By Andrew Kessler, Federal Policy Liason
A few years ago, my wife took me to see one of her favorite musicals – Rent. The first song of the second act, “Seasons of Love,” poses a question:
Five hundred twenty-five thousand six hundred minutes,
Five hundred twenty-five thousand moments so dear.
Five hundred twenty-five thousand six hundred minutes,
How do you measure, measure a year?
Well, for an advocate in DC, it’s not quite that simple. Success – or failure – is not measured in quantities of time. Or, in any other quantities for that matter. Some successes or losses can be measured in terms of legislation passed or regulations established, but for the most part, it comes down to this: Have you done enough for your constituency to be recognized as a leader in its respective field?
In this regard, IC&RC has had an uphill struggle. The field of substance abuse prevention/treatment and its professionals is not well recognized by policy makers, for a variety of reasons. It is overshadowed by doctors, psychologists, social workers, and others, whose ranks are larger and have been organized advocates for far longer. Substance abuse treatment also suffers from an ever-present social stigma, and policy makers are never quite sure whether the issue is best addressed from the perspective of law enforcement or health.
IC&RC is also unique amongst advocates, as it is not an organization of individual members, making grassroots advocacy somewhat difficult. The final piece of the puzzle is that for decades, NAADAC has been the only voice for addiction counselors in Washington. While IC&RC is not in competition with NAADAC, we must work hard to assure that IC&RC is included in all conversations where counselors can contribute, or just as importantly, can benefit.
Then again, who doesn’t love a good challenge? In August 2009, in conjunction with IC&RC’s leadership, Slingshot Solutions designed a strategy – and goals – for IC&RC’s first year back in the advocacy arena. In large part, we have achieved these goals.
Our first and most important goal was to announce our arrival in Washington. We did this by joining several coalitions, focused on both substance abuse, and on health issues in general. These coalitions allow us to share information with other organizations, and learn about issues such as legislation, funding, and regulations that impact the field. IC&RC is now an active member in the Coalition for Whole Health, the Addiction Leadership Group, and the Coalition for Health Funding, the Friends of NIDA, the SAMHSA Recovery Month Planning Partners, and the Health Professionals & Nurses Education Coalition.
A common misperception is that advocates spend all their time working with Congress. If anything is true, it’s the opposite. Working with Congress takes up less than half the time we put into advocacy. The largest chunk of our time is spent working with executive agencies and other policy making bodies, mostly within the US Department of Health and Human Services. These include the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute on Drug Abuse (NIDA), and the Health Resources and Services Administration (HRSA).
Mary Jo Mather and Andrew Kessler attended the NIDA Blending Conference in April 2010, and our meetings with NIDA produced an idea that we hope can move forward in the near future. We will actively seek the input of NIDA scientists for our next round of exam development, in order to ensure that our counselors are being tested for the latest in evidence-based practice.
We have also put a large amount of effort into working with the Office of National Drug Control Policy (ONDCP). Through working with former Deputy Director Tom McLellan, we are involved in an effort in which the Department of Labor will attempt to recruit over 50,000 new substance abuse counselors over the next decade. We have also met with other senior officials at ONDCP, to discuss prevention, prescription drug abuse, and the role of substance abuse professionalswithin the new health care reform era.
Our work with SAMHSA has been centered on workforce development. We are involved in ongoing discussions with other national certifying bodies, which began in March 2010. Our inclusion in this process is the direct result of our presence in Washington, DC.
Of course, the one issue that dominated the legislative landscape, for all DC advocates, was health care. Not since 9/11 has one single issue dominated the political landscape so thoroughly. In the recently passed and enacted health care reform legislation, the “Affordable Health Care for America Act,” there are many provisions that concern health professionals, including substance abuse professionals. The law, for the most part, focuses on the rights of the consumer, and the role of health professionals is only addressed in one section.
Title V of the law provides funding for scholarships and loan repayment programs, thus increasing the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists in the areas of the county that need them most, such as rural areas and inner cities. Those with a graduate degree in substance abuse treatment qualify for Title V programs.
Now that health care reform has become law, there is still more work to be done. All of the programs and changes it provides for must be implemented. Also, these new or modified programs must be funded, which means a whole new round of advocacy at the appropriations level – for many years to come. IC&RC accomplishes this work through participation in two coalitions: The Coalition for Health Funding (one of only two members of the coalition committed to working on addiction prevention and treatment) and the Coalition for Whole Health.
Perhaps the single greatest benefit to representation in Washington, DC is the opportunity to form collaborations. In the past year, IC&RC has forged relationships with groups such as the American Society of Addiction Medicine (ASAM), the National Association of State Alcohol and Drug Abuse Directors (NASADAD), and Strategic Applications International (SAI).
Of course, having spent the last year laying a foundation for our future in advocacy, we now turn toward building upon it. Health care reform implementation will continue to impact our field, as will legislation that could alter the criminal justice system, care for the active military and veterans, and high-tech training for health professionals. A far more detailed report is forthcoming at the fall IC&RC meeting in Scottsdale next month, so prepare for a lively discussion there!