Shortening Addiction “Careers”

Gerald Bernard

There is a near universal principle in medicine suggesting that the earlier the treatment of a health problem begins, the better the prognosis for full and sustained recovery. Whether one suffers from traumatic injury, infectious disease, or such chronic conditions such as diabetes, hypertension, and addiction; the timing of treatment initiation matters.

Research scientists have used the concept of drug addiction and treatment careers to move beyond the study of a particular phase of alcohol and other drug (AOD) use or a particular episode of addiction treatment to study the long term course of AOD problems and the stages and processes through which they are resolved. In the U.S., more than 2.5 million individuals are admitted to treatment each year within the nation's more than 16,000+ specialty sector addiction treatment programs. The existence and utilization of such resources marks a substantial improvement in the treatment of addiction over the past half century, but the majority of people admitted to addiction treatment seek help at a late stage of problem development. Recovery outcomes are compromised by this prolonged delay in help-seeking. There are millions of individuals in long-term recovery. What would it have meant to these individuals, their families, and their communities if they could have initiated recovery years earlier. What burdens brought into the recovery process might have been avoided and what lost assets might have been salvaged?

The personal health of millions and the public health of the nation could be significantly enhanced by promoting help-seeking for AOD problems at the earliest stages of their emergence. At present, we are failing to achieve that goal. Below is a list of broad systematic strategies that might well bring us closer to achieving that goal. Some are already being designed, developed, implemented, evaluated, and replicated.

1. Medically define and culturally disseminate norms that distinguish healthy and unhealthy AOD use (as has been attempted in recent years for alcohol use).

2. Require that all AOD-related government-funded studies published in scientific journals be accompanied by a press release describing the major findings and implications of the study in non-technical language, with a particular emphasis on effective problem resolution strategies. (See Harvard's Recovery Research Institute for samples of such summaries.)

3. Provide targeted prevention and early intervention services to all children affected by addiction in their families (i.e., children with parents or older siblings who have experienced significant AOD-related problems).

4. Support recovery advocacy organizations that increase the public visibility of recovery and convey the variety of recovery pathways via recovery education and celebration events.

5. Provide leadership development activities within the recovery community to increase the density of local recovery carriers.

6. Cultivate the development of local recovery support institutions that enhance recovery stability and quality of personal/family life in long-term recovery, e.g., recovery community centers, recovery residences, recovery schools, recovery industries, recovery ministries, etc.

7. Saturate services and ongoing recovery supports for all persons who have experienced severe physical or emotional trauma (severe defined in terms of intensity, duration, multiple events, multiple perpetrators, victimization by persons of trust, or denying/blaming/shaming responses to trauma disclosure).

8. Explore research-grounded strategies for postponing age of onset of AOD use (separate and distinct from strategies aimed at preventing all such use).

9. Promote dissemination of self-screening devices for AOD problems, including online screening tools for individuals and families.

10. Screen all first offenders for AOD-related problems and risks, with assertive linkage to early intervention, treatment, or mutual aid resources.

11. Establish AOD use screening as an integral component of intake and annual screenings by primary care physicians.

12. Provide active recovery management for all patients identified with AOD problems, e.g., monitored moderation or sobriety sampling, linkage to self-help and mutual aid resources, linkage to specialty sector addiction treatment, and ongoing recovery checkups.

13. Conduct AOD screening as part of all emergency medical services with assertive follow-up and linkage for more rigorous evaluation of those identified with potential AOD-related problems.

14. Culturally promote self-help and mutual aid resources on par with addiction treatment resources.

15. Provide addiction screening card and treatment resource info insert with all prescriptions for Schedule II drugs.

16. Strengthen AOD-specific early intervention capabilities with the workplace (via employee assistance programs, professional assistance programs), schools (via student assistance programs), religious institutions (via pastoral counseling and peer assistance programs) and family counseling agencies (via enhanced professional training and screening related to marital separation/divorce).

17. Develop evidence-based protocol for the treatment of AOD problems of lower severity, complexity, and duration.

18. Conduct regular recovery check-ups for up to five years (the recovery stability set point) on all persons treated receiving specialty sector addiction treatment.

Given knowledge of your local community, what strategies would you add to this list?

As a country, state, city, or local program, we can measure our progress toward the goal of intervening early in the development of AOD problems by measuring changes in the annual average time lag between AOD use (as well problem onset) and attempts at recovery initiation (with and without professional assistance). If we are serious about addressing AOD problems, including patterns of severe addiction, then we should see progressive improvement in the timing of recovery initiation for such problems. Achieving that goal will require changes in public understanding of the sources and trajectories of such problems and a substantial investment in resources to support early problem resolution.