Care Redesign
Clip
Addiction Is a Community Disease (03:03)

“From a substance abuse perspective, it’s a community disease. People don’t call into work or not follow through on family duties or the community aspects of their life because their hypertension is out of control. But for addiction, all of those things are at the wayside,” says Corey Waller, Senior Medical Director for Education and Policy at Camden Coalition of Healthcare Providers’ National Center for Complex Health and Social Needs.

Addiction is a community disease, and yet in often in addiction medicine, it isn’t treated that way, says Waller. People with substance use disorders are placed in recovery facilities for maybe a month, and then when they say they are better, are returned to their communities — where their next-door neighbor or significant other might be a drug dealer.

“You have to be able to get someone well in their community for it to stick,” explains Waller. Recovery failure rates are so high because of a lack of community-based solutions. “Quite honestly, without the community-based approaches, the ecosystems that envelop these patients, it’s not going to ever get better.”

Jürgen Unützer, Chair of Psychiatry and Behavioral Sciences at the University of Washington, adds that health care providers can achieve a lot when partnering with communities on mental health.

Most mental disorders surface between the ages of 14 and 24, explains Unützer, when someone is most likely in school — that’s their primary community, apart from where they live. “On a good day, kids are spending a good part of their day in school; on a bad day, they might be in juvenile justice. But those are both places where we don’t think of providing mental health services,” says Unützer. His team has worked to ensure that every middle and high school in their community has a mental health program.

As for adults, many are employed and so a big part of their community is their employer. Yet employers don’t want psychiatrists like Unützer to treat depression or panic disorder. They want him to treat absenteeism — when someone is having a bad day and doesn’t go to work because they are struggling with a mental health problem — or, “even worse,” presenteeism, when someone is having a bad day but is at work, and colleagues wish they weren’t.

“That’s not a diagnosis I learned about in medical school,” says Unützer, “so I have to really think about what does that mean and what is it that I can do as a health care provider to really help that person do better at their job.”

“But those are communities,” he says, “and if we partner with those kinds of settings, we probably can do a lot of good.”

From the NEJM Catalyst event Expanding the Bounds of Care Delivery: Integrating Mental, Social, and Physical Health, held at Vanderbilt University Medical Center, January 25, 2018.

More From Care Redesign
Griffin Myers Head Shot Oak Street Health

Rebuilding Health Care as It Should Be: Personal, Equitable, and Accountable

How Oak Street Health, a full-risk, value-based primary care model and social determinants practice, embeds itself in the community to keep its elderly population, “happy, healthy, and out of the hospital.”

Telemedicine Online Care Group Cleveland Clinic Express Care Online Quality Improvement - Next Steps

Ensuring Clinical Quality in Telemedicine

How Cleveland Clinic and Online Care Group designed a data-driven quality improvement telemedicine ecosystem.

Endless Forms Most Beautiful - Evolving Toward Higher-Value Care Cover Image

Endless Forms Most Beautiful: Evolving Toward Higher-Value Care

How Providence St. Joseph Health devised a Value-Oriented Architecture to guide physician practice.

Standard Treatment Algorithm for Patients with hepatitis C virus HCV at Geisinger Clinic and for Improved Sustained Virologic Response Rates in Geisinger ProvenCare Model

Enhanced Cure Rates for HCV: Geisinger’s Approach

To reduce the burden of hepatitis C in central Pennsylvania, Geisinger Clinic designed a comprehensive assessment and treatment protocol to improve sustained virologic response rates.

The HCD Human-Centered Design Kaiser Permanente Compass

Human-Centered Design and Performance Improvement: Better Together

Kaiser Permanente’s initiatives with combining HCD and PI point to the potential to improve the health care experience and outcomes of patients and providers.

Choi01_pullquote customizable electronic health records

Subscribing to Your Patients — Reimagining the Future of Electronic Health Records

Rather than searching EHRs to check on patients, what would it be like to instead subscribe to Ms. Jones in room 328?

Consensus That Design Thinking Is Useful in Health Care

Survey Snapshot: Design Thinking Is Useful, So Why Aren’t More People Using It?

NEJM Catalyst Insights Council members agree that design thinking is useful, but leadership buy-in and understanding of how to implement it may create barriers.

Artificial Intelligence AI Technologies - 5 Approaches to Augmentation of Health Care Decision-Making

Artificial Intelligence and the Augmentation of Health Care Decision-Making

Artificial intelligence is most likely to improve health care by augmenting the work of human clinicians.

Improving Scores Through Human-Centered Design

Designing and Implementing Better Patient Experiences

An ophthalmology provider with facilities in the greater Mexico City area is using Human-Centered Design to improve both the patient and staff experience.

Joseph04_pullquote_hospital_wellness

Designing Hospitals That Heal as Well as Treat

Hospitals must provide wholesome food, sound sleeping conditions, and human connection to promote healing and wellness.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Social Needs

81 Articles

Addiction Is a Community Disease

Partnering with the community to tackle substance use and mental health disorders is the optimal…

Mental Health

27 Articles

Addiction Is a Community Disease

Partnering with the community to tackle substance use and mental health disorders is the optimal…

Coordinated Care

121 Articles

Ensuring Clinical Quality in Telemedicine

How Cleveland Clinic and Online Care Group designed a data-driven quality improvement telemedicine ecosystem.

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now