By David Rosenbloom, Ph.D.
If addiction relapse occurs, clients, families, and payers often think that treatment “failed.” But addiction professionals know that their work may not be enough if their client has no home, job, or access to food stamps or child care. Many of the major obstacles on the road to recovery are the result of public and private policies that discriminate against people with alcohol or other drug disease.
That is why addiction professionals across the nation are getting personally and professionally involved in the fight to end discrimination. Addiction counselors and other caregivers — along with advocates for people in recovery — can make treatment successes visible and build the case for giving people with addictive disorders access to housing, jobs, medical care, and the other services they need to succeed.
Change Starts at Home
The National Institute on Drug Abuse’s Principles of Drug Addiction Treatment state that “to be effective, treatment must address the individual’s drug use and any associated medical, psychological, social, vocational, and legal problems.” All too often, addiction professionals recognize the issues, but think someone else in their organization is addressing them.
To start the effort to end discrimination, treatment professionals must figure out what they have to do in their own programs to make sure that every client gets the services he or she needs to succeed. Programs may get help from a lawyer, advocate, or case manager, or establish partnerships with housing, healthcare, job training, and day-care centers. The solution will differ in each community.
The Need for Local Leadership
Treatment programs can’t solve many of the problems of discrimination on their own; they need to get other community leaders involved. A plan to give a voice to treatment and recovery may include giving presentations to local civic organizations, talking to employers, meeting with the editorial board of the local newspaper, writing letters to the editor, hosting a town meeting, and educating other health professionals about the benefits of screening, referral, and treatment.
When the community holds a hearing about where to place a treatment facility or sober house, treatment leaders need to work with recovery advocates to organize a group to attend and talk about the benefits of treatment and recovery, and the importance of allowing treatment facilities and sober housing to open where they are needed and easily accessible.
Reach Out and Take Action
Many of the most damaging discriminatory policies can be modified through local change in the public and private sectors. I have seen many examples of community action overcoming even the most hostile federal impediments when leaders in different agencies decide they are going to solve the problem together.
Treatment professionals can talk to employers about choosing health insurers that provide comprehensive coverage for treatment. They can work with office-based physicians and emergency rooms to provide routine screening and referral, and improve reporting so payers and general healthcare practicioners know clients are getting needed services.
Local housing authorities have wide discretion in providing housing and services to people with past drug or alcohol problems, but many of them don’t use it because they have no local treatment partner to provide effective support. In New Haven, Conn., treatment providers worked with the local public-housing authority to build a continuum of care. Now, addiction professionals are available at one apartment complex for 12 hours a day, seven days a week, and the housing manager reports a greater sense of a functioning community as a result.
NIMBY is one of the biggest challenges facing the expansion of treatment capacity. The Americans with Disabilities Act prohibits discrimination against the placement of treatment facilities, but it happens every day — unless addiction professionals and recovery advocates take the lead to stop it. A few years back, town leaders in Framingham, Mass., allowed a methadone clinic to open in the downtown area despite overwhelming community protest because treatment providers filed a lawsuit claiming the town was discriminating against people with substance use disorders.
If public education doesn’t work, perhaps the threat of a lawsuit will.
Help Enforce Existing Laws
Many of the discriminatory practices against people with addictions are illegal, and protective laws often aren’t enforced as written.
For example, Pennsylvania, like other states, has a minimum mandated benefits law. When managed-care companies made it difficult to access the full benefits guaranteed under the law, a group of treatment and recovery advocates came together to fight for the right to treatment. The group met with the governor and attorney general, and threatened to file lawsuits against managed-care companies through the state’s insurance commissioner. The group also managed to change the procedures of some of the insurance companies. It’s not easy — and it’s an ongoing struggle — but more people in Pennsylvania are getting treatment as a result.
Investigate your state laws and mandates that govern access to treatment. You may be surprised by what you find.
Talk to Elected and Appointed Officials
Legislators at the local, state, and federal levels consistently complain to me that their constituents do not tell them about the problems that people seeking treatment face. They tell me they hear from people with lots of other diseases, but not addiction. Therefore, they are largely ignorant about the damage caused by some of the policies they create.
Treatment and recovery advocates need to tell elected and appointed officials about what they face on a daily basis. Form a coalition of your peers and make educational visits to your representatives, as providers in the Rochester, N.Y., area do annually. Prepare a concise message with specific requests. Be persistent and follow up. But let them know you want change.
You may think it’s unfair to be asked to carry this extra burden — and you might be right. But who else knows as well as you how unfair the world is to people with addictions? And who else but you can make such an important difference?
Editor’s Note: David Rosenbloom, Ph.D., is the director of Join Together. This article is adapted from a commentary originally published in Addiction Professional magazine.