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Advocacy for Treatment, Recovery Tested in Focus Groups

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A growing grassroots advocacy organization is using a series of focus groups to help shape its messages in support of addiction recovery and treatment.

The Alliance Project conducted focus groups in December, 1999, and April 2000 to assess support for a nationwide campaign aimed at changing the national dialogue on addiction policy. Participants included addiction field stakeholders, people in recovery, family members, media, members of the business community, and lawmakers — the same groups that the Alliance Project needs to target with its advocacy messages, project director Jeff Blodgett tells Join Together. “We essentially have two audiences: an internal one that includes people in recovery and their families, and an external one that is the opinion-leading public — those who make or influence public policy,” said Blodgett.

Although not representative of the population as a whole, the focus groups provided some insight into how key players in shaping addiction policy view the issue, and how receptive they would be to policy initiatives being considered by advocates. The Alliance Project plans to hold a series of focus groups over the coming months, and also would like to conduct a national opinion poll to get feedback on advocacy issues from a cross-section of Americans.

Significantly, most participants were supportive of efforts to prevent and treat addiction, and agree that alcohol and other drug addiction is the root of myriad societal problems. Most also accepted as accurate statistics showing that untreated addiction costs the nation $274 billion annually. “We found that a little surprising, and heartening,” said Blodgett. “It allows us to address addiction as a public-health problem, and avoid the whole conversation about whether addiction is a disease or a personal failure. It says that there are several possible openings there for a more enlightened response to addiction. If decision-makers are really looking at the bottom line, we can probably make some headway if we can make the case about investing in treatment.”

Debating the Disease Concept

That's not to say that the Alliance Project plans to ignore the disease concept of addiction; in fact, focus group participants rejected the term “substance abuse” — which they said conjures up images of youthful, recreational drug use — in favor of “the disease of alcohol and drug addiction” as the preferred phrase to describe the issue. Some participants felt the disease concept was more applicable to alcohol than illicit drugs, however, and some felt that talking in terms of a disease may not be appropriate for youth prevention activities.

“We're trying to figure out phrases and concerns that are strategic,” Blodgett explained. “The phrase 'alcohol and drug addiction' seems more serious, more comprehensive.” While outsiders may still have some reservations about the disease concept, he added, within the addiction field “we should probably decide that the debate is over and move forward with confidence … If we share that ambivalence, where does it leave us? Not far along on an advocacy path.”

Blodgett adds, “We need to set aside this lingering controversy internally and … take another run at the issue using the most updated science” about addiction, such as the data showing that alcohol and other drug abuse is a brain disorder and often rooted in genetics.

Almost all of the focus group participants supported “feel-good” prevention efforts such as urging parents to talk to kids about drugs, and encouraging retailers not to sell alcohol and tobacco to kids. But there also was surprising levels of support for some progressive policies that advocates say would be highly effective in fighting addiction, such as mandating treatment rather than prison for non-violent, addicted offenders. “I think there's a mood swing in the country about the war on drugs and whether people whose real problem is addiction should be thrown in jail,” said Blodgett. “The key word in there is non-violent offenders: people see them as not dangerous.”

Drug courts also were perceived as being highly effective by participants. “Drug courts in particular combine this rational approach of dealing with addiction with a heavy dose of accountability and personal responsibility,” which policy makers and the general public seem to demand, said Blodgett.

Resistance to Parity, Treatment on Demand

Treatment on demand and mandating parity coverage for addictions, however, got a more mixed response. “Many panelists tell us that they would like to support these goals, but worry about the cost,” according to a report prepared by Peter D. Hart Research Associates. “When the principal concern is cost, it is persuasive to argue that these programs are cost-effective. When making the case for addiction treatment, the issue should be framed around increasing understanding of the scientific, medical and public-health aspects of the disease, rather than on money or funding alone.”

“People worry that treatment on demand seems to be a blank check, which raises questions about efficacy and affordability,” explained Blodgett. “As for parity, there seems to be some misunderstanding about the insurance industry's funding of treatment; people believe they fund it adequately, but they don't. We need to highlight gaps in coverage and advocate that this disease is comparable to other disorders and worthy of coverage equal to other disorders.”

Blodgett said advocates will have to address both spending concerns and parity in order to increase the availability of treatment. “On the public side it is a funding question; on the private side it is an insurance/HMO question, and they go hand-in-hand,” he says.

As a young organization still seeking major funding and constituency support, the Alliance Project also came away from the initial focus groups with a sense of encouragement about its core mission. “The most striking element of the [meetings] is the near-unanimous support for a campaign to raise the salience of drug and alcohol addiction as a public-policy issue,” according to the Peter D. Hart Associates report. “Not only are the people we talked to supportive of the message, but nearly all the recovery professionals, people in recovery and family members also are willing to take an active role in the campaign.” Blodgett noted that legislators would also like to see the addiction field be more organized in its advocacy efforts, and said that family members, in particular, could be a powerful asset for the recovery community. “They have first-hand knowledge of the problem, of the difficulty in getting someone into treatment, and to a person they were raring to go,” he said. “We definitely saw a lot of potential out there for involvement, and we think the time is right for some kind of active recovery movement.”

The Alliance Project: 651-645-1618

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