More than 25 years ago, substance use disorders were recognized under parity law, which stipulated they should be treated the same as other diseases. Leaders are now calling for a shift in recovery to emphasize proactivity and education amid growing stigma, John Driscoll, president and CEO of Wernersville, Pa.-based Caron Treatment Centers, told Becker’s.
About 80% to 90% of resources spent on substance use disorder recovery and mental healthcare are directed toward crisis care, Mr. Driscoll said. While crisis care remains essential, he said the system must undergo a paradigm shift .
“What we’ve got to do is shift the entire industry to get more into prevention, early intervention and meeting patients where they’re at,” said Mr. Driscoll, whose organization treats patients in Pennsylvania, Georgia and Florida. “It’s just like cardiology. You still need cardiac surgeons. You still need to do open heart surgeries. But it’s a lot easier, it’s a lot cheaper, it’s a lot more beneficial if I can address the core of that major heart surgery 20 years earlier, when they simply have high blood pressure.”
Prevention should start as early as middle school, a critical period of brain development, he said. Introducing mind-altering substances while the body is already undergoing chemical changes can be disastrous. If substance use can be delayed until age 23 or 24, progress can be made, as the brain is nearly fully formed by that time.
Substance use disorder is often perceived as a moral failing, but color-coded brain scans have helped reframe the condition in medical terms, Mr. Driscoll said. By comparing an unaffected brain with that of a person with substance use disorder, patients can better understand the physical toll of the disease. This helps reduce shame and stigma, supporting patients and clinicians in treating the brain as the organ of affliction.
In 2018, the surgeon general released a report on substance use disorders, defining the condition as a brain disease, Mr. Driscoll said. Like other diseases, it requires continuous treatment and innovation.
“They get up in the morning, they look at themselves in the mirror and make themselves a promise, saying ‘I’m not going to drink today,’ only at the end of the day you have not been able to fulfill the promise,” he said. “It’s similar to somebody with blurry vision looking at themselves in the mirror and saying, ‘Not today. Today, I’m going to see and focus.’ It doesn’t really work that way. It’s an organ that needs treatment.”’
The resources dedicated to analyzing hormone levels, identifying brain-affecting chemicals or pinpointing affected brain regions are limited. Brain scans can offer clarity on changes that occur during active use versus abstinence and serve as progress measures, he said. They can also show chemical reactions in the brain triggered by anxiety, fear and stress. Brain mapping also enables patients and clinicians to see which areas are activated.
Recovery outcomes vary, from complete sobriety to occasional use or relapse. But by the time a relapse occurs, it is often too late, Mr. Driscoll said, comparing it to seeking cardiac care only after suffering a heart attack, after the damage has been done.
“We need regulators. We need policymakers. We need payers to agree that this is the type of focus we need to help people move forward, because it is a legitimate disease,” he said. “We are healthcare.”
