Abstract
The addiction crisis is pervasive and is certainly intensifying due to COVID-19—up by as much as 42 percent 1 in May compared with last year. Alcohol use is up significantly, 2 and many who were in recovery have had relapses. We do not know the full implications at this time, but I can say anecdotally that there is a big increase in those suffering from substance use disorder and/or mental health issues.
Family gatherings have been postponed and casual outings with friends canceled. Not only has access to treatment and recovery supports become more difficult to access, but physical distancing is also intensifying the existing isolation those addicted already feel, due to the stigma unjustly associated with this illness. Add, COVID-related unemployment is anticipated to lead to millions more people becoming uninsured, which will make it more difficult for people with substance use disorders (SUDs) to access treatment. With an opioid-related death occurring every 11 minutes, the opioid epidemic is devastating and just getting worse. Sadly, the pandemic will have a lasting, tragic impact on many.
For many, this addiction crisis is something that happens to other people. For me, it is personal. My son Brian’s struggle with addiction began in high school. Over 8 years, Brian battled his disease courageously, attending 8 different treatment programs. On October 20, 2011, I was awakened in the middle of the night and told my son had just died. Perhaps more tragic, it was not addiction that took my son’s life. On his last day alive, Brian researched suicide notes, wrote one of his own, lit a candle, and took his life. Alone.
When you lose a child, you spend countless hours revisiting what you could have done differently—the moments that may have made the difference. Shatterproof, like so many other philanthropic organizations, was born from profound loss and pain. For me, dedicating the remainder of my life to helping others avoid the tragedy my family had suffered started as a tribute to my son’s life and has now grown to be a tribute to millions of Americans.
And while our nation has responded to the addiction epidemic—changing prescribing practices for dangerous opioid, increasing funding for treatment and expanding the use of naloxone, a medication that can instantly reverse an overdose, there are 3 areas Shatterproof is focused—transforming addiction treatment, ending the stigma around addiction, and educating and empowering our communities.
The true key to ultimate change that must occur lies in changing the way that people think about this disease. It lies in addressing and eliminating the stigma that causes so much shame, loneliness, and ultimately, so much tragedy. In many respects, the work we are doing at Shatterproof is needed more today during the pandemic than ever before.
Transforming Addiction Treatment
We are transforming the healthcare delivery system so that every person facing addiction has access to quality care and treatment based on science, just like any other disease.
Shatterproof formed the Substance Use Disorder Treatment Task Force, with a mission to completely transform the addiction treatment system in the United States. With advice from members of the Task Force, our team developed a 5-point plan to achieve our mission to significantly improve the quality of and access to addiction treatment.
The 5-Point Plan
National Principles of Care©
Shatterproof partnered with Pew Charitable Trusts and other leading experts and established a national standard of quality care for addiction treatment that is being widely and consistently adopted by health care practitioners and payers. To date, 23 insurers representing over two hundred million Americans have adopted our Principles of Care. We are just getting started. With your ongoing support, these Principles of Care will be fully integrated into our healthcare system over the coming years.
Eight National Principles of Care to look for when seeking addiction treatment: Routine screenings in every medical setting A personal plan for every patient Fast access to treatment Long-term disease management Coordinated care for every illness Behavioral healthcare from legitimate providers Medications for addiction treatment Recovery support services beyond medical care
Addiction treatment needs assessment
Shatterproof, in partnership with the American Society of Addiction Medicine (ASAM) and Open Beds, developed the Addiction Treatment Needs Assessment, a free, web-based, confidential resource which provides a user-friendly assessment that directs families toward the appropriate type of care based on scientific evidence.
This groundbreaking, easy-to-use assessment cuts through the clutter of predatory marketing by high-cost treatment centers and will help save countless lives. Thanks to Shatterproof and our partners, those seeking treatment now have access to evidence-based resources informed by patient needs and outcomes.
This resource, derived from the ASAM Co-Triage tool used by clinicians, launched in June 2020 and is now available at www.shatterproof.org/addictionassessment and at recovertogether.withgoogle.com/treatment/.
Quality measurement of treatment providers; ATLAS®
Well-supported scientific research has proven that those with a substance use disorder can be effectively treated, with relapse rates no higher than those for other chronic illnesses such as diabetes, asthma, and hypertension.
However, our healthcare system has never ensured adherence to a standard set of treatment quality measures. Responding to this critical void, Shatterproof created and launched in July 2020 our nation’s first quality measurement system for addiction treatment.
ATLAS will help to transform the treatment system in the United States by delivering valuable information to states, health insurers and treatment facilities to enable data-driven and continuous quality improvement.
Equally important, ATLAS is already helping those searching for treatment for themselves or a loved one locate addiction treatment facilities that provide evidence based high-quality care.
ATLAS has been piloted in 6 states: Delaware, Louisiana, Massachusetts, New York, North Carolina and West Virginia and will be growing to more states this coming year.
Visit www.TreatmentATLAS.org to learn more.
Payment reform
Shatterproof has been successful in informing policy changes that improve access to science-based addiction treatment and enable lasting recovery. Our current work includes the adoption of payment models (e.g. the Collaborative Care Model) that incentivize primary care treatment for Medicaid beneficiaries and will expand treatment access in primary care settings.
Treatment capacity
Currently only approximately one-third of all medical schools provide clinical didactic training of both recognition and treatment of substance use disorder (SUD). Shatterproof is the leading voice in our country to correct this and ensure that all healthcare professionals are properly educated.
Ending the Stigma of Addiction
The true key to ultimate change that must occur lies in changing the way that people think about this disease. It lies in addressing and eliminating the stigma that causes so much shame, loneliness, and ultimately, so much tragedy.
Shatterproof identified 9 commonly cited drivers of the opioid epidemic, 7 of which are either partially or entirely driven by stigma. However, addiction-related stigma is not being addressed nationally and thus creating a massive gap in the nation’s response to the epidemic—a gap that Shatterproof and our partners will close.
We are leading the mobilization of organizations throughout the country to implement evidenced-informed actions to address this underlying cause of this mounting public health crisis. These actions will address the discrimination and negative public attitudes and behaviors toward those with addiction that have been a critical barrier to treatment and recovery for millions of Americans.
Shatterproof has exhaustedly researched case studies and data from effective social-change movements, including those related to HIV/AIDS, marriage equality, and mental health, to create a comprehensive national strategy to engage people and institutions across our country in transforming how our society views the disease of addiction. Our research suggests that the stigma unjustly associated with this disease can be significantly reduced. And we built a plan to do so.
The Movement to End Addiction Stigma has been created for those who are looking to learn how to best affect change to confront the pervasive stigma in this crisis. It includes a conceptual framework for combatting addiction stigma—and numerous, practical suggestions on how to impart that change.
The strategy addresses 4 key areas of stigma along with intersectional stigma: Public stigma also known as social stigma and related to society’s attitudes toward a group of people Structural stigma occurring at the systems level through policies and practices Self-stigma referring to the process by which “stigmatized individuals accept societal stereotypes and consequently experience reduced self-esteem and self-efficacy”; and, Stigma against medications for opioid use disorder (“MOUD”) which has limited the use of evidence-based treatment.
As the central coordinating body, Shatterproof will address stigma by partnering with stakeholders within 6 segments of our society that will have the largest impact on ending addiction stigma—employers, healthcare, government, criminal justice, media and entertainment and local communities.
People with lived experience will be critical across each of these systems and play a variety of roles in the delivery of this work. Evidence-informed, implementable Action Plans tailored to each stakeholder systems will include 2 components: 1) Action items which are specific activities focused on educating with contact-based strategies, adjusting language, and eliminating harmful policies; and, 2) Implementation tools with “off-the-shelf” content to easily incorporate action items into their organization. These will include online education, language materials and prototypes for policy change.
In just a few months since finishing our Business Plan, Shatterproof has already solidified numerous partnerships and its Movement to End Addiction Stigma began in September with the launch of its state-based campaign, Life Unites Us, in the state of Pennsylvania.
Maybe you’re someone who is coping with addiction, or maybe you have a family member who is. Maybe you are a provider looking to improve the care you deliver, or maybe you’re the CEO of a large company. Maybe you are someone who simply wants to help save lives. No matter who you are, this movement is built for you.
Supporting and Empowering Our Communities
We are providing science-based educational resources that aid in the prevention, treatment and recovery of addiction, while building hope, confidence and resiliency within our families and communities.
Research shows that the general public is often unaware of or misinformed about the basic facts of addiction. Lack of knowledge and misconceptions can perpetuate stigma and prevent people from seeking help for themselves or loved ones.
To address this gap, Shatterproof developed a digital education program, Just Five, curated to be highly effective for all audiences. Just Five is an online, self-paced, mobile-enabled program focused on increasing awareness, reducing stigma, and sharing information and resources about addiction prevention and treatment. Through the Just Five program, Shatterproof partners with companies to provide life-saving education to their employees and communities.
Since its launch in fall 2019, more than 20 businesses, representing more than 300,000 employees, have committed to the program. Partner companies include JP Morgan Chase, GE, Optum Behavioral Health, and several other large employers.
Additionally, Hazelden Betty Ford has also recently partnered with Shatterproof to provide this resource to thousands of individuals and families using their helpline.
I often think about my son’s last visit home, 4 months before he died. His last night at our house, we were sitting on the back porch talking, and the conversation turned to his addiction and stigma. Brian looked at me and said, “Dad, I wish that someday…someday people would understand that I’m not a bad person. I am a good person with a bad disease. And Dad, I am trying my hardest to be a good son.”
It’s too late to bring my son back. But it’s certainly not too late to save the next son, daughter, brother, or sister who suffers from addiction and has so much love to bring to their family.
It is time that addiction become a national conversation and safe to discuss at work, in the community and around the kitchen table, because telling our stories, honestly and without shame, is one of the most powerful ways to change hearts and minds. Breaking down the stigma, especially in the face of the COVID-19 pandemic, will open the opportunities for more people to seek quality treatment and create hope in a very dark world of despair.