Friday, December 6, 2013

Integration: The Great Debate



Kimberly Johnson, MS Ed, MBA

Deputy Director, NIATx

Co-Director, ATTC Network Coordinating Office
 

If there's one thing that we seem to be constantly fussing about in addiction treatment, it’s integration.

When I first started in the field, we were still resisting the integration of alcohol and drug abuse treatment. Younger people may be saying “What? That seems silly!”  But it was a big debate at the time. The drug treatment people felt they would be taken over by the bigger, more established alcohol treatment system, and the alcohol treatment system wasn’t sure it wanted to deal with the drug problem.

When I was a student, we kicked people out of treatment for having co-occurring disorders. I think the rationale was that these clients were too sick to focus on their addiction, or something like that. I know I never graduated a single client during my internship because I kept learning they had mental health problems. Toward the end, I started wishing they would be less open with me.

So, when I became the executive director of a treatment agency in the mid-1990s, I was very enthusiastic about trying to figure out how to integrate mental health and substance abuse services for people with co-occurring disorders. It was a big debate because the addiction treatment people were worried about being taken over by the big mental health centers, and the mental health people weren’t sure they wanted to deal with addicts.

Remember what I said earlier about integrating alcohol treatment with other drug treatment?

It was déjà vu all over again.

Now, we’re talking about integrating behavioral health (even though we are still fighting about that term) into primary care. It’s a big debate because the behavioral health providers are worried about being taken over by the big primary care systems, and the primary care systems don’t really want to deal with people with behavioral health disorders.
Maybe I’m just getting old…but I think there’s a pattern here.
What’s funny (or sad, depending on your perspective) is that in many ways alcohol and drug treatment really do remain separate; psychiatric disorders other than substance use disorders are still treated really differently; and very few of us understand the interaction between mind and body at even an elementary level.

But we have to keep trying. And I suppose we have to keep debating, not about whether to do it, but about the best way to do it. We have to debate, we have to experiment, and we have to keep trying to figure out the best ways to integrate, because we still don’t really know.
 

During the next year, The Bridge, the ATTC Network's quarterly e-journal, will be devoted to the topic of integration in healthcare. The discussion starts with the next issue. If you haven’t yet subscribed to The Bridge, please do. We will review the literature, debate what it tells us, and propose next steps based on where our research and discussion leads us. Join us in this debate. It will be fun.
 
I’m trying to imagine what the next big integration debate will be. I’m too blinded by the current controversy to think too far ahead, but maybe you have some ideas.

The SAMHSA-HRSA Center for Integrated Health Solutions  (CIHS) offers a wealth of resources and information dedicated to healthcare integration. (And the images in this post are from the CIHS website--check out their excellent infographic on the benefits of integrated care.)

Kimberly Johnson served for seven years as the director of the Office of Substance Abuse in Maine. She has also served as an executive director for a treatment agency, managed intervention and prevention programs, and has worked as a child and family therapist. She joined NIATx in 2007 to lead the ACTION Campaign, a national initiative to increase access to and retention in treatment. She is currently involved in projects with the ATTC Network and NIATx that focus on increasing implementation of evidence-based practices, testing mobile health applications, and developing distance learning programs for behavioral health professionals.

3 comments:

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  2. I think some in the MH and SUD treatment field feel threatened by those in primary care. And of course many are just naturally opposed to change. I believe the change is inevitable and we have to stay flexible enough to adapt when needed. Those who can't adapt should feel threatened because they probably won't last. Thanks for the insightful article.

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  3. It seems that on MH and SUD side of the fence we are engaged in thoughtful discussion and debate about the advantages and challenges to integration with primary care. Less so among primary care professionals. As we move toward integrated care, I hope we expand the range of the conversations such that both sides are talking with each other and not just among themselves.

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