, proving it is a disease of the brain, also helps fight stigma by providing necessary education and understanding.

We are pleased that this is in line with Governor Christie’s public statements about addiction being a disease and making substance use treatment a priority for New Jersey. The political will to expand access to services is essential, and it is very heartening to know that leaders in both our state and federal governments are focused on addressing this critical health need that has grown to be a public health crisis.

The Surgeon General’s Report details biological and other factors that increase risk for substance use, misuse and addiction and highlights programs that aim to not only mitigate risk factors, but also reinforce protective factors. These factors are the same for depression, bullying and risky behaviors, and they are predictive factors of addiction and other behavioral health challenges. This reinforces the importance of prevention and early intervention, as such efforts are designed to have a far-reaching impact on individuals’ lives.

Notably, the Report acknowledges and expounds upon the many paths to recovery and the need for ongoing recovery support services. This reinforces the fact that the medical model is not sufficient for treating SUDs because these illnesses rarely, if ever, follow a linear path toward resolution. Unexpected stressors in individuals’ lives could trigger symptoms and relapse at any time. Therefore, the full continuum of services must always be available to everyone at every stage of treatment and recovery.

The Report illustrates the U.S. Department of Health and Human Services’ (HHS’) dedication to leverage opportunities identified in ongoing efforts for healthcare and criminal justice reform, information technologies, research and resulting clinical advances to expand access to effective prevention and treatment services. The report’s emphasis on integrating physical health care and substance use services, as well as a public health approach, is greatly appreciated and clearly demonstrates the Surgeon General’s and his team’s knowledge of what works and what is needed to truly address the addiction crisis throughout our country. Sixty percent of individuals with SUD’s also have mental illnesses and in this population, only 48 percent receive treatment for either disorder. Integrated care is necessary to address both of these disorders, as well as physical co-morbidities that are common in this group and often not treated. The lack of treatment for these multiple health conditions leads to a greatly declining quality of life and tremendous need for costly healthcare services. All of this can and must be prevented.

The Report also contains a call to action and recommends specific endeavors different groups of individuals – parents, families, educators, healthcare professionals, public policy makers, researchers and all community members – can undertake to help ensure access to SUD treatment for those in need and to help prevent others from developing SUDs.

Addressing the addiction crisis absolutely requires a team effort and we admire Dr. Murthy for taking the lead in convening experts from HHS, the Substance Abuse and Mental Health and Services Administration and other areas of the field and rallying all stakeholders nationwide to work together on this critical issue. All of us at NJAMHAA look forward to our ongoing partnerships with federal and state leaders, our members and other stakeholders to give individuals with SUDs opportunities to achieve recovery and help others protect themselves from the dangers of alcohol and other drugs.

Lives Are at Stake; Changes Must Be Made

I’m going to Europe this fall and I’m always struck by the fact that throughout Europe and especially in France, they always have strikes and demonstrations. Since I joined NJAMHAA 21 ½ years ago, I’ve seen that while we agree it is effective to show what the mental health and substance community provides and how much it is depended on, there has never been a strike because providers are mission driven and would never hold back services even for a day from the children and adults who rely on them.

Community-based mental health providers are moving to a fee-for-service (FFS) reimbursement system with some rates that won’t work and the simultaneous removal of State contract dollars, as we have been demonstrating – without going on strike. Data from providers throughout New Jersey indicate that tens of thousands of individuals will lose services if FFS rates are not increased and if contract dollars are not continued while providers make the transition, which should be extended.

So, it is realistic – and frightening – to ask, “What if providers had to close their doors not for a day, but forever, because they were no longer viable?” This has been the experience in other states throughout the country, including Massachusetts, Michigan and Kansas. The move to Medicaid managed care and the concurrent termination of contracts with State dollars resulted in programs and even entire agencies closing, which led to individuals’ mental illnesses and substance use disorders becoming worse and requiring much more expensive treatment in emergency rooms and inpatient hospital units. If positive changes are not made for New Jersey’s FFS system, these same tragedies – which have been occurring due to the long history of insufficient funding – will inevitably occur to a greater degree. Such tragedies can and must be prevented.

Our member providers are so committed to those they serve that they are doing all they can as they face the multiple challenges inherent in the time frame in which FFS is being implemented. However, there is still a limit to what they can do with limited funds. It’s my hope that State legislators and policymakers will invest more State dollars in the community mental health and substance use system to ensure that all children and adults – whether they have Medicaid or they are underinsured or uninsured – so that even though providers refuse to quit, the FFS system won’t have such a devastating impact that it would seem as if providers had gone on indefinite strike.

As a good friend of  mine, Randy Hall, eloquently stated, “People seldom change when they see the light; they only change when they feel the heat.” Our State leaders need to feel the heat, to know what’s at stake: people’s lives.

While the unquantifiable cost of people’s lives is certainly a compelling reason on its own, the quantifiable fiscal cost is also of great concern and cannot be ignored. The cost of community services must be viewed as an investment that yields a tremendous return. Community services cost hundreds of thousands of dollars less than hospital services and save the State millions of dollars every year in prevented emergency room visits, hospitalizations, homelessness and incarceration.

People’s lives and the State’s fiscal situation represent a lot of “heat” that should incite positive change to strengthen and maintain the safety net that is our community mental health and substance use system.
 

Ensuring that Everyone who Needs Help Can Get Help

The summer passed so quickly and we jumped into fall at full speed as the transition to fee-for-service (FFS) had been and continues to be on everyone’s mind.

Ever since I began receiving feedback from members that some of the FFS rates won’t work, I’ve been asking myself every night, “What will it really take to ensure not only that no one loses services as we go through the system transformation, but also that we can expand services as there is so much unmet need?”

Of course, we are continuing to persevere in our advocacy and we are employing a variety of strategies, including recent videos, We Have a Potential Problem and The Number of People in Need Continues to Increase , on YouTube. The videos, as well as our press releases and letters to editors, have resulted in substantial media coverage. Highlights include a page 1 article in the Star-Ledger, several articles in NJ Spotlight, a feature in Mental Health Weekly and interviews on NJTV News. We have had some impact on FFS rates and the transition to FFS. We are also making significant strides toward eliminating stigma and discrimination.

The momentum keeps building. As others have been worrying along with me around the clock, which is evident by the nonstop communications, the potential loss of services for tens of thousands of individuals is of grave concern. This concern has prompted much positive action by our staff and members, including advocacy to legislators in writing and in person, a petition (click here to sign on before October 19th) and legislative breakfasts being held this month in Bergen and Essex Counties.

I fully support all of these efforts. They augment the advocacy that our staff and I do on behalf of all our members. I think there will be a solution and we will be heard if every individual at every member organization, as well as all clients and their family members, become actively engaged in advocacy. I believe that if we all join voices on this issue, leaders will know that services are needed and valuable.

We are glad the State Senate Health, Human Services and Senior Citizens Committee unanimously passed a bill for independent oversight of the FFS system operation and rates, and we anticipate an Assembly hearing on this legislation on November 14, 2016. We strongly encourage our members to make a strong showing at this hearing with clients and their family members. Stay tuned for details.

Debra L. Wentz, Ph.D.
President and CEO
New Jersey Association of Mental Health and Addiction Agencies, Inc. (NJAMHAA)