To speak to the topic of “Addiction: Exploring the Science and Experience of an Equal Opportunity Condition,” Yale School of Medicine’s Michael V. Pantalon will join a panel of experts at the 51st Nobel Conference at Gustavus Adolphus College in St. Peter, Minn. on Oct. 6-7. For five decades, the conference has brought together scholars and researchers from around the world to discuss contemporary issues relating to the natural and social sciences.
YaleNews talked to Pantalon, a senior research scientist in emergency medicine, about his research and approach to the challenge of addiction treatment. The following is an edited version of the conversation.
How did your participation in the conference come about?
The Nobel conference organizers were interested in my work on scientifically supported treatment options for addiction, and in particular, motivational interventions. They brought together a panel to speak about addiction treatment and where it should be headed. The panelists include William Cope Moyers, Bill Moyer’s son, of the Hazelden Betty Ford Foundation; Mark Willenbring, an addiction psychiatrist and former National Institutes of Health director; and Anne Fletcher, an award-winning medical writer and author of ‘Inside Rehab.’ I will talk about how the science of addiction treatment and recovery can help address the opioid epidemic in the United States, which is a central focus of my research. After the panel presents, we will be joined by keynote speakers, including neuroscientist and Nobel Prize-winner Dr. Eric Kandel, for a broader discussion.
What will you talk about specifically?
I’m going to talk about three things: first, the fact that much of what people think is good addiction treatment is not actually scientifically studied, let alone supported, or evidence-based. Take rehab, for example. Everyone thinks that if you have an addiction, you absolutely have to go to rehab. But 90% percent of rehabs do not offer evidence-based treatment. In fact, much of what they provide runs counter to what the evidence suggests should be done.
Much of what people think is good addiction treatment is not actually evidence-based.
— Michael Pantalon
I will also talk about how to motivate an individual to enter treatment. Much of our society believes an “intervention” is the method of choice — you sit in a circle and you confront the person because he or she is in denial. But when this sort of intervention has been studied in a scientifically rigorous way, only 20% of individuals went to treatment, and of that 20%, 80% left before treatment was completed. However, there are alternative motivational approaches, which have been studied here at Yale, and at the University of New Mexico, and they have been shown to get approximately 65% of people into treatment.
The final issue I will address is the fact that the mainstay of the support that people with addiction have, day to day, is largely a 12-step-based approach. While 12-step programs have helped many, many people with their addictions, they are not appealing to, or have not been effective for, countless others. Moreover, when you look at the 12-step meetings in a scientifically rigorous way, success is minimal, only about 5%-10%. We need a more evidence-based system of support. That’s where I think recovery coaches are critical.
What is a recovery coach?
A recovery coach is a professional coach, much like an executive or health coach, who has been trained and certified to help people with addiction and their families to: 1) find evidence-based treatment and 2) motivate them to make the best use of that treatment, using evidence-based coaching strategies. In particular, they use brief motivational interventions, such as the ones our team has researched at Yale. Rather than confrontationally telling someone what he or she has to do, through motivational intervention we ask the individual to tell us why they might, of their own free will, choose to change. The results are often stunning.
Has this kind of recovery support been studied?
Yes, our group and a team of researchers at Chestnut Health Systems in Illinois have shown that recovery coaches (alternately referred to as health promotion advocates or recovery managers, respectively) can use brief motivational interventions to get people into treatment at a rate of 65%, and to get them back into treatment if they drop out at a rate of 70%. Compare that to the 20% or less that we get with traditional, confrontational “interventions.” People helped by evidence-based recovery coaches are also less likely to relapse and experience significant drug-related problems once they are back in treatment.
Opioid overdoses is a topic addressed by every major presidential candidate.
— Michael Pantalon
The best thing about recovery coaches, however, is that they do not need to spend years in school to get trained or be licensed healthcare providers. Because of this, the use of recovery coaches could dramatically improve access to evidence-based treatment, especially for those who currently need it the most — those at risk for opioid overdose death, a topic addressed recently by every major presidential candidate.
For example, a recent study at Yale that examined treatment initiated in the emergency department showed that, when offered our brief motivational intervention and a medication called Suboxone, nearly 80% of opioid-dependent patients entered treatment after they left the ER. The motivational interventions were conducted by non-licensed professionals.
Does the recovery coach approach apply mainly to patients who come to the ED for addiction treatment? Or more broadly?
The idea of a brief motivational intervention has spread like wildfire throughout very different systems to motivate people to get treatment for addiction. I have trained case managers at the United Way as well as probation officers throughout the state of Connecticut. People from many walks of life can be trained to do this as recovery coaches. Significantly, the White House Office of National Drug Control Policy recently announced that it would use “Public Health Coordinators,” who serve a role that is very similar to a recovery coach. They work with law enforcement to connect opioid-dependent people who have been arrested with treatment.
Because of all of this, I have developed a training program for people who want to help people with addiction, especially their loved ones, and even make a career of it, to become recovery coaches. Our mission is effective addiction help for all.