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Recovery is a Marathon, Not a Sprint: Extended Care in Emerging Adult Populations

Recovery is a Marathon, Not a Sprint: Extended Care in Emerging Adult Populations

When we talk about reoccurrence of use in emerging adult populations, the stats paint a very grim picture. It’s easy to feel hopeless and think that desperate families are just trying to hit the proverbial lottery and wind up with the kid who makes it. The reality is far from as bleak, but equally troubling. The reality is we don’t have an issue with the quality of our best continuums of care. What we have, is an issue with the majority of American families’ ability to access those continuums of care. Quality extended care has simply been inaccessible to the majority. Consequently, we see financially distressed families being forced to cut corners and skip entire levels of care. Unsurprisingly, success rates drop dramatically when emerging adults don’t actually receive treatment and are instead forced from one chaotic situation into another along a bootleg pseudo treatment continuum. If I asked you, “Do you think young adults do better receiving medical detox followed by one to four months of residential or wilderness treatment, followed by a 1 month transitional step-down period, followed by six months of transitional living in a recovery residence; the first three months of which they are concurrently attending an intensive outpatient program and the last 3 months of which they are attending aftercare services, and during that time, they will be integrated into a collegiate recovery community which will provide low-level subacute care support services for the next four to six years? Or—do you think they will do better going to detox, skipping treatment all together and moving directly into a ‘halfway house’ with immediate pressure to find employment less than 5 days after they were actively using drugs and alcohol?” The question is so ludicrous; it sounds like a strawman argument. Which brings us to our problem. People who don’t actually receive treatment along a continuum of care aren’t failing because they “weren’t ready” or because “treatment doesn’t work.” People are failing because we, as a cluster of industries and as a society, have failed to provide them access to continuums of care that provide support and clinical care for an appropriate period of time. We simply do not have this issue with the treatment of other diseases. The insurance industry doesn’t cover only one quarter of a round of chemo for a cancer patient and no oncologist has ever said “I guess they just weren’t ready,” when a patient’s cancer came out of remission.

If we want people to actually succeed in recovery, we’re going to need to actually set them up for success. If we know that families do better working with an education consultant or an interventionist over the first year, we need to develop systems to make that available to as many people as possible. If we know young adults with substance use disorders do better with a solid foundation in wilderness or residential treatment (also referred to as “not less than 1 mile from your drug dealer at too low a level of care to have a prayer of making it treatment”) we need to make sure that too is available. If we know young adults have an order of magnitude higher success rate in long term extended care models than they do in their mother’s basement that they were using drugs in a couple of weeks ago, our system needs to account for that as well. If we know that young adults who attend a collegiate recovery program and concurrently see an outpatient therapist maintain their recovery at astronomically higher rates than their peers who don’t have access to those supports, it is our moral responsibility to build and maintain systems that support them in succeeding. If we know entire communities have higher success rates when recovery high schools and recovery community organizations are accessible, as opposed to the communities which don’t offer these services, then we need to build the pieces that are missing. And here’s the thing, we do know all of these things. This is not a matter of lacking the knowledge. This is a matter of lacking the heart to charge a broken and dysfunctional system which sends emerging adults to the morgue or prison more frequently than it sends them to the comprehensive continuums of care that can and do actually get people better every single day that they have access to them.

Andrew Burki outcome based reimbursement









Andrew Burki, MSW

CEO, Life of Purpose


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