On January 29, 2014, CLARE Foundation celebrated the opening of Conscious Recovery, our new outpatient program that meets the financial, programmatic, and environmental needs of a mid-market clientele that has few effective, cost-efficient options for addiction treatment services on the Westside of Los Angeles. More than 50 of Los Angeles’s leading addiction, mental health, and primary care treatment providers gathered at Conscious Recovery’s Santa Monica headquarters to mingle, tour the facility, and experience the “State of Addiction 2014: Implementing and Understanding the Affordable Care Act and The DSM-V” panel.
The “State of Addiction 2014” panel featured experts from the worlds of policy, academics, and treatment, who provided a glimpse into the latest trends in substance abuse treatment and diagnosis and explored the ways in which parity and healthcare reform will affect substance abuse treatment provision.
After some brief welcome remarks from yours truly and panelist introductions from CLARE Clinical Director Matt Healy, Dr. Westley Clark, head of the federal Center for Substance Abuse Treatment at SAMHSA, took the stage to discuss the implications of the Affordable Care Act and parity for substance use disorder treatment.
Key points covered by Dr. Clark’s presentation include the following:
- Especially with the advent of the Affordable Care Act (ACA), substance abuse treatment providers need to broaden focus and play a more substantial role in the healthcare delivery system.
- CLARE is to be commended for its proactive efforts to meet the challenges of healthcare reform, including opening Conscious Recovery to address the increasing demand for substance use disorder treatment under the Affordable Care Act and the large and growing treatment gap for mid-market clients.
- Substance abuse is a chronic condition that can require treatment from medical, behavioral health, social service, and pharmacological professionals—treatment is not one-size-fits-all.
- Under the ACA, substance abuse is one of 10 Essential Health Benefits that must be covered by every insurance provider. As a result of the Mental Health Parity and Addiction Equity Act (Final Rule passed November 2013), substance abuse must be given parity with other health conditions.
- From October to December 2013, Covered California enrolled more than 500,000 people, more than 424,000 of whom received subsidized insurance.
- In addition, more than 548,000 individuals became eligible for MediCal, and an additional 630,000 transitioned to MediCal from low-income health programs.
- Of these new MediCal enrollments, almost 200,000 are expected to need substance abuse treatment services.
- “In the absence of system re-design for at risk populations, these populations could continue to experience barriers to service access, poor treatment outcomes, and high utilization of costly services such as EDs and inpatient care.”
- Patient care will become increasingly integrated, and substance abuse treatment and behavioral health service providers must be ready to be a part of that network in order to be effective.
Dr. Margaret Fetting, USC professor and renowned clinician, then took the stage to explore recent changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Her presentation focused on innovative ways of diagnosing substance use disorder in an attempt to expand clinical thinking about diagnosis
beyond the bilateral terms of “addicted” and “not addicted”.
Dr. Fetting’s presentation covered the following developments in diagnosis and their implications for treatment models:
- Along with the intricate new treatment delivery system defined by Dr. Clark, there is emerging an intricate new treatment system for substance abuse.
- The Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) has excised the terms “substance use” and “substance dependence.” It has also declared that “addiction” will not be applied as a diagnostic term in the current publication.
- The bilateral terminology has been replaced with a spectrum of “substance use disorder” that ranges from “non-pathological” to “severe”.
- This spectrum approach encourages individuals and clinicians to examine the relationship with the substance rather than just undergoing a behavioral intervention like treatment or sobriety.
- Historically, treatment professionals have been good at taking care of the extremes—addicted and not addicted. We now need to develop expertise in all phases of the spectrum.
- There are four times as many problem drinkers as there are alcoholics—yet we provide fewer services for problem drinkers.
- Dr. Fetting then provided an overview of her mapping of the spectrum of healthy and unhealthy substance use behaviors among adults and adolescents. Categories included familiar terms such as “use,” “social use,” and “misuse”, as well as new and somewhat controversial descriptors like “mindful use,” “watchful use,” and “shadow use.”
Conscious Recovery’s Clinical Director Dr. Diana Cho closed out the panel by speaking about the importance addressing co-occurring disorders, and the ways in which CLARE and Conscious Recovery are making comprehensive treatment available for anyone in need. Major points covered by Dr. Cho’s presentation include the following:
- CLARE encourages personal growth. In order to live that philosophy, the organization has spent much time expanding its expertise and program offerings.
- CLARE is increasing its focus on screening and treatment for co-occurring disorders.
- In 2009, 20.8 million people abused substances, and 42% of this number—8.9 million people—had a co-occurring disorder.
- Co-occurring disorders worsen a patient’s prognosis and make both the substance abuse and co-occurring disorder more difficult to treat.
- CLARE is moving from a social model to a biopsychosocial model that includes medically and clinically sound processes, including screening for co-occurring disorders before and throughout treatment.
- Substance abuse is the most common cause of psychiatric relapse, and mental health issues are a common cause of substance use.
- This fact makes integrated treatment principles and cost-effective treatment like that found at Conscious Recovery vital to clients in need.
- Conscious Recovery is rooted in CLARE’s 40 years of success, and will offer a much-needed resource for mid-market clients in Los Angeles.
After the panel’s conclusion, CLARE’s Clinical Director Matt Healy moderated a lively Q&A session, which was followed by continued tours that invited guests to learn more about Conscious Recovery. This new program provides IOP and Day Treatment programming administered primarily by doctorate- or master-level clinicians. Conscious Recovery’s customized programs include 12-Step principles, evidenced-based therapies, and pioneering treatment modalities like Logotherapy and Strategic Risk-taking, which are designed to build a foundation for real recovery in real life and promote long-term success. This innovative program is built on CLARE Foundation’s more than 40 years of experience with successful addiction treatment provision and I am proud that it will help usher in a new era in CLARE’s development into a sustainable nonprofit. To view more photos of the event, visit Conscious Recovery’s Facebook page.