Building a System of Addiction Treatment, One Addiction at a Time
By: Robert Shearer, MD
Doctor, Middle Tennessee Addiction Center
Incorporating TCOM into Addiction Treatment
I discovered the work of Dr Lyons somewhat by accident when I began working with a case management group that belongs to the Tennessee HealthLink program. This program utilizes the Adult Needs and Strengths Assessment. To best communicate with the case workers, I thought I should get certified in ANSA. I used the training videos of the TCOM team and instantly found the utility of the core concepts of Communimetrics and TCOM. These concepts have opened the door to a significant problem I and physicians like me are facing.
I am an addictionologist who focuses on women with an opioid addiction and who receive TennCare insurance. My practice is in an office based opioid treatment (OBOT) facility and uses medication assisted treatment (MAT) and psychosocial support.
The impact of opioid addiction has been devastating to the children and families of Tennessee. It is estimated that,
- 300,000 individuals abuse drugs,
- 80,000 individuals have an addiction,
- 1,600 drug related deaths in 2016,
- 80 % of crimes have a drug-related nexus, and
- Approximately 1,000 babies are born with neonatal abstinence per year.
Families are in disruption.
- Parents are incapacitated by drug use, incarceration, or dead from overdose
- Grandparents are raising children again
- Foster care system is overwhelmed – 8,000 currently in foster care
Communities are in crisis.
- Loss of industry/jobs
- Disruption of local social fabric
What caused the opioid epidemic-
A series of events occurred in early 2000 which created the perfect storm. First, pain pills became stronger impacting the neurobiology of the brain significantly. Second, pressure was placed on physicians to treat pain as one would treat an abnormal vital sign. And third, pain clinics opened to better treat pain but just made patients more addicted to the opioids being prescribed.
By 2013- 2014 there were 333 pain clinics in Tennessee alone and more than 8.5 million prescriptions were written for pills such as oxycodone, hydrocodone, and oxymorphone. The United States is the leading producer of oxycodone in the world and this placed Tennessee as one of the leading users of oxycodone in the world.
Treatment of Opioid Addiction-
Opioid addiction is a chronic condition that does not respond to short term treatment. It requires long term recovery-oriented services. The occurrence of withdrawal from opioids is so severe that relapse is typical in an individual who tries to maintain abstinence. It is for this reason that medication is used as a maintenance treatment to prevent withdrawal, maintain engagement, and allow the individual to build on strengths and address needs. This life course perspective is changing the treatment concept from a short stay and discharge to a more integrated long-term recovery.
To quote William White and John Kelly from Addiction Recovery Management “the call is to extend the design of addiction treatment from a model of acute biopsychosocial stabilization to a model of sustained recovery management that is comparable to how other chronic primary health disorders are effectively managed”. Recovery over a lifetime must be maintained but to do so requires a quality of care and an engagement in treatment.
Hser and Anglin, also featured in Addiction Recovery Management, states “while the vision and goals for sustained recovery are admirable, these concepts and procedures need to be operationalized and strategically developed…if addiction treatment providers are to be held accountable for improved quality of life of their patients, what are the mechanisms and resources for service providers to achieve such performance goals?”
Communimetrics and Transformational Collaborative Outcomes Management (TCOM)-
Dr Lyons teaches us that human service enterprises are balanced between the scientific perspective and the business perspective. This correlates with Hser’s and Anglin’s quest for mechanisms and resources to provide long term care for addiction patients.
Dr. Lyons has established a framework for managing complex systems. The Praed Foundation states “within this framework there is a philosophy, a strategy, and a set of tactics all designed to facilitate an effective and integrated approach to addressing the needs of people.”
The conclusion I come to is that TCOM offers the most effective tool to be utilized in sustained recovery management of addiction patients. I hope that others might agree with this concept and a conversation begin to develop a communimetric tool for this purpose.
 Kelly, J. F., & White, W. L. (2011). Addiction Recovery Management Theory, Research and Practice. Totowa, NJ: Humana Press.
 Lyons, JS (2009). Communimetrics: A theory of measurement for human service enterprises. New York: Springer.