Hospitals, Insurers Invest Big Dollars to Tackle Patients’ Social Needs

Hospitals, Insurers Invest Big Dollars to Tackle Patients’ Social Needs

PHILADELPHIA — When doctors at a primary care clinic here noticed many of its poorest patients were failing to show up for appointments, they hoped giving out free rides would help.

But the one-time complimentary ride didn’t reduce these patients’ 36% no-show rate at the University of Pennsylvania Health System clinics.

“I was super surprised it did not have any effect,” said Dr. Krisda Chaiyachati, the Penn researcher who led the 2018 study of 786 Medicaid patients.

Many of the patients did not take advantage of the ride because they were either saving it for a more important medical appointment or preferred their regular travel method, such as catching a ride from a friend, a subsequent study found.

It was not the first time that efforts by a health care provider to address patients’ social needs — such as food, housing and transportation — failed to work.

In the past decade, dozens of studies funded by state and federal governments, private hospitals, insurers and philanthropic organizations have looked into whether addressing patients’ social needs improves health and lowers medical costs.

But so far it’s unclear which of these strategies, focused on so-called social determinants of health, are most effective or feasible, according to several recent academic reports by experts at Columbia, Duke and the University of California-San Francisco that evaluated existing research.

And even when such interventions show promising results, they usually serve only a small number of patients. Another challenge is that several studies did not go on long enough to detect an impact, or they did not evaluate health outcomes or health costs.

“We are probably at a peak of inflated expectations, and it is incumbent on us to find the innovations that really work,” said Dr. Laura Gottlieb, director of the UCSF Social Interventions Research and Evaluation Network. “Yes, there’s a lot of hype, and not all of these interventions will have staying power.”

With health care providers and insurers eager to find ways to lower costs, the limited success of social-need interventions has done little to slow the surge of pilot programs — fueled by billions of private and government dollars.

Paying for Health, Not Just Health Care

Across the country, both public and private health insurance programs are launching large initiatives aimed at improving health by helping patients with unmet social needs. One of the biggest efforts kicks off next year in North Carolina, which is spending $650 million over five years to test the effect of giving Medicaid enrollees assistance with housing, food and transportation.

California is redesigning its Medicaid program, which covers nearly 14 million residents, to dramatically increase social services to enrollees.

These moves mark a major turning point for Medicaid, which, since its inception in 1965, largely has prohibited government spending on most nonmedical services. To get around this, states have in recent years sought waivers from the federal government and pushed private Medicaid health plans to address enrollees’ social needs.

The move to address social needs is gaining steam nationally because, after nearly a dozen years focused on expanding insurance under the Affordable Care Act, many experts and policymakers agree that simply increasing access to health care is not nearly enough to improve patients’ health.

That’s because people don’t just need access to doctors, hospitals and drugs to be healthy, they also need healthy homes, healthy food, adequate transportation and education, a steady income, safe neighborhoods and a home life free from domestic violence — things hospitals and doctors can’t provide, but that in the long run are as meaningful as an antibiotic or an annual physical.

Researchers have known for decades that social problems such as unstable housing and lack of access to healthy foods can significantly affect a patient’s health, but efforts by the health industry to take on these challenges didn’t really take off until 2010 with the passage of the ACA. The law spurred changes in how insurers pay health providers — moving them away from receiving a set fee for each service to payments based on value and patient outcomes.

As a result, hospitals now have a financial incentive to help patients with nonclinical problems — such as housing and food insecurity — that can affect health.

Temple University Health System in Philadelphia launched a two-year program last year to help 25 homeless Medicaid patients who frequently use its emergency room and other ERs in the city by providing them free housing, and caseworkers to help them access other health and social services. It helps them furnish their apartments, connects them to healthy delivered meals and assists with applications for income assistance such as Social Security.

To qualify, participants had to have used the ER at least four times in the previous year and had at least $10,000 in medical claims that year.

Temple has seen promising results when comparing patients’ experiences before the study to the first five months they were all housed. In that time, the participants’ average number of monthly ER visits fell 75% and inpatient hospital admissions dropped 79%.

At the same time, their use of outpatient services jumped by 50% — an indication that patients are seeking more appropriate and lower-cost settings for care.

Living Life as ‘Normal People Do’

One participant is Rita Stewart, 53, who now lives in a one-bedroom apartment in Philadelphia’s Squirrel Hill neighborhood, home to many college students and young families.

“Everyone knows everyone,” Stewart said excitedly from her second-floor walk-up. It’s “a very calm area, clean environment. And I really like it.”

Before joining the Temple program in July and getting housing assistance, Stewart was living in a substance abuse recovery home. She had spent a few years bouncing among friends’ homes and other recovery centers. Once she slept in the city bus terminal.

In 2019, Stewart had visited the Temple ER four times for various health concerns, including anxiety, a heart condition and flu.

Stewart meets with her caseworkers at least once a week for help scheduling doctor appointments, arranging group counseling sessions and managing household needs.

“It’s a blessing,” she said from her apartment with its small kitchen and comfy couch.

“I have peace of mind that I am able to walk into my own place, leave when I want to, sleep when I want to,” Stewart said. “I love my privacy. I just look around and just wow. I am grateful.”

Stewart has sometimes worked as a nursing assistant and has gotten her health care through Medicaid for years. She still deals with depression, she said, but having her own home has improved her mood. And the program has helped keep her out of the hospital.

“This is a chance for me to take care of myself better,” she said.

Her housing assistance help is set to end next year when the Temple program ends, but administrators said they hope to find all the participants permanent housing and jobs.

“Hopefully that will work out and I can just live my life like normal people do and take care of my priorities and take care of my bills and things that a normal person would do,” Stewart said.

“Housing is the second-most impactful social determinant of health after food security,” said Steven Carson, a senior vice president at Temple University Health System. “Our goal is to help them bring meaningful and lasting health improvement to their lives.”

Success Doesn’t Come Cheap

Temple is helping pay for the program; other funding comes from two Medicaid health plans, a state grant and a Pittsburgh-based foundation. A nonprofit human services organization helps operate the program.

Program organizers hope the positive results will attract additional financing so they can expand to help many more homeless patients.

The effort is expensive. The “Housing Smart” program cost $700,000 to help 25 people for one year, or $28,000 per person. To put this in perspective, a single ER visit can cost a couple of thousands of dollars. And “frequent flyer” patients can tally up many times that in ER visits and follow-up care.

If Temple wants to help dozens more patients with housing, it will need tens of millions of dollars more per year.

Still, Temple officials said they expect the effort will save money over the long run by reducing expensive hospital visits — but they don’t yet have the data to prove that.

The Temple program was partly inspired by a similar housing effort started at two Duke University clinics in Durham, North Carolina. That program, launched in 2016, has served 45 patients with unstable housing and has reduced their ER use. But it’s been unable to grow because housing funding remains limited. And without data showing the intervention saves on health care costs, the organizers have been unable to attract more financing.

Often there is a need to demonstrate an overall reduction in health care spending to attract Medicaid funding.

“We know homelessness is bad for your health, but we are in the early stages of knowing how to address it,” said Dr. Seth Berkowitz, a researcher at the University of North Carolina-Chapel Hill.

Results Remain to Be Seen

“We need to pay for health not just health care,” said Elena Marks, CEO of the Houston-based Episcopal Health Foundation, which provides grants to community clinics and organizations to help address the social needs of vulnerable populations.

The nationwide push to spend more on social services is driven first by the recognition that social and economic forces have a greater impact on health than do clinical services like doctor visits, Marks said. A second factor is that the U.S. spends far less on social services per capita compared with other large, industrialized nations.

“This is a new and emerging field,” Marks said when reviewing the evaluations of the many social determinants of health studies. “The evidence is weak for some, mixed for some, and strong for a few areas.”

But despite incomplete evidence, Marks said, the status quo isn’t working either: Americans generally have poorer health than their counterparts in other industrialized countries with more robust social services.

“At some point we keep paying you more and more, Mr. Hospital, and people keep getting less and less. So, let’s go look for some other solutions” Marks said.

The covid-19 pandemic has shined further light on the inequities in access to health services and sparked interest in Medicaid programs to address social issues. Over half of states are implementing or expanding Medicaid programs that address social needs, according to a KFF study in October 2020. (The KHN newsroom is an editorially independent program of KFF.)

The Medicaid interventions are not intense in many states: Often they involve simply screening patients for social needs problems or referring them to another agency for help. Only two states — Arizona and Oregon — require their Medicaid health plans to directly invest money into pilot programs to address the social problems that screening reveals, according to a survey by consulting firm Manatt.

The Centers for Medicare & Medicaid Services, which is funding a growing number of efforts to help Medicaid patients with social needs, said it “remains committed” to helping states meet enrollees’ social challenges including education, employment and housing.

On Jan. 7, CMS officials under the Trump administration sent guidance to states to accelerate these interventions. In May, under President Joe Biden, a CMS spokesperson told KHN: “Evidence indicates that some social interventions targeted at Medicaid and CHIP beneficiaries can result in improved health outcomes and significant savings to the health care sector.”

The agency cited a 2017 survey of 17 state Medicaid directors in which most reported they recognized the importance of social determinants of health. The directors also noted barriers to address them, such as cost and sustainability.

In Philadelphia, Temple officials now face the challenge of finding new financing to keep their housing program going.

“We are trying to find the magic sauce to keep this program running,” said Patrick Vulgamore, project manager for Temple’s Center for Population Health.

Sojourner Ahebee, health equity fellow at WHYY’s health and science show, “The Pulse,” contributed to this report.

This story is part of a partnership that includes WHYY, NPR and KHN.

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’Tis the Season to Be Laid Off

’Tis the Season to Be Laid Off

The holiday season is a special time of peace, joy, goodwill toward others, and … job cuts.

Just scan the headlines of companies announcing layoffs.

It wasn’t always this way. But even before the pandemic, companies had become less gun shy about blasting employees around Christmastime. Shedding jobs in the fourth quarter of the fiscal year helps companies to balance their books and start fresh in January. For the jobless, it can make for a wrenching cheerless holiday. Meanwhile, those on the employment bubble are left thanking their lucky stars, that is, until the next round of cuts.

Heartless or just business?

Actually it’s both. The motive is certainly not about “Joy to the world, the Lord is come.” This is why, ironically, losing your job during the holidays may be the best gift for you.

How do I know? It happened it me.

One November, a few years back, my supervisor called me into his office as if nothing was wrong, told me that my services were no longer needed and handed me a manila folder. This was just six months after I had joined the well-known company, relocated my family (with two teens in high school), and bought a home. As devout and God-fearing as I would like to think I am, I didn’t feel very spiritual at that moment. But the scripture is true: “What man means for evil, God can turn to good” (Gen. 5:20). I eventually chose to join God’s plan to use that dark moment to refocus me on faith, family, and a brighter future.

I got fired up.

How did it happen? My book, Fired Up, explains the four steps:

1. Talk About It. I immediately told friends and family what happened, instead of wallowing in shame.

2. Pray About It. Through daily prayer I reflected on my past accomplishments, which inspired and helped me plan my next career move.

3.  Feel It. I embraced my emotions, but managed them. When anger raged and I felt like hurting the guy and cursing the company’s owner for the cowardly classless way they fired me, I let it flow. I also took a kickboxing class as an outlet to kick and punch out anger.

4. Forgive. These first three steps helped me to learn from the situation and reject the bitter feeling of wanting harm to come upon my ex-supervisor and the company’s owner. They weren’t thinking about me, and so I was cheating my family and myself by ruminating about them. I refocused on “Me Inc.”

Job cuts come with the territory. Especially if you’re an at-will employee (and not under contract), you can be slashed at any moment. For those who have gotten the ax, wanting to return the favor to your former boss is a waste of time and energy.  The appropriate F-word is “forgive,” so that you can move up to what God has prepared for you.

As I mentioned, employers want to start fresh after the New Year, so December and January are actually good times to find your next job, if that’s what you want. Maybe God wants you to start that business he placed into your heart! Either way, stay focused, keep your head up and put your feet to the pavement. For those who are dealing with a jobless loved one or spouse, particularly a male, here’s some advice to help them press on:

1. If you’re married, encourage your spouse. The Bible teaches that women have the power “to build up” or “pull down” their homes (Prov. 14:1). Wise women understand “death and life is in the power of the tongue.” (Prov. 18:21). The guy is already feeling inadequate as a breadwinner. Instead of tossing more dirt on his fragile ego, show that you’re in the trenches with him. Likewise, men must encourage their wives through a job loss and love her sacrificially (Eph. 5:25-27).

2. If you have children, include them in the recovery process. Together, tell the kids what’s going on. Too often we shield children from bad news because we don’t want them to be disappointed. Forget that. It’s a disservice to them. Children need to learn how to handle hard times because they will become adults who will have to handle hard times. So, there won’t be any expensive Christmas gifts under the tree this year? Tell them why and that the holiday is about Jesus the giver not Santa the credit card debt creator. They’ll survive, and you will too.

3. Cut expenses and eliminate debt. Most of the economic pundits claim that America must spend its way out of the recession for jobs to return. Guess what? Those old jobs that required obsolete skills aren’t coming back. The banks — especially the ones that were bailed out by our tax dollars — are cutting expenses, investing and reaping huge profits. Do the same.

4. Pray together. Job losses often trigger divorces. God allows us to face challenges so that we can shed the excesses and distractions of daily life in order to refocus on Him — the source of our increase. Losing income is a wakeup call to recognizing who your Provider truly is.

It hasn’t been easy, but these God-directed steps worked for my family and me. None of us have been hungry or without shelter. I moved on to better employment. I have my own radio show. I’m pursuing a doctorate. My book and consulting business are doing well. (These things likely would not have happened had I remained in that old position.) Our two teens are in college. My wife and I remain on the journey.

Losing your job is never easy, but it’s not a death sentence. What you do afterward is an opportunity to grow in your relationship with God and think more creatively about the days ahead.

The Christmas season is about faith, family, and future. Don’t let a job loss — a painful but temporary thing — take your focus off of what really matters.

Helping Victims of Hurricane Sandy

Helping Victims of Hurricane Sandy

NEW YORK UNDERWATER: A photo taken on Oct. 29, 2012, shows vehicles on a flooded street in the Queens Borough of New York City. Hurricane Sandy, the tenth hurricane this year, was one of the strongest storms ever to slam the U.S. East Coast. (Photo: Wang Chengyun/ZUMA Press/Newscom)

In the wake of Hurricane Sandy, and the unprecedented havoc that she wrought, there is a tremendous need for support services for those that sustained damage to their homes and businesses, as well as the first responders and volunteers on the ground who will be helping them. Many people are still without electricity, facing flooding, a shortage of food, and the potential loss of property and income. While emergency personnel from both local and state governments are working to assist many in the affected regions, there is always a need for more support. You can help by donating money to relief organizations. Below is a list of just a few. Feel free to add others to the comments section.

In addition, one of the most important things we can do is to pray for Sandy’s victims, as well as the emergency responders and volunteers who will be helping them in the days ahead. The Christian Post offers this list of specific needs that you can use to focus your prayers.

Charities Offering Services for Hurricane Sandy Victims

Red Cross

Red Cross operates emergency shelters throughout the affected areas, provides medical and food services, and has emergency vehicles ready to help with transportation needs.

Americares

Americares is a medical and supply organization that helps distributes emergency supplies to afflicted areas.

Salvation Army

Salvation Army provides emergency supplies, food, medicine, care, and transportation services in areas affected by Hurricane Sandy.

National Firefighters Endowment Fund

An emergency fund for victims of Hurricane Sandy

Save The Children

Save the Children provides food, medical, and emergency services for poor children and families. They have a specific program for those affected by Hurricane Sandy.

Convoy of Hope

Convoy of Hope is a faith-based humanitarian organization that’s loosely affiliated with the Assemblies of God. It has a long history of responding to natural disasters in the U.S. and abroad.

World Vision

World Vision is a Christian relief and development organization dedicated to serving the world’s poor. It also has team in place to respond quickly to natural disasters in the U.S. and around the globe.

Helping Victims of the Colorado Fires

Helping Victims of the Colorado Fires

HOW TO HELP THOSE AFFECTED BY

WILDFIRES IN COLORADO

FINANCIAL GIFTS ARE THE BEST WAY TO HELP! 

FINANCIAL SUPPORT TO VOLUNTARY AGENCIES RESPONDING TO DISASTERS IS THE MOST EFFECTIVE WAY TO HELP

Cash allows disaster agencies to purchase exactly what is needed.

To make a financial gift to the organization of your choice, dial 2-1-1 (or 1-866-485-0211) for a list of reputable agencies responding to the disaster.

Member agencies of Colorado Voluntary Organizations Active in Disaster does not promote one charity over another. Please donate to a charity of your choice. At this time, the following charities are responding to multiple wildfires in Colorado.

 Agencies Responding to Boulder Fire:

American Red Cross
1-800 RED CROSS
444 Sherman St.
Denver, CO 80203
(designate to the Boulder Fire)
www.coloradoredcross.org

Agencies Responding to Waldo Fire:

American Red Cross
1-800 RED CROSS
444 Sherman St.
Denver, CO 80203
(designate to the Waldo Fire)
www.coloradoredcross.org

The Salvation Army
303-866-9216
1370 Pennsylvania Ave.
Denver, CO 80132
www.imsalvatoinarmy.org

Designate to Disaster Relief

Agencies Responding to High Park Fire:

American Red Cross
1-800 RED CROSS
444 Sherman St.
Denver, CO 80203
(designate to the Northern Colorado Chapter-High Park Fire)
www.coloradoredcross.org

The Salvation Army
303-866-9216
1370 Pennsylvania Ave.
Denver, CO 80132
www.imsalvatoinarmy.org

Designate to Disaster Relief 

Larimer Humane Society
5137 S. College Ave.
Fort Collins, CO 80525
www.larimerhumane.org

Adventist Community Services LIFT
www.acslift.org
Note in comments that donation is for High Park Fire

Rist Canyon Volunteer Fire Department
Donations can be mailed to:
RCVFD-Treasurer
PO Box 2
Bellvue, CO 80521
Glacier View Volunteer Fire Department
Please send financial donations in the form of a check to: 1414 Green Mountain, Livermore CO 80536
Poudre Canyon Volunteer Fire DepartmentMail donations to:

Poudre Canyon Volunteer Fire Department

PO Box 364 LaPorte, CO 80535-0364The local Canyon Utilities is helping by taking credit card donations over the phone, please dial (970) 881-2262.

VOLUNTEERING

DO NOT GO TO THE SCENE OF A DISASTER

The arrival of unexpected volunteers will interfere with response efforts.

STAY SAFE by volunteering with a reputable agency!

Volunteers will be needed most during the recovery phase. Please be patient and WAIT until relief agencies can train you and use your help.

Please Click here to sign up to volunteer and list in the ‘Comments’ section the name of the fire you would like to give your time to. If a volunteer need is identified, you will be contacted by the agency that can utilize your skills.

A limited number of volunteer opportunities have been identified to assist at the Donations Collection Center for the High Park Fire. Shifts are from 7:45am-12:00pm, 11:45am-4:00pm, 3:45pm-8:00pm everyday of the week. In the ‘Comments’ section, please list your availability (date and desired shift). Please wait for the Donations Collection Center representative to contact you to schedule you for a shift- do not self deploy to the Donations Collection Center.

To make a financial contribution to the organization of your choice, please dial 2-1-1 (or 1-866-485-0211 ) for a list of reputable agencies responding to disasters in Colorado.

‘Addiction Is Spiritual’

‘Addiction Is Spiritual’

LOST SOUL: Amy Winehouse in London on July 23, 2009, exactly two years before her death. (Photo by Shaun Curry/Newscom.)

This week, Amy Winehouse’s official cause of death was finally announced, three months after the singer was discovered dead in her London home on July 23. After initial autopsy results came back inconclusive, the coroner determined that Winehouse died from consuming an extreme amount of alcohol. According to test results, the 27-year-old singer’s blood alcohol level was five times the drunk-driving limit. Her doctor said the troubled star had resumed drinking in the days prior to her death, after a short-lived period of sobriety.

Besides being a talented artist, Winehouse was emblematic of the numerous celebrities today whose public battles with substance abuse are regularly in the headlines. By the end of her life, Winehouse’s struggles had stretched to the point of becoming fodder for jokes and riddles (“Q: What was Amy Winehouse’s biggest hit? A: Her last one!”). Sadly, our society has grown so accustom to addiction that we now laugh it off. But for those in its grips, it’s no joke.

We asked LaTonya Mason Summers, a Charlotte, North Carolina-based mental health therapist, to comment on the realities of drug and alcohol addiction and what we can do to help those affected by it.

UrbanFaith: After Amy Winehouse’s death, the Huffington Post featured a commentary by Rabbi Shais Taub which asked the question, “Was the World Powerless to Stop Amy Winehouse?” In other words, are there addictions so strong and pervasive that they’re beyond human understanding and control? How would you answer that?

LaTonya Mason Summers: The word choice is interesting here, and I agree: the “world” was powerless to stop Amy Winehouse. But it was the “world” that fueled Winehouse’s addictions. Not “world” in the sense of the “earth,” but “world” as defined by Winehouse’s frame of reference — the background, culture, and lifestyle out of which she lived. Addictions are strong, pervasive and hard to understand and control, but it’s even more difficult when one tries to stop addiction by their own strength and understanding. It is reported that Winehouse died from alcohol poisoning. Drug and alcohol abuse is a byproduct of something far deeper. Oftentimes, it’s a symptom of low self-esteem, unresolved trauma and abuse, rejection and abandonment, and mostly fear. We do a great disservice to addicted persons when we focus on their addictions and ignore the underlying problems.

We see so many celebrity drug and alcohol addicts today that our culture has almost grown cold and callous to it. For instance, before her death there was a website devoted solely to the question of “When will Amy Winehouse die?” We see celebrities such as Winehouse, Lindsay Lohan, Whitney Houston, and Charlie Sheen, and we make jokes about them. How does this affect our culture’s understanding of addiction?

When we have a culture entertained by reality TV shows, court and crime TV, and sensationalized Web broadcasting — not to mention today’s popular music — we can’t help but have a desensitized society. We are no longer afraid of or empathetic toward anyone or anything because we’ve been there and done that through TV and the media. So, why wouldn’t we have a “When will Amy Winehouse Die?” website?

Unfortunately, we live in a society that “dumbs down” addictions but tacitly gives a “thumbs up” to its portrayals. Remember when there used to be cautionary documentaries on drugs and alcohol, and on people who struggled with them? Now, we have reality shows that glorify dysfunctional behavior. No wonder we are ignorant. Understanding addictions is no longer newsworthy.

How do you counsel a person with a serious drug addiction? Where do you begin, and what kinds of things should family and friends understand as they’re trying to help that person?

I used to set up and run treatment programs for adolescent and adult substance abusers. I absolutely loved that line of work, but it was emotionally tough. After 11 years of doing it, I stepped away to work solely with mentally ill people. The public sees addicted persons as weak people who lack self-control and deserve every consequence they face. But can you imagine the level of shame, guilt, frustration, and hopelessness that those substance abusers felt by the time they got to me? Imagine having failed everyone, including yourself, family, friends, employers, and the legal system — not to mention God. I always started treatment by instilling hope and restoring the addicted person’s sense of worth. It was much easier to establish rapport, trust, and motivation that way.

God forbid I say this, but oftentimes the families were more sick than the addicts. In fact, family members would wind up on my couch before the addict would. Family work is important in substance-abuse treatment, because the family members can make recovery hard. They help too much. Their helping sometimes hurts the addict. When my patients had toxic families, I’d send my patient to a treatment program in another city or state so they could get better.

Over the summer, former NBA star Jalen Rose was sentenced to 20 days in jail for drunk driving. Some wondered if the treatment was overly harsh because he was a black celebrity, since others have gotten off easier. Do you think jail time is an effective way to steer people clear of destructive behavior involving alcohol and drugs?

In my experience working in the court system as an advocate for my clients, the courts made it worse. The punishment given rarely fit the crime. The probation officers were inconsistent. The judges sent mixed messages by punishing minor crimes with maximum sentences and vice versa. Jail time is punitive, and punishment does not work when the drug or alcohol use is secondary to something else. Addicts don’t mind punishment because they typically feel useless and worthless anyway. That kind of punishment affirms what they believe about themselves. However, I am not saying they should not suffer consequences for drunk driving, drug use, etc. I am saying that offering them rehab while they’re incarcerated might yield greater results.

What kinds of miracles have you seen in your work with people battling addictions?

LaTonya Mason Summers

Goodness, the stories I can tell. I’ve had a hand in imparting into the lives of addicted persons who are now pastors, business owners, and even addictions counselors. I had a 15-year-old girl whose parents brought her to me as a last resort. She had refused other counselors, and I assumed she would do the same with me. After I asked her parents to leave, the girl opened up to me like a book. (It wasn’t because of anything special that I said to her, but other professionals simply had failed to remove the parents.) The girl was a cocaine user and held me by her confidentiality rights, so I could not tell her parents. We made a pact that if she stopped using I would keep her secret. I cannot tell you the anxiety I had for weeks thinking something would go wrong. I collaborated with her physician to drug test her weekly to ensure the girl’s abstinence. After three months, her parents called thanking me for my help. The girl had returned to a healthy weight, her appetite had been restored, and her mood had improved. Today (four years later) she is a successful college student studying psychology.

Among the celebrity success stories that stand out are Robert Downey Jr.’s eventual victory over substance abuse. It only came after several stints in jail and a long, public battle. What kinds of things contribute to a successful road to recovery, and when do you know that someone is legitimately recovered?

My biggest weapon is instilling hope. I do this by challenging the addicted person’s mentality and perspective. I am a cognitive behaviorist, which means I help change the way people think. I do not know what works, as I have often thrown up my hands on clients who later recovered. Then I have lost clients whom I thought had arrived. All I really know is, pray hard in each session. I ask for God’s help. I ask Him to give me the words to say, and I hold on to Isaiah 50:1-7, believing I am called as a therapist.

I honestly don’t know when a person is legitimately recovered, as I believe it’s a lifelong process. Like those of us who are not addicted, we have our own lifelong battles — we try to stop lying, cheating, stealing, yelling, cursing, overeating — everyone has a Goliath they must face. And can any of us say we’ll ever arrive in this world? From my perspective, messing up is just as much part of the recovery process as getting it right is. And, if you get it right all the time, how do you know you’re recovered?

Is it possible to effectively treat addiction without addressing the spiritual aspects of the problem? 

Absolutely not! I’ve had to learn how to minister without saying “God” and “Jesus,” so that I can reach everyone. However, I know how to make others want what I have. I was mentored by a man who told me, “I may not be able to make a horse drink the water, but I should be able to make him thirsty.” And that’s the approach I take in therapy. I see myself as sowing seeds, believing someone will come behind me and water them, and eventually increase will come.

Addiction is spiritual. I believe an addict’s zealousness can be indicative of the great calling on his life. He just needs to move that zealousness away from destructive behavior to purposeful, life-giving behavior.

LaTonya Mason Summers is the founder and executive director of Life Skills Counseling and Consulting in Charlotte, North Carolina, and the cofounder of the NC Black Mental Health Professionals Alliance, which aims to educate African Americans about mental health issues and wellness.