How to bolster the addiction-treatment workforce

With millions of Americans suffering from addiction, and an overwhelming number of addiction-related deaths, National Addiction Treatment Week, Oct. 21-27, seeks to educate on which evidence-based treatments are available, that addiction is a disease, and that recovery is possible. This week also highlights the real and ever-growing need for clinicians to go into addiction medicine.

During the last 20 years, I’ve had the privilege of managing the delivery of addiction treatment services in two vastly different settings — first within the public health sector, and currently for a large, private multi-hospital health system. In each setting, I experienced challenges with the availability and recruitment of a credentialed and experienced workforce. These challenges pose a real threat to effectively improving access to addiction treatment. 

For the last six years, I’ve led the only addiction hospital owned and operated by Ascension Health — Ascension Brighton Center for Recovery (ABCR). Operating as the nation’s second oldest addiction hospital, ABCR receives payment, as an acute-care hospital, through a wide range of commercial insurers, as well as through federal insurance programs like Medicare. Nationally, however, facilities such as this are rare — resulting in too few well-paid career opportunities for inspiring treatment professionals. But this trend is reversing. States, counties, health systems and payers have been re-evaluating how they are currently positioned to address the addiction epidemic, resulting in the construction of new treatment facilities and channels for funding care.

Across the U.S., the largest portion of treatment infrastructure — residential and outpatient treatment facilities and programs, recovery housing, support groups, etc. — operates outside the funding channel that supports acute-care hospitals. Correspondingly, a majority of patients receive treatment services in the public sector. For a decade, I led programs such as this in the city of Detroit. Funded through federal block grants and Medicaid, programs across the country like the ones I led often work within tight budgets. The low reimbursement rates realized by many of these programs make it difficult to recruit and retain experienced treatment clinicians and medical personnel. 

Thus, nationally, given the ever-growing need for addiction treatment, we now have an insufficient workforce of well-educated, highly-trained, and experienced addiction treatment professionals. This in turn leaves many treatment programs, private and public, vulnerable to staff turnover and related swings in bed availability and thereby access to care.

Closing gaps in the addiction treatment workforce starts with valuing all persons struggling with addiction, and those providing care — regardless of the treatment setting. We must grow the workforce to improve access to care. I urge you to ask your member of Congress to cosponsor the AHA-supported Opioid Workforce Act (HR 3414), bipartisan legislation to reduce the nation’s shortage of opioid treatment providers by increasing the number of resident physician slots in hospitals with programs focused on substance use disorder treatment. This legislation would help address existing shortages by adding 1,000 Medicare-funded training positions in approved residency programs in addiction medicine, addiction psychiatry or pain management. 

We all have a role in improving access to treatment for substance use disorders. Together we can reduce stigma, educate others on the value and effectiveness of addiction treatment, and ultimately improve the lives of individuals with substance use disorders. But to do so, we need to work together to bolster the workforce that provides the treatment. 

Raymond Waller is hospital administrator at Ascension Brighton Center for Recovery in Brighton, Michigan, and the 2020 Chair of the American Hospital Association’s Behavioral Health Council.