From Rhetoric to Reality: Commentary on Flynn & Brown (2016)

Abstract

Drs Flynn and Brownmake crucial points in their article, namely, the failings of treatment programs around the country to reflect the conceptualization of substance dependence as a chronic health condition; and the need for the best minds in the nation to put their collective muscle into the issue of substance abuse. I have never been more optimistic about the treatment of alcohol and drug dependence. The priority given to substance use in the Affordable Care Act (ACA) is unprecedented. It creates the opportunity for a long-isolated and marginalized substance-abuse treatment industry to become an integrated part of healthcare. The moment for the creation of an Institute of Medicine (IOM)-like platform to respond to substance use has never been better. Wemay finally be at a pointwhere public awareness, political will, and community need have reached the necessary criticalmass. Creating such a vehicle early in the implementation of the ACA allows for the best minds to bring shape to what will ultimately lead to a more pliable multisystem-involved response to substance abuse. This is happening at time when our communities are flooded with the highest-quality laboratory tested illegal drugs the world has ever produced. The businessmodel yields extraordinary profits, the distribution networks are incredibly sophisticated, and the production, sales and the consumer base are truly international. Let me set that optimism aside for a moment. There is a real chance that the medical field will not embrace this new responsibility; that this issue will be simply be seen as yet another mandate foisted on an already overburdened healthcare system – not the kind of pivotal issue that grossly affects health, healthcare outcomes and life trajectory, and bends the cost curve. With few exceptions, physicians, nurses, psychologists, social workers and a variety of other healthcare disciplines are not well prepared to respond to substance abuse, having received little training in the diagnosis and treatment of substance use disorders. The ACA provides the mandate to enlarge the scope of practice for these disciplines, it is up to academic, professional and healthcare leadership—all three—to push this change. Further, as ubiquitous and necessary as they are, it is always difficult for commissions, councils, institutes and the like to gather the needed politicalmomentum to enact their good ideas and avoid creating yet another advisory report collecting dust. In order to succeed, any IOM-like initiative must be extremely deliberate in the framing of its mission and goals, and in its selection of participants, work process, work products, governance, lead-in and rollout. To that end it will be crucial to create a platform that is structured to allow real movement toward action and productive engagement of external decision makers as the body moves through its work. This