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Alan Johnson, the president of the Hina Mauka addiction treatment center, sees an increase in patients and more complex conditions.
Q: How has the problem of substance abuse in Hawaii evolved?
Johnson: The number of people wanting formal residential and outpatient treatment has been steadily increasing. The stigma is decreasing so more people are coming forward; mostly, more family members encourage their loved ones to get help.
What is changing is that people are having more chronic conditions. Hina Mauka has evolved its programs to treat multiple chronic conditions — a combination of chronic substance-use disorders and mental health disorders (depression, anxiety, PTSD), coupled with physical conditions (diabetes, pain issues, heart and liver disease, COPD, arthritis and more). We still need more support for higher qualified medical staff because high utilizers of health care, who suffer greatly from their conditions, struggle with recovery, often leading to dangerous relapses. We need integrated treatment.
Outpatient is less serious, yet still enough to warrant evidence-based practices for treatment. At Hina Mauka, about two-thirds of people with substance-use disorders start as outpatient, while one-third qualify for residential treatment, which is by far the most effective treatment for chronic conditions.
Hina Mauka also is one of a few agencies that provide treatment and prevention for kids within the schools. It is highly successful and well worth the small state resources used to support this effective treatment and engage prevention. Kudos to the state for granting funding for treatment in every public high and middle school in the state. We hope it continues its support.
How has substance abuse treatment changed over the years?
Nationally standardized screening and assessment tools provided by a qualified professional can readily determine the need for effective treatment and at what level: residential or outpatient. There are only a few evidence-based treatment agencies around.
People and their families should know to seek a screening and learn how treatment can help.
Heavy users with low behavior functioning often need residential treatment before transitioning to outpatient. Because they have a chronic condition with relapses just like other chronic illnesses, complex patients need support after treatment to achieve the only proven outcome: abstinence. However, for those challenged with abstinence, such as the chronic homeless or people with severe multiple conditions, case management can help for a few years to develop a “process of consistently pursuing abstinence.”
Heavy users with high functioning need abstinent-based treatment (science says this is most effective) and can start at residential or outpatient depending on criteria. Some patients do well with non-abstinent recovery, provided they can have “controlled use” and function well with interpersonal relationships, behavior controls and emotional responding. Limited case management can help with this too, if needed.
For moderate to mild use, the numbers are huge — maybe 30% of our population — and non-abstinent-based recovery is best. Primary care can provide medications to help, especially with alcohol and opioids, though counseling and medications are best. Preventive treatment doesn’t have to be complex for this group, since it can take a lot of resources for large numbers. Treatment and prevention in schools are golden.
How will better analytics help tackle substance abuse problems?
The 2016 Surgeon General report indicated that substance use disorders cost about $500 billion a year. We won’t know the full impact and how to better address it until we start gathering historical data for each significant illness about any misuse of alcohol, prescriptions, opioids and illegal drugs. Then we would know what the impact to Hawaii is, and if it is as big as the federal reports suggest.
So many people could benefit from learning “how much is too much.” Also, we could inform policymakers about the magnitude of the problem, and the worth of investing in cost-effective solutions, especially science-based ones with demonstrable outcomes.
What more can be done to encourage people to get the right kind of treatment they need?
No one starts out wanting to have a problem with alcohol and substances. No one wants debilitating depression and anxiety, and, especially, no one wants physical trauma in their life. Yet these are very real illnesses, and large numbers of people have conditions that could be treated. Suffering could be abated, and recovery can be real for many.
Generally, people need encouragement from family and friends to seek treatment, because often they don’t choose to help themselves. For providers and state systems, we need more complex solutions, using evidence- based treatments, including case management, to help them “pursue abstinence” or, if less severe, help with “controlled use” with high-functioning goals so that people can see that recovery can be possible for them, too.
We need state and insurer resources to help our community prosper, including for those who are the most vulnerable and most severely affected.
How does Hina Mauka fit in with the state’s efforts to treat residents with substance abuse problems?
Hina Mauka leads the way in Hawaii with complex treatment solutions for people with complex problems. Often complex patients are uninsured or underinsured. Sometimes the state is challenged with diminishing resources such that they choose less-expensive solutions that are less effective. It may look good in the short run, but eventually the state returns to evidence- based practices that research has proven works.
Let’s hope that we stay the course to provide complex residential treatments with supporting longer-term case management to “pursue abstinence” for the low functioning, and that the best recovery model with demonstrable outcomes is encouraged for those in need.
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The bio file
>> Position: President and CEO, Hina Mauka
>> Previous experience: With Hina Mauka for over 25 years. That’s a lot of previous experience.
>> Personal background: Family is a loving wife who works in the field as a licensed counselor; my amazing step-kids, including a local doctor and a daughter with a successful retail company. Like most everyone, I have family who needed help. I find calmness in the practice of silence, and I really, really enjoy grandkids.
>> One more thing: I love being in service to others and am grateful to be the chairman of the Hawaii Substance Abuse Coalition, which supports our field.
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