By Jason Snyder, Director, Substance Use Disorder Treatment Services, BH Division, RCPA

In September 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a report, “Recovery from Substance Use and Mental Health Problems Among Adults in the United States.”

Although the definition and concept of recovery from addiction have been morphing for some time, the self-reported data contained in the report, coupled with SAMHSA’s definition of recovery, lays out starkly that what is considered recovery today is far different from what it has been considered historically. In some ways, it begs the question, then, “What is the purpose of addiction treatment?” What are the implications for addiction treatment providers, who for decades have operated with a mission of helping their patients stop their use of drugs and alcohol?

Using data from the 2021 National Survey on Drug Use and Health (NSDUH), SAMHSA’s report shows that 70 million adults aged 18 or older perceived that they ever had a substance use or mental health problem. For substance use specifically, of the 29 million adults who perceived that they ever had a substance use problem, 72 percent (or 20.9 million) considered themselves to be in recovery or to have recovered from their drug or alcohol use problem (see SAMHSA’s press release).

Of the 72 percent who considered themselves to be in recovery or to have recovered from their drug or alcohol use problem:

• 65 percent reported using alcohol in the past year;
• 68 percent reported using marijuana in the past year;
• 60 percent reported using cocaine in the past year; and
• 61 percent reported using hallucinogens in the past year.

Curiously, it doesn’t appear that respondents were asked whether they used illicit opioids in the past year.

To the traditional addiction treatment provider and many in the recovery community today, recovery and drug and alcohol use can’t co-exist. One possible but unlikely explanation for the SAMHSA-reported data is that all of the respondents who identified as being in recovery but having used drugs or alcohol in the past year is that their recovery began within the last year. This would presume that their definition of recovery includes abstinence. But this is not likely. Consider SAMHSA’s definition of recovery:

“Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life; and strive to reach their full potential.”

No mention of abstinence from drugs and alcohol. What this means is that for millions of people, recovery can and does include moderated use of drugs and alcohol.

In 2004, SAMHSA’s Center for Substance Abuse Treatment said, “Treatment for substance use disorders is designed to help people stop alcohol or drug use and remain sober and drug free. Recovery is a lifelong process.” Twenty years later, it’s a far different message coming from SAMHSA.

As recently as 2019, the Pennsylvania Certification Board defined recovery as highly individualized, requiring abstinence from all mood and mind-altering substances, and may be supported by using medication that is appropriately prescribed and taken.

Talk about evolution and conflict.

Nora Volkow, director of the National Institute on Drug Abuse, said “Healthcare and society must move beyond this dichotomous, moralistic view of drug use and abstinence and the judgmental attitudes and practices that go with it.”

So what does this mean for addiction treatment providers? What, then, is the purpose of addiction treatment? One managed care organization in Pennsylvania recently talked about the purpose of addiction treatment in much the same way as SAMHSA defines recovery, addressing health, home, purpose, and community. This would seem to mean that providers are now expected to address not only addiction but myriad social determinants of health as well. In fact, it is what payers expect providers to do today.

This is a sea change. The addiction treatment system was not built in this way. This is not to say that it is not evolving or cannot evolve along with the definitions of treatment and recovery. But to do so will require much broader systemic change than philosophical and cultural changes within addiction treatment organizations. Regulation and payment structure must also change to reflect the changing expectations and demands placed on providers.

(shared by the mother of two sons with intellectual & developmental disabilities/autism, Nechel spoke at the Capitol at one of our recent rallies)

My name is Nechel. My education is in art education. I am no doctor, so do your own research, I can only speak from my experiences, and would like to share them with you.

I have two sons, 22/21; both are on the autism spectrum. My 22-year-old was diagnosed at three years and has high functioning Asperger’s with severe generalized anxiety. Secondary diagnoses are sensory integration disorder, OCD, ADHD. My 21-year-old was diagnosed at 11 months old. He actually has two primary diagnoses – severe autism with aggression and ID. Secondary diagnosis – SI, OCD, language delay, ADHD.

Both sons struggled with childhood sicknesses like most do, including allergies, RSV, croup, ear infections, sinus infections, etc. My youngest son suffered more with these illnesses, which exacerbated the aggressive behaviors! He was taking an average of eight antibiotics per year! He has had six sets of ear tubes, tonsillectomy, sinuses were cauterized, but still needed to be on antibiotics several times a year! His health was impacting behaviors and therapies profoundly. I went on a mission to get my sons healthier.

We have tried many therapies and services over the years, both outpatient and in school. We have utilized Occupational Therapy, Speech Therapy, and assistive technology for language including devices such as “Say it Sam,” and Prologue2go. We have explored/accessed BCBA, BSC, TSS, MT, talk, special school programs, social groups, different foods, and therapies such as play, equine, and music. We have been to specialists, and experimented with homeopathic medicine, and many medication trials!!

I have been using all natural items I have researched in determining each boy’s needs. I capsulize several items for ease of dispensing and avoiding sensory issues. The silver tastes like water so I add to drinks. My sons use immune boosting supplements such as a multivitamin, D3, B-complex, Zinc, Magnesium, Probiotics, and Melatonin. For anxiety, one of my sons uses CBD, Bergamot tablet/roll-on, and Valerian root. My 22-year-old son is now off all prescription medications. My 21-year-old has now gone almost five years with no need for antibiotics, and five fewer prescriptions!

Both use natural remedies such as Mullein EO, sovereign silver liquid/nasal spray PRN for allergies. At the onset of any illness symptoms, we use oregano, elderberry, increase D3, increase Zinc, C, and sovereign silver (liquid, spray).

Due to dietary selectiveness, I utilize a vegetable and fruit-based protein powder with probiotics to bake cookies/brownies. Utilize whatever way works for your child. Amazing flavor, several flavor options, with no chalkiness! I replace flour with this product, undetected!

One experience I would like to share is extraordinary. I learned about Red Pine Needle Oil. Several studies on this refer to use in people with autism, Alzheimer’s, and Dementia, in regards to language, mental clarity, and neurological transmitter repair. In the studies I reviewed, EVERY participant showed some type of improvement! So I had nothing to lose! My oldest son, at age 20, had very limited functional language. He spoke in one word responses, and never wrote anything independently. On the second day using red pine needle oil, he spoke independently and clearly, “Pennsylvania polka calendar!” On the fourth day, he said “I love you” to me for the first time ever, independently and clearly! By the second week, he was writing independently, legibly, and spelled “beach hotel!!!” Of course, his favorite place on Earth. Since then, we hear new language all the time. He writes many requests/words!!!

What if we utilized these methods alongside traditional therapies? What if you had a child to work with that was healthier, clearer thinking, lower anxiety, with behaviors lessened? How much more effective would these traditional therapies be?? With this holistic approach, how much more progress could we attain with our amazing children?? Take it day by day! Start with one product and grow it! Don’t forget, you are all warriors!

–Nechel

In June of 2022, Pa House Resolution 212 was adopted, establishing a legislative task force on intellectual disabilities, developmental disabilities, and autism (ID/A), and directing the Joint State Government Commission to study the impact of this Commonwealth’s current delivery of services to individuals with ID/A. The task force is to report its findings and recommendations to the House of Representatives in December of 2023.

The task force is charged with examining the efficiency, uniformity, and best practices of the administration of services through the county system, Quality of Life outcomes, including waiver services, waiting lists, and transitional protocols; and of moving into and out of one waiver or program to another, transitioning out of high school, and how current Federal and State laws and regulations impact and limit supports and services. There are several areas specified in the House Resolution that the task force members are to consider, including:

• Collaborations between the Department of Human Services, managed care organizations, and providers, including reimbursement rate settings, direct support professionals, other funding sources, and how providers collaborate to serve individuals with ID/A.
• Opportunities for integrated job coaching, community participation supports, including for individuals who chose not to go into the community because of underlying issues, and additional programs offered through the Office of Vocational Rehabilitation, or the Employment First Commission.
• Current treatment needs, including network capacity to treat and care for high acuity individuals, individuals with complex medical needs in addition to intellectual disabilities, and individuals who need special care and assistance with intensive behavioral health issues. The study examines all available living settings, including intermediate care facilities, community homes, state centers, services in family homes, Lifesharing, independent living with assistance, farmhouse settings, campus settings, and any other innovative residential services.
• Barriers and obstacles in transportation for individuals living in the home or receiving community-based services for jobs, medical appointments, and peer-to-peer groups.
• Workforce issues with direct support professionals, supports coordinators, behavioral and mental health specialists, or health care practitioners who assist with the provision of services.
• Providers who have ceased operations since the beginning of the COVID-19 pandemic.
• Input from representatives and advocates from all aspects of the sector and continuum of care to assist the Joint State Government Commission with its findings and recommendations in the report.

The task force held its introductory meeting in October to begin the process. Dr. Richard Edley, RCPA President and CEO, has been appointed to serve on the task force. Additionally, RCPA was successful in advocating for members and partners to be assigned; Marian Baldini, President/CEO of KenCrest; Christopher Betts, MA, Executive Director of Devereux Advanced Behavioral Health; Lisa Liston, Coordinator of Special Services and Family Support at Clelian Heights School for Exceptional Children; and Amy Lutz, PhD.

Representative James Struzzi, II, and Representative Eric Nelson, along with Representative Benham and Representative Joseph Hohenstein have also been appointed to serve on the task force.

Additional appointed members include Oscar Drummond, Representative, Pennsylvania Department of Human Services Office of Developmental Programs; Mayme Carter, MSW Director, Bradford County Human Services; Jane Gonzalez, Guardian, Advocate, Mother; Anne M. Couldridge, Executive Director, The Arc of Cumberland & Perry Counties (CPARC); Ryan E. Hyde, MEd, CRC Executive Director – Acting Pennsylvania Department of Labor and Industry Office of Vocational Rehabilitation; G. N. Janes, Chief Executive Officer, Valley Community Services; Daisy V. Shirk, DO, DFAPA Adolescent Psychiatrist Reading Hospital, Honorable Ryan M. Tira Pennsylvania Supreme Court Autism and the Courts Task Force Member; Melissa Watson, PhD, LPC, BCBA, Senior Vice President PAHrtners Deaf Services; Maria Martin, Representative, Pennsylvania Developmental Disabilities Council; Ned Whitehead, Vision For Equality; Edward Yongo, CEO Pathways of Southwest; Pamela Zotynia, Service Director, Participant Directed Services, Values Into Action.

The task force is staffed by Executive Director Glenn J. Pasewicz, Yvonne Llewellyn Hursh, Esquire, Staff Attorney Stephen J. Kramer, Esquire, and Executive Secretary/Office Manager Wendy L. Baker.