6 June 2004

Can current addiction services cope with demand? US study.

McLennan AT, Carise D, Kleber HD. Can the national addiction treatment infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment (2003) 25:117-121

Dear Colleagues,

This ‘commentary’ teaches us some very important lessons regarding staffing, education and career development in the dependency field. Arising out of an unrelated study, the authors had the opportunity to interview key staff in 175 assorted American dependency treatment agencies. Ten percent were traditional methadone clinics.

The most dramatic finding, almost invalidating the other information being sought, was that within the treatment services examined, staff turnover was extremely high (up to 53% annually). Also, medical and nursing services were under represented with part-time and even volunteer workers in senior positions in many centres. Thus we should be concerned about continuity and consistency of treatment, keeping highly trained and experienced staff in the field and allowing career pathways which can be both rewarding and sustainable. Remarkably, 15% of the agencies identified for the study had either closed down or else ceased to provide addiction services at all! A further 29% had been reorganised under different management, showing yet more starkly how much volatility there is in addiction treatment services.

Drs Kleber and McLennan are highly respected veterans of the dependency research field. What they say in their discussion is both telling and embarrassing for an embattled and threatened rehabilitation ‘industry’ in their country. They found that much time was wasted in these agencies having to collect data required for insurance, city, state and federal requirements. Little if any of this information was used in any way clinically and it took between 2 and 4 hours of staff time to collect. Few agencies used computers. The final comment of these authors goes so far as to compare addiction treatment agencies with the degraded electrical grid which was blamed for the massive recent outages in North America.

I have tried to compare these results with agencies in New South Wales and believe that things are not as grim here, but there are warning signs. I found similar staffing data in some clinics while in others, there were managers and senior staff who had been in the field for decades, providing excellent care for dependent patients/clients.

comments by Andrew Byrne ..