Changing the way people think about addiction
When John Purcell was looking for an addiction treatment recovery program in 2009, he likened the online search to walking in a minefield. “There were scams, there were dead ends. I knew I probably needed dual diagnosis care, I knew probably non 12-step. But which facility? Would my insurance cover it? And was it even legitimate? It was my responsibility to find treatment, but there were no resources. There was no way to narrow my search to give myself the absolute best chance. I would call number after number…”
Enter ATLAS, an addiction treatment locator, assessment, and standards platform that helps people search for and compare addiction treatment facilities. The platform is the brainchild of Samantha Arsenault, the vice president of national treatment quality initiatives at Shatterproof, a national nonprofit dedicated to reversing the addiction crisis in the United States (Miraflora endorses Shatterproof’s mission). Purcell’s experience—and those of countless others—was Arsenault’s impetus for founding the ATLAS platform.
“I’ve helped plenty of people look for treatment,” she said on a recent Zoom call from her apartment in New York City. “It’s hard to know what’s going to be good versus what might be fraudulent or even harmful. We see people jeopardize their life’s savings on treatment that isn’t even going to help them. We needed to make it clear, and to create something to help people identify what their needs are.”
The ATLAS platform, which launched on July 21 in six states (Delaware, Louisiana, Massachusetts, North Carolina, New York, West Virginia), is essentially the Yelp of addiction-treatment programs, and it’s the first of its kind. It’s a free one-stop shop that enables users to find programs in their area, get user-generated reviews and objective, validated data about which facilities are using best practices, see what insurance or payment methods are accepted, what groups the facility serves, and the types of treatments that are offered. The program will be offered in four additional states in 2021 and will include all 50 states by 2023.
ATLAS has already garnered huge support in both the recovery and medical community. The U.S. Surgeon General Vice Admiral Dr. Jerome Adams stated that the platform would help ensure quality in addiction treatment and provide data that would eventually spur improvement. “I look forward to hearing about the progress and the contributions this platform will make to our shared aim of high-quality accessible treatment for anyone battling substance use disorder,” Adams said. “In many cases, if it’s not available when someone needs it, it might as well not be there at all.”
To develop ATLAS, Arsenault considered the needs of four groups involved in the process: The end user, i.e. the people who are seeking treatment; addiction-treatment providers; health-insurance providers, who need a way to identify high-performers and align financial incentives with quality; and the states, who needed a standard metric by which to be able to allocate funds appropriately. “A lot of addiction treatment is paid for by the states, and right now they’re allocating that funding with a sledgehammer approach,” Arsenault said. “We’re creating a system that will allow them to make data-driven decisions.”
Arsenault designed it around existing health-care data systems, similar to those like The Leapfrog Group, which evaluates hospitals and makes the data available to the public. “Now hospital CEOs are tied to their letter grades,” Arsenault said. “It created accountability. They started measuring things like C-section rates, and once they did, they went down across the board. We were able to blend best practices with systems like that with a really awesome consumer-facing website.”
Arsenault also hopes ATLAS will incentivize addiction treatment centers to adopt best practices that are proven but are not yet in widespread use. When the opioid crisis hit, for example, the medicines proven to reduce death rates and increase retention in treatment were only used in 30% of the treatment facilities. (The number is only slightly higher now, Arsenault said.) With ATLAS, users can see immediately which facilities offer this treatment, and insurance companies can reward those facilities with coverage. Treatment centers, then, may implement these practices to keep up with demand.
Another example of a best practice that is proven but not widely used is a behavioral therapy called contingency management, which has been shown to help methamphetamine addicts. The therapy uses tangible rewards—like money—to help people stay off the drug. The lack of widespread use of contingency management also points to another major issue that Arsenault and Shatterproof hope to tackle: stigma. “If there is a cash reward for attending addiction treatment meeting, people scoff. ‘You’re going to give that person who’s using drugs money?’ But it’s shown to be effective to help them stay in treatment.”
To that end, Shatterproof is also gearing up to implement an initiative plan to change the way we talk and think about addiction and addicts. Arsenault believes it’s key to dissolve the shame and stigma associated with addiction in order to encourage people to seek treatment early on, which is the most effective way to treat the disease.
“Addiction is a spectrum disease—mild, moderate, and severe,” she said. “Think about it like heart disease. If you have high blood pressure, you make changes to your lifestyle. The same can be said for addiction. But because there’s shame in needing help, that person doesn’t get it until he or she has hit rock bottom. If you’re getting help, that should be seen as a great thing, and that should be supported.”
Another factor in catching addiction early is health care coverage. “You can treat addiction with a lower cost on a longer frame of time, and people are going to do better,” she said. “We aren’t trying to get insurers to pay for a miracle cure. We’re trying to incentivize quality over quantity.” ATLAS is a starting point to achieve that goal, she said, because it provides the first ever baseline measurement for these programs’ efficacy.
Ultimately, Arsenault said, specialized addition treatment—and a system by which to benchmark it—is so vital because addiction itself is so complex. It’s biopsychosocial, Arsenault said, which means that it has biological, psychological, and social/environmental factors. “You can’t boil it down to one thing. Often it’s a combination of all of these.”
The complexity of addiction was what originally drew Arsenault to work in this field. She had her lightbulb moment when she did a research project on risk-seeking behavior. “I was perplexed because my grandmother smoked cigarettes, and I had friends who smoked, and they all knew it was bad for them but did it anyway. That’s what led me to a career in public health. And when you start working in the field of addiction, it becomes more important personally, because you know more people who have been impacted.”
Arsenault, who is 27, has seen great success at a relatively young age—moving from public health to a position at the Pew Charitable Trust, where she worked on federal policy for substance abuse treatment, and then to Shatterproof three years ago. She’s been interviewed on the TODAY Show as well as by countless other publications. ATLAS is just the beginning for her there, she said.
“There are countless very brave people along the way who have informed the process,” she said. “My aunt’s in long term recovery—she always reminds me of what this work means to her. I have so many friends who have been impacted, and so many people I’ve met who have said, ‘This has helped me.’ We are helping to change the system.”
Shatterproof is a national nonprofit dedicated to reversing the addiction crisis in the United States. Dedicated to reducing the stigma and secrecy associated with addition, Shatterproof works to remove the shame felt by those struggling with the disease and their families. To learn more or donate, go to shatterproof.org.