One of my people has a disabling traumatic brain injury and a history of numerous incarcerations. He has bounced around as an inpatient and as an outpatient in about half a dozen different substance abuse facilities. There is only one in our area that I recommend and it's an outpatient facility. Problem is that a judge ordered a month of inpatient treatment to start. This would have been fine except that the rules and level of staff skills in some of these facilities leaves very much to be desired, in my opinion, when it comes to brain injured individuals.
There is a self righteous component to traditional addiction treatment which posits that a one-size-fits-all program works for everyone. Moreover, if this doesn't help you, it's your fault... despite a long record of treatment failures among these facilities. It's extremely frustrating, especially since a high-level of substance misuse has been reported in the brain injured popuation.
I've spent a significant portion of this morning texting back and forth with one of my people about this... yet again. Issue is that if he doesn't succeed, he could lose his housing and be returned to jail, then back to the streets.
We don't force court ordered inpatient treatment upon people who smoke, who may be obese, who may drive too fast, etc., for their self-destructive behaviors. I'm not sure what the answer is with respect to addictions and traumatic brain injuries but putting people in jail or out onto the streets does not seem to me to have had a strong record of success either. Plus it is ultimately the most expensive option.
At the very least, we need to start requiring outcome data from these programs. In every other field of treatment, institutions with poor treatment outcomes will no longer receive compensation from health insurers. They cannot simply blame the victims for poor results and also expect to be paid. I think that this would improve addiction treatment outcomes substantially.
If we are to end the seemingly endless recycling of chronically homeless, disabled individuals, this issue needs to be addressed.
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