Shawn Vestal: Treatment is everyone’s favorite solution, but it’s not so simple

Often, when social issues become politicized – whether it’s homelessness in Spokane or gun violence nationwide – there is a brief, urgent flare of interest in “treatment” as a solution. Treatment for addicts. Treatment for the mentally ill.

Sounds good. Makes sense. And it’s too simplistic by half, because the scope and complexity of the problem dwarfs the available resources and, with addiction in particular, there is the stubborn problem at the heart of recovery known as human motivation.

Those who work with addicts are skeptical in particular about forms of compulsory treatment for addiction, and note that people often relapse repeatedly before finally succeeding.

“People have to be ready,” said Dr. Bob Lutz, health officer for the Spokane Regional Health District. “If you talk to anyone who has dealt with addiction, they have to want the treatment for it to really work.”

Beyond that challenge, there is a shortage of treatment options. Alison Poulsen, the executive director of Better Health Together, said that people often need very particular forms of help at different times in their addictions – whether they’re beginning to seek information about opioid treatment or looking for support after completing a detox program. The right service at the right time is crucial.

“I think there are fundamentally not enough resources at the time people are motivated to access the services,” she said. “The system’s so packed right now that getting that alignment between ‘I’m motivated’ and ‘I can get into treatment’ is really challenging.”

In 2017, an estimated 28% of those in this region with a substance use disorder – an addiction or dependency – had received some form of treatment during the prior year, Poulsen said. That gap includes people with addictions who aren’t seeking services and it reflects a lack of capacity, officials said.

BHT coordinates and manages health care in a six-county region of Eastern Washington, as part of the state Health Care Authority. Among its chief goals has been improving the coordination among the behavioral health and physical health services.

Lutz cites similar estimates, and notes that it’s part of a “national resource deficit” in behavioral health care, which includes addiction treatment and mental health services.

“You’ve got a huge gap between those in treatment and those who need treatment,” Lutz said this past week. “We just don’t have enough resources nationally, regionally and locally to meet the need.”

Statewide, too, the challenges of the opioid epidemic – in concert with persistent alcohol addiction and a resurgent meth problem – are testing the health care system’s ability to keep up, though the differences among communities can be great.

Michael Langer, deputy director of behavioral health and recovery within the state Health Care Authority, which administers a range of state and federal health care programs, said the HCA has been working to address the gap in resources and improve access to behavioral health care in a number of ways.

State and local officials are working to bring behavioral health care more into the realm of the primary care doctor. That includes making it easier to coordinate and refer among providers and allowing more doctors to directly prescribe the medications used in so-called medication-assisted treatment, such as methadone or buprenorphine, that show promise with opioid addiction.

Langer said another recent change has been decoupling medication-assisted treatment prescriptions from a requirement for regular counseling. That has increased the number of addicts who can get the medication, at least.

People might imagine “treatment” as an inpatient program – particularly as it comes up in the context of homelessness. But a lot of medication-assisted treatment is outpatient, with regular visits to get medicine and other services.

For a homeless person, keeping up with such a program can be extra challenging. Langer said that successful treatment for people living on the streets often depends on the availability of additional resources like stable housing, job training, reliable transportation and other support.

Lutz said he’s disappointed that the challenges of addiction, in relation to homelessness, have been oversimplified in the public dialogue.

“The thing that concerns me is we’re politicizing this issue on the back of those who don’t have the resources to take care of themselves,” he said. “I’d like to say there’s enough treatment for everyone, but the reality is it’s not there for those who can’t afford it.”

Health officials said they’d like to see a community conversation that destigmatizes addiction and mental health, and treats them as the illnesses they are.

“It’s hard to imagine that if you exchange the word ‘cancer’ for ‘mental health’ that we would treat people the same way,” Poulsen said.

Addiction is a serious problem, as is mental illness, and thousands of people in this community are dealing with both. We should keep seeking more ways – and smarter ones – to treat them. Along the way, let’s not kid ourselves about how difficult the problem truly is.