Over the past year, I have blogged and spoken about the need for transformational change in the addiction treatment system. This week, we took a major step towards stimulating that change, by forming a corporate structure for clinical, educational, advocacy and research efforts. ALLTYR™, the name of the organization, has now been incorporated in Minnesota!
There are two major areas of activity. The first is to develop a model for 21st Century specialty addition treatment. Built on a foundation of science, compassion and common sense, the ALLTYR™ Clinic will provide medically based, multidisciplinary evaluation and treatment for the entire spectrum of substance use disorders. The Clinic will use the ASSET™ Model of care. ASSET™ stands for Alcohol and Substance Use Screening, Evaluation and Treatment. We will provide comprehensive evaluations with recommendations for any indicated treatment. The ASSET Clinic will have several areas of specific expertise, including impaired professionals and executives, managing patients with brain injuries, complex chronic pain management, patients with serious medical problems such as cirrhosis and pancreatitis, patients with treatment-resistant alcohol or drug addiction and patients with complex mixes of psychiatric, medical and addictive disorders. The planned opening for the ASSET Clinic is Fall 2011, although we may be able to start accepting patients sooner.
The second focus for ALLTYR will be to help existing healthcare organizations address substance use throughout their system of care. Most people who drink too much or use other psychoactive drugs are not addicted, but are “at-risk” users. That is, they are using at a level that places them at elevated risk for developing problems later. They are currently not symptomatic. For example, someone drinking 4 or 5 drinks several days a week, or using marijuana several times a week, but who does not endorse any criteria for substance dependence. For this group, who do not have a diagnosable disorder, the goal is to counsel them about their use, so as to reduce the risk. They are similar to people with high cholesterol before a heart attack, or high blood pressure before a stroke. Treatment is not appropriate for them. This group is quite responsive to brief counseling, either by health care clinicians or on the internet, by workplace health initiatives, and so forth. When I was at NIH, we developed a product specifically for at-risk drinkers called Rethinking Drinking.
The second group are people who have some symptoms of alcohol addiction (or dependence, these are interchangeable terms) but who are functional. This group primarily endorses symptoms such as repeatedly going over limits, a persistent desire to quit or cut down, and use despite physical or psychological problems caused or exacerbated by their use, such as hangover, nausea, or insomnia. They do not have the kind of problems we usually associate with addiction such as major life disruptions involving employment, parenting, school performance, or serious interpersonal or legal problems. This group, called functional alcohol dependents, are not appropriate for specialty addiction treatment, but respond well to medications and brief support, much like mild to moderate depression is treated in primary care. Both of these groups are best dealt with in non-addiction specialty settings such as primary care or mental health care (general psychiatry).
For these groups, ALLTYR will provide consultation and training for existing health care systems. The goal is to help them address substance use throughout their healthcare system. For too long it has been considered forbidden for anyone but an addiction counselor to address substance use, which is why so few people now receive any risk reduction or treatment. Attending to substance use needs to be brought back into the mainstream of health care, including mental health care.
I am very excited about this next step in my new venture: making scientifically based addiction treatment available to the public in ways that are attractive, accessible, affordable and effective.