Panel Spreads Recommendations to Key Players to Lower Barriers to Substance Abuse Treatment

Combating stigma and vying for insurance coverage continue to be major tasks for those involved in substance abuse and addiction treatment, and a new panel of professionals from this field recently organized efforts to confront these issues. The Join Together National Policy Panel on Addiction Treatment and Recovery, which consists of state representatives, leaders of mental and public health organizations, and legal groups, recently came up with six recommendations for changing the status of addictions treatment.

The addiction panel is a recent project instigated by Join Together, a national resource for communities fighting substance abuse and gun violence. It is funded primarily by the Robert Wood Johnson Foundation through a grant to the Boston University School of Public Health.

The panel held hearings in Baltimore, Chicago, Detroit, and Portland, Maine, throughout 1997 to learn about substance abuse treatment needs and proposals for meeting them. Panel Chair Robert E. McAfee, M.D., said officials from every level of government, people in recovery, judges, police officers, and representatives of health care organizations and treatment programs reported that the need for treatment is not being met.

Reports from the panel were distributed this year to all state legislators, members of Congress, and the public health community, said McAfee. "We hope to help people understand the barriers to and crisis over treatment."

McAfee, a former president of the AMA, said that over time, the panel's recommendations will influence the public and business community, and stimulate education and research that are "independent of the financial bottom line."

According to the report, 4 million persons dependent on alcohol and other drugs are searching for care in public and private systems that seldom connect to the health care and supporting systems that researchers say can reduce symptoms and return people to families, jobs, and communities. About a million people seeking care in the public system can find no openings.

The panel's recommendations for improving treatment include the following:

• Treatment for alcoholism and other drug addiction must be covered as a health insurance benefit on an equal basis with treatment for other diseases.



• Limited access to treatment for alcoholism and drug addiction is a national crisis that calls for a broad-based, national campaign to educate the public and build political support.



• Research on the nature and treatment of addiction and recovery should be expanded. The results should be made more promptly and easily accessible to professionals, policymakers, and the public.



• Education and training on the nature of addiction and recovery should be required for all health, mental health, social service, and justice system professionals.



• Treatment for alcoholism and drug addiction must be monitored by independent treatment managers with no vested financial interests in order to ensure ongoing treatment effectiveness.



• Diagnosis, treatment, and long-term recovery must be integrated into a coordinated, communitywide strategy to reduce alcohol and other drug problems. This strategy should encompass economic development, health and mental health care, the justice system, and other key institutions.

The recommendations, said McAfee, offer a foundation on which communities can fashion their own local strategies for overcoming substance abuse. These community strategies, he noted, are the base for changing the way policymakers approach substance abuse treatment and related services at the local, state, and national levels.

One way that Join Together has been able to spread the word about the recommendations of the Panel on Treatment and Recovery has been through contacting professionals in the substance abuse field in 48 states and suggesting that they do presentations for state legislators. The Bill Moyers television series "Close to Home" on the Public Broadcasting System was a vehicle for this effort. Join Together's contacts set up meetings with legislators in state capitols in which they showed a clip from the series and presented their concerns about substance abuse treatment in their districts. Mental health professionals, the corporate sector, people in the community, and those in treatment spoke about the necessity of adapting current policy to address needs in their districts as well as new scientific knowledge.

The need for better coverage for substance abuse has been addressed within the AMA and the Clinton Administration, said McAfee, but there is a long way to go toward making that coverage a reality. His panel recognizes the need for a combined and sustained effort to change substance abuse treatment.

The National Alliance for Research on Schizophrenia and Depression (NARSAD) gave a record $16.8 million in research grants for 1998, the organization announced March 30.

This includes funding for 146 new grants and 159 continuing grants. Of these, 16 went to "distinguished investigators," that is, experienced researchers with established track records, while 130 went to "young investigators" in the early stages of their research careers.

The topics funded for established researchers ranged from genetic studies of bipolar disorder to a pilot magnetic resonance imaging study of the children of schizophrenic patients.

Among young scientists, topics funded ranged from the relatively unconventional, for example, an investigation of how the herb ginkgo biloba affects treated schizophrenic patients to the elaboration of a process-oriented model of dysfunction in schizophrenia.

"NARSAD is doing phenomenally in terms of raising money," remarked Herbert Pardes, M.D., president of NARSAD's Scientific Council and dean of Columbia University's College of Physicians and Surgeons.

He credited Constance Lieber, president of NARSAD's board of directors, for much of this success. NARSAD has successfully used "a variety of techniques to make it happen," said Pardes, who is a former president of APA. The sense that NARSAD continues to reach both "forward and higher" has created excitement that generates financial contributions and loyalty, he observed.

Those who have contributed to NARSAD have been able to see that their donations are advancing research on the frontiers of brain science and behavior, he noted.

Samuel Guze, M.D., chair of APA's Council on Research, spoke with Psychiatric News about NARSAD's grant record.

"I think NARSAD has unquestionably been one of the great developments for the future of psychiatric research," said Guze. "I have tremendous admiration and respect for the lay board of directors of NARSAD and especially for Connie Lieber. She has been unexcelled in her devotion, know-how, and commitment of time and energy to the crucial goal of evolving an important nongovernmental source of funds. This complements the funds available from the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Mental Health, and the National Institute on Drug Abuse, so we can really make sure that good people and good work are supported."

Although dwarfed in size by the federal agencies, "in terms of commitment of energy, time, and resources, NARSAD is without parallel," Guze added.

NARSAD is the largest private international philanthropic organization supported by public contributions that is devoted to funding for basic research on schizophrenia, depression, and related severe psychiatric disorders.

NARSAD also seeks and has received restricted grants for administration and fund-raising so that 100 percent of contributions earmarked for research go directly to research grants.

Since its inception, NARSAD has funded 885 scientists at 130 institutions.