In this video interview, Alexa Connors, LMSW, discusses changes to the U.S. addiction treatment system that could improve results. Connors is assistant director of The Dorm, an intensive outpatient treatment program for young adults in New York City and Washington, D.C.
The following is a transcript of her remarks:
What I think we’re really seeing is that addiction across the globe is on the rise. Within the last year, 15% of people reported having a substance use disorder or substance misuse, and about 94% of those people did not receive any treatment for it. If we’re thinking about young adults there’s another statistic — about 13.5% of Americans over 12 years old actually reported use within the past month, which is about a 4% increase year-over-year.
So I think what we’re seeing is that, in general, addiction’s on the rise. Demand is really high for addiction treatment, but the supply for addiction treatment is not really there. So there’s a need for it, but there’s a lack of resources. Even when there are resources, those resources aren’t always accessible to everyone equally across the board.
Right now, if we’re thinking about just New York as an example — and I know that this is happening across everywhere — a lot of substance use treatment and mental health treatment are very separate from each other. While these things can be great on their own, what would be really beneficial is wraparound care that kind of includes both of these things combined into one. A lot of times, substance misuse is a symptom of another type of mental health struggle or something like that. So yes, you can treat one without the other, but it’s not going to be as effective as if you were tackling both at the same time.
And when I talk about wraparound care, I mean you want to have treatment that involves health and wellness, physical activity, mindfulness — you want to be able to have treatment that helps people engage in life outside of substance use. You want to connect people with community. Again, a lot of times when you’re in a strictly substance use type of program, they’re not always able or don’t always have the resources to offer all of those things.
Another thing that I would recommend is the need for prevention measures, especially among young people. I think we know that the DARE [Drug Abuse Resistance Education] programs and the “don’t do drugs” [weren’t] super effective for a lot of reasons. So with that being said, we really need people to go into schools and really educate students and staff about the risks of substance use and talk about it in a very blunt way, not as a scare tactic, but really have an education piece to it.
In addition to that, I think staff at schools need to be equipped for managing a potential overdose or something like that. And really, in schools, doing things that you can to reduce some of the risk factors that lead to substance use among young people and increase the protective factors that might help somebody not turn to substances. So again, thinking about community or outside activities, extracurriculars, that’s really going to be for the prevention piece of it.
In addition, I think there is a shortage of providers who specialize in substance use treatment, and so that can be another really big issue. That’s kind of what I was talking about before in regards to accessibility.
Probably one of the things that I see being a barrier is because people don’t feel necessarily equipped to navigate those things, they may not ask the questions or be as direct or blunt, so that’s really preventing people from being able to talk about it. It’s just a total missed opportunity.
So number one, being able to train primary care providers on what addiction looks like and then what resources in the community they may be able to direct someone to. Also, primary care providers being a little more equipped to prescribe or [be] more knowledgeable about medications that help with substance use, naltrexone or Antabuse [disulfiram] or things that can really help people in that realm.
Other things that I’m thinking of are — I know this is talked about a lot — but more harm reduction within the community. Right now I think a lot of treatment focuses on getting people to stop using drugs, and while that is obviously a great long-term goal, that’s not really where everyone always is.
We know that there are kind of six stages of change when we’re thinking about addiction and substance use and any other behavior. We really need treatment that’s tailored to each stage of change. It’s kind of impossible if someone’s in the “contemplation” stage — or not even there, the “pre-contemplation” stage — to get somebody to just stop using drugs. We really need treatment that’s going to meet people where they really are.
We talk about these [safe injection sites], and I know a lot of people think that encourages substance use, but really if we kind of reframe that and look at it more as somebody taking a step towards self-love, somebody who’s saying that this is a problem that I have and I want to do this in a safe way, that’s actually a good sign of somebody who’s wanting to take better care of themselves.
I guess reframing the way that we’re seeing those kinds of strategies as a society, but also just having more options for people, again, based on where they’re at in their journey.
And then finally, more family and peer involvement whenever that’s possible. More resources for families who have a loved one who is struggling with addiction. I think similarly to what I was saying about primary care providers or other non-specialized providers, I think families also often feel not equipped to deal with addiction.
If families learn how to talk to their loved ones or, again, not shy away from asking questions and being curious, there’s a really big opportunity there for family members or peers to be able to support people in their recovery process.