By Tom Horvath, PhD
In the US many individuals who might benefit from addiction treatment never attend. Although there are probably many reasons for this non-attendance, surely one of the primary reasons is the typical rigidity of US treatment programs. In a commentary published in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM), the committee overseeing the development of ASAM’s Engagement and Retention of Nonabstinent Patients in Substance Use Treatment presents a summary of the document. The California Department of Health Care Services funded this project, and it offers a path forward to get more people to seek addiction treatment.
As this commentary states in its abstract:
To improve population outcomes, it is important to reach those who are not engaged in treatment and increase retention of those who do engage in care. To do this, treatment providers must proactively engage individuals in care, including those who are uninterested or ambivalent about treatment, and design services with the intention of increasing patient retention.
They begin by summarizing the relevant statistics. Of the 50 million US individuals with a substance use disorder, less than 15% participate in treatment in any year, and only 40% complete a treatment episode (so, 3 million people or fewer).
Their primary recommendation is not to require a commitment to abstinence to enter treatment. Other recommendations include having a welcoming and non-judgmental rather than confrontational approach, considering client retention as an important aspect of services, discharging clients only as a last resort, having a clinical staff that fully supports this harm reduction perspective (that term is included in this article but not emphasized), prioritizing the retention of frontline staff, and reaching out to individuals who are not currently seeking treatment.
We need to remain aware that perhaps half of those who resolve an addictive problem do so on their own, without treatment or a mutual help group. However, if treatment were more appealing and more people entered it, we might significantly improve outcomes, without necessarily having everyone in treatment (a prospect that seems highly unlikely). We also need to consider that “reaching out to individuals not currently seeking treatment” is going to be a low priority in a for-profit oriented, private healthcare system. Such outreach would be much more likely with a national health service.
It is encouraging that ASAM and other organizations are finally endorsing ideas that Practical Recovery, established in 1985, adopted very early in its existence (as did other outlier organizations and individuals). It is unfortunate that these changes have taken so long in mainstream addiction treatment, but better late than never.
Liked this article on how to get more people to seek addiction treatment? You might also be interested in: How to be Unpopular in the Addiction Treatment Industry.
Sources:
Boyle, MP, Gibson, E, Lien, J, Manages, S, Mohr, S, Ryan, C, Tsai, G. Clinical Considerations for Engagement and Retention of Nonabstinent Patients in Care, Journal of Addiction Medicine ():10.1097/ADM.0000000000001455, February 5, 2025. | DOI: 10.1097/ADM.0000000000001455, https://pubmed.ncbi.nlm.nih.gov/39908483/
