Michael Flaherty was, and continues to be, a driving force behind the paradigm shift in addictions treatment from an acute to a chronic care model

Dr. Flaherty (second from left) and IRETA staff in 2004

Bill White recently added an interview with Michael T. Flaherty, PhD, to his online Pioneer Interview library.  There, Flaherty’s voice joins those of Drs. Keith Humphreys, Bob DuPont, David Lewis, LeClaire Bissell, Tom McLellan, and a host of other game-changers in the field of addiction.  (All are posted in Bill White’s extensive online library–happy reading!)

An accomplished speaker in his own right, Flaherty brings to life in the interview his personal confrontations with addiction and the people it impacts. It is a particular treat for Pittsburghers (especially those who remember St. Francis Medical Center) and anyone who worked with him on the many, many projects he springboarded, locally and nationally, to improve our understanding of addiction and recovery.

(Read the full interview transcript here.)

Personal path

Flaherty began his career in the addictions field shortly after leaving the Navy, working as a therapist in the local penitentiary. He recounts in vivid detail the many inmates addicted to drugs and alcohol, how little their disease was acknowledged, and how their addictions often continued even on the inside.  Inmates, he said, “used bread to filter the alcohol from aftershave lotion or vanilla extract and then fought over the bitter liquid they obtained.”

A few years later, he became the Director of the Division of Psychiatric and Addictive Services at St. Francis Medical Center. His experiences there molded his career path.

It was at St. Francis that he began to recognize the ubiquity of co-occurring disorders and illness resulting from substance use in the population. He believed this was “evidence of major societal denial” and has based his career on trying to reduce that denial, to bring change to public perceptions and policies surrounding addiction.

Also at St. Francis, he became dismayed by efforts mobilized by managed care to decrease costs at the expense of the patient.  He recalls fighting daily with payers to explain that addiction treatment required continuing care and recovery support.

Notably, Flaherty points to his work in the NICU at St. Francis, where he witnessed newborns surviving opioid detox and going on to thrive, as his first impression of the power of recovery.

IRETA’s beginning

Flaherty started The Institute for Research, Education and Training in Addictions (IRETA) in 1999. IRETA, he recounts, was born out of frustration with the fragmented nature of behavioral care, social denial of the role mental health and substance use play in health care, and policies that did not follow best practices.

IRETA was designed to construct solutions to these challenges and promulgate the principles of Recovery Management (RM) and Recovery-Oriented Systems of Care (ROSC).

He had a specific interest in educating policy makers and providers about research-based approaches to addiction care. However, he encountered ignorance and denial in many segments of society, including the scientific community.  Flaherty recalls:

When the Institute of Medicine report came out in 2001 on “Crossing the Quality Chasm – A New Health System for the 21st Century,” it left out the addictions as a top 20 illness to be addressed. America’s most costly and preventable illness wasn’t mentioned! I began to see that the clinical denial, minimization, rationalization, and projection observed daily in each actively addicted person was similarly present in our society.

Initially funded by grants from the Jewish Healthcare Foundation and the Scaife Family Foundation, IRETA received its first ATTC grant from SAMHSA in 2001 and has remained a federally-designated ATTC ever since.

MTF and John Walters

Dr. Michael Flaherty and former Director of the ONDCP John Walters, in 2009

On language

Not surprisingly, given his background in qualitative research, Flaherty pays close attention to the ways in which we talk about and write policies for those who have SUDs. “How we language the illness is how we stigmatize those who have it.”

“For example,” he continues,

While often chronic in nature, we don’t have reoccurrences of the illness; we have “relapses” to it. When we do a toxicology screen, our results aren’t positive but are “dirty” for what might be found. Those who come for help are often looked down on, especially in an ER or within a medical setting, and referred to as “addicts” or “junkies” when they are in reality persons with an addiction and human beings. Just look at our language and you can see much about how we stigmatize the person with the illness who then adopts that stigma as their self-identity. This is not healing medicine.

Other interview highlights

On the addiction workforce, integration, and interprofessional collaboration:  “Treat an ‘illness’ first and build…skills and competencies from there. Doing it in reverse builds silos and creates unnecessary polarities and professional aloofness. Let the ‘illness’ and its ‘recovery’ build and unify all practice and workers as a unified team.”

On his decision to focus on addiction:  “Ironically, my early teachers told me addiction treatment was a simple cookbook and my valued clinical training would be squandered by focusing on people who were addicted. That was 40 years ago and I still am learning…Guess I was a slow learner.”

On medication supported recovery: “The issue..is far from resolved…A recovery paradigm would seek a more clearly defined and generalizable pathway based on actual experience of the person, how and what medication is used, and how it can support recovery. When used as prescribed, it is medication. Recovery is possible. When used outside of as prescribed, it becomes a drug.”

On starting IRETA to educate policymakers: “We were also frustrated by having to start over explaining the illness and its societal costs after every major election. Everyone campaigned on ‘locking them up,’ and we spent the next two years showing that newly elected official that this didn’t make financial or clinical sense. We would ask ourselves, why can’t we politically and socially evolve?”

***

Finally, Bill White asks Flaherty what he’d like to accomplish in the years ahead.

Ending with just as much enthusiasm as he began the interview, Flaherty replies:

Refine myself and my focus. Give back and have the guts to accept. Keep working on building recovery-focused care and building it person by person, community by community. Leave my campsite better than I found it.

Read more from the interview here.