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A Change;
It Is A Coming...

Solid recovery services programs are anchored in the bedrock of peer support. One recovered person helping another and, in so doing, nurturing their own recovery. Twelve step fellowships didn’t invent this concept, but rather borrowed it from the ages. Humans have always relied upon one another to overcome life challenges. Artisans begin as apprentices. Those who have achieved success teach others what they have learned through guided, experiential learning. Less classroom; more active participation. This practice is so core to the human condition, we often refer to it as: Monkey see; monkey do. 

The Social Model Philosophy of Recovery is grounded in this bedrock.  Its origins trace back to the early days when twelve step fellowship groups emerged in California during the 1940’s. Individuals seeking recovery also had need of alcohol & drug-free housing. As they communed together under a common roof, they discovered how readily and effectively their peer-supportive roles transferred to their living environments.  Over time; these homes assumed the moniker “Sober Livings”.  To the outside world, it may appear the primary benefit is the absence from the household of alcohol & drugs. However; though a criteria, this element is not the key to their success. The “key to successful outcomes” is the implementation of a deliberate and intentional, peer supportive infrastructure. That’s the alchemy that creates such a powerful force for altering the life trajectory of recovery residence inhabitants. This “family unit” structure evolved to embody many of the traditions that sustain twelve step fellowships. Acknowledging the human tendency of leaders to impose their will on followers, a defined set of suggested rules for governance were passed along from one residence to the next. Eventually; due to the unusually high preponderance of positive outcomes originating from of this sector, academics arrived to study the formula and report on the influences that produce these outcomes.  How do Social Model Programs support those afflicted with addiction in their mission to achieve sustainable recovery?

In the 1960’s, the term “The Social Model Philosophy” was formally introduced. Recovery residences founded on this philosophy migrated across the nation. Many thousands of Americans have benefited from the simple practice of embedding twelve step and twelve tradition principles in recovery housing. Academic research demonstrates that the Social Model Philosophy, when effectively implemented, fosters “community cultures” that produce extraordinary outcomes. The degree to which programs implement the Social Model reflects their core mission.  A distinct difference exists between the underlying philosophies of treatment versus recovery. One is not necessarily better than the other. Best practices suggests that an assessment of the individual seeking service should determine the most appropriate level of care and/or support. In a perfect world this would always be the case. Unfortunately for consumers; commerce often skews assessment in favor of treatment because it’s there that meaningful paydays enter the equation.

In the 1970’s, as third party payers were forced to treat substance abuse as a behavior health disorder, they began to ask the questions: “exactly who are we paying and what credentials do they have?” Commerce opportunities drove the industry focus towards The Medical Model of Recovery. Physicians, nurses and therapists flood the space. This led to new curriculums offering credentialing for addiction treatment specialists, behavioral health technicians and other treatment related functions. Due to overwhelming life challenges that frequently accompany active addiction, the space becomes fertile ground for social workers with varying degrees of knowledge and experience. All this, coupled with a few other factors, results in a dramatic swing away from the Social Model towards the Medical Model as the industry itself becomes addicted to the insurance dollar. After four decades and largely due to three separate Acts of Congress, the pendulum is now gradually returning to center. Third party payers are, for the first time in nearly fifty years, interested in developing tools that measure the efficacy of services. For a moment, let’s place ourselves in the shoes of an insurance company executive and looks out at the vista from a unique perspective. What do we see? According to SAMHSA’s 2013 annual survey, an estimated 24.6 million individuals aged 12 or older were current illicit drug users, including 2.2 million adolescents aged 12 to 17. In 2013, 60.1 million individuals aged 12 or older were past month binge drinkers, including 1.6 million adolescents. That of the estimated 22.7 million individuals aged 12 or older in 2013 who needed treatment for an illicit drug or alcohol use problem, only 2.5 million received treatment at a specialty facility. Those are very sobering statistics for all of us and, in particular, an insurance executive. This means that 20.2 million individuals needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty facility in the past year. Couple this statistic with the fact that, in combination, the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) have changed the rules of the game dramatically. Our insurance executive can no longer exclude or even cap SUT coverage. Teams of such executives are now narrowly focused on determining service modalities that produce positive outcomes for a lower net cost. They now care very deeply about what actually works.

This turn of events provides tremendous opportunity for service providers who also care deeply about what works. While short-term opportunists chase windfall profits initially generated by ACA & MHPAEA, true care givers will invest linearly across the continuum. They’re creating systems of care and support that actually improve outcomes. They recognize that one size and flavor does not meet the needs of every potential client and are taking steps to implement assessment tools to more accurately determine the level of care and/or support most appropriate for each individual. These industry executives view outcome measurement tools as a means to assess the efficacy of their programming as opposed to tools designed to produce favorable marketing statistics. This isn’t so much a noble or virtuous approach as it is a sound business practice. Programs that produce consistently high rates of return for third party payers will be the champions on this new playing field. Ultimately, it is the consumer and their families who will benefit most. This is a very exciting moment in the history of a malady that has continuously ravaged humankind for as long as we’ve been standing upright.