In the world of high school education, there are teachers who leave a lasting impact on their students. For me, one such teacher was Brother Patrick, a man who bore a striking resemblance to the late Irish actor Barry Fitzgerald (whose movie credits include How Green was My Valley, Bringing Up Baby, and The Quiet Man). While he may have looked like a Hollywood star, Brother Patrick’s true star quality lay in his ability to teach Latin with a dramatic flourish. His command of ancient Roman and Greek civilizations, along with his disdain for the contemporary times he lived in (1967 – 1971 was a mess), made him a memorable figure in my high school days. Though his teaching style could be tiresome, there were valuable lessons hidden within his passionate lectures.
The Greeks and the Romans
Brother Patrick had a unique way of categorizing the Greeks as “great thinkers” and the Romans as “great builders.” According to him, the Romans took the ideas of the Greek thinkers and built upon them. This classification stuck with me, even though he assured us that we were unlikely to be either Greeks or Romans.
As I ventured further in my education, particularly in graduate school, I began to see the wisdom in Brother Patrick’s distinction. It wasn’t just about categorizing ancient civilizations; it was about understanding the fundamental difference between concepts and operations.
Concepts vs. Operations
In the realm of science, there exists a crucial distinction between conceptual definitions and operational definitions. This distinction is not trivial; it is the very essence of how we conduct scientific research and test ideas. Concepts are the abstract ideas and theories, while operations define those concepts in observable, measurable terms. In essence, operations bridge the gap between the abstract and the concrete, from concepts to actions.
Brother Patrick’s wisdom took on new meaning as I realized that concepts without operations are like a partial score of a baseball game – (“And in Pittsburgh today, after 8 innings the Pirates 2…”) – true but incomplete and unsatisfying.
The Dominance of the Greeks
Looking at the landscape of addiction treatment, I can’t help but see the dominance of the Greeks. Conceptually, we have developed comprehensive decision support standards, theory-based understandings of addiction, and a well-defined conceptual framework for effective treatment. These conceptual assets are essential, but we seem to struggle when it comes to translating them into operational, results-oriented clinical practice.
We Need Romans Too
What we need in addiction treatment are the Romans. We need individuals and systems that can take the conceptual ideas about addiction and turn them into actionable, intentional, and planful interventions. In essence, we need to move from understanding the concepts to effectively performing the operations.
The Roman Approach to Treatment
So, what would the Romans do for addiction treatment? They would take the Greeks’ ideas and turn them into actual practices. Treatment programs should be intentional, planful interventions tailored to the assessed needs of individuals and adjusted based on their responses to treatment. Conceptually, we understand addiction as a chronic, progressive disorder, but operationally, we struggle to maintain effective practice.
Money Isn’t the Only Answer
It’s tempting to think that more funding is the solution to improving addiction treatment. States that took the Medicaid expansion have a robust source of funding for treatment. Steady expansion of federal grants (e.g. State Opioid Response Grant) and the soon to be realized opioid settlement funds provide additional sources of funds that make “we just need more money” sound flat. We should consider a different perspective: building and sustaining treatment program operations that align with our conceptual understanding of addiction as a chronic disorder.
Shifting from Conceptual to Operational
The strategy for improvement lies in shifting from the conceptual to the operational. We must focus on program and client outcomes. By targeting treatment to increase continuity of care and reduce readmissions, we give operational meaning to our conceptual understanding of addiction and effective treatment.
Steps Toward Effectiveness
To make this shift, we must take action:
- Set Realistic Outcome Measures: Define clear, observable, empirically valid, and reliable outcome measures, such as continuity of care and readmission rates.
- Compare Program Data: Internally publish data for clinical staff, allowing them to compare the program’s performance to regional, state, or national benchmarks.
- Establish a Quality Assurance Function: Re-engineer program functions to create a Quality Assurance department that spans across all areas. This department will gather and interpret data to improve program performance continually.
In the world of addiction treatment, it’s time for the Romans to rise. We have the conceptual understanding; now we need the operations to match. By focusing on outcomes, comparing data, and embracing quality assurance, we can bridge the gap between theory and practice. It’s not just about money; it’s about turning knowledge into action. Now is the time for Romans.