You have talked about the nation needing a commitment to addiction research similar to the Cancer Moonshot currently being led by Joe Biden. Can you explain why such a commitment is necessary?
I think what I should say is that we need a “Mars Shot.” I am saying that to point out the slow pace of improvements in clinical care in behavioral health. We are several decades behind most other diseases in both research and improvement of our care strategies. I came to Carrier after 15 years on the acute care side of things at AtlantiCare. I see the lack of research, science and clinical trials available in behavioral health. We are still using tools from 20 years ago.
Why is addiction medicine treated differently than other areas of medicine?
Prior to Prohibition, we did consider addiction to be a brain disease. Then Prohibition introduced the concept of “willfulness.” And later we had a strong dose of “Just Say No.” That thinking hurt us in philanthropy and in research dollars. We are still recovering from the stigma 80 years later. In the drug and alcohol field, we accept that there will be multiple relapses. In what other disease would multiple relapses be accepted? We expect that if you go in for heart surgery you will get better and go back to your normal life. Because I was acutely aware of the lack of science, we have multiple clinical trials at Carrier. They include the FDA-approved Nexalin device, which creates a frequency waveform that affects key brain structures involved in resetting the hypothalamus function to decrease relapse potential in early recovery. We are researching wearable devices that can identify when the person in recovery is getting into risky situations. Psychosocial treatment is not enough for everyone. We also are working with Press Ganey to identify more of the science behind compassion so that we can hire, train and treat more effectively.
What do you think about Gov. Christie’s plan to limit initial opioid prescriptions to five-day supplies?
I want to say that we are very proud the governor has taken a stand for patients who have been marginalized and stigmatized. The governor also wants to create more beds for patients in need of addiction services. That’s great. We absolutely need more beds. I am not sure whether there ought to be five or seven day limits in prescribing opioids. I don’t think a law should be a substitute completely for clinical judgment. I am very pleased the Governor wants people to be insured during acute episodes when they need care. You want to treat people when they are ready for treatment. We’ve got to get better at delivering the right level of care at the right time and at the right price. We don’t want the cost of behavioral health treatment to create an undue burden on insurance premiums and on the overall cost of healthcare.
How will possible changes in the health insurance landscape affect addiction treatment for people in New Jersey?
A long-standing Federal regulation called the IMD exclusion does not allow Medicaid to be used for private community-based alcohol and addiction residential facilities, such as ours. Every day we turn people away because Medicaid covers them. This is true even though we are willing to accept what Medicaid pays. Governor Christie has asked Medicaid for a waiver to the IMD exclusion, which would give more treatment options to people covered by Medicaid. And as we add beds I hope we can add detox beds for people covered by Medicare. As we restrict opioid prescribing, I foresee elderly people who have been treated for pain for years with opioids seeking detoxification and treatment. But elderly people often can be more difficult to treat because they have co-morbidities and take more medicines. At Carrier, we only have four federally approved beds certified to treat Medicare patients. I believe the total number in the state is quite low and not enough to treat the future demand.
Can you tell us what prompted you to seek a career in addiction medicine? What was your path?
Early in my career I ran a detention center and a shelter and I saw a lot of addicted kids. My first wife died of acute alcoholism. I had personal experience and professional experience that guided me in the addiction field. About 20 years ago, I moved over to acute care where I worked at AtlantiCare. When I retired from AtlantiCare I wanted an encore career and an opportunity to have significant impact. I have been able to bring my experience in acute care to bear on my work in behavioral health today. I am happy to be able to return to my “roots” as a Clinical Social Worker.