Kevin Kirby, who has been in remission for twelve years, is building the infrastructure for a chronic care model of addiction recovery that engages communities and employers alike, breaks down silos between the two, and destigmatizes this age-old disease.
The New Idea
Alcohol and other drug addictions affect nearly 10 percent of the adult population in the US yet less than 10 percent of those struggling with it actually seek help. Kevin is working to ensure that addiction is understood and treated as a chronic disease in order to increase the number of people who seek help and their success rate in sustaining their remission.
Though other initiatives seek to destigmatize addiction, many continue to approach treatment through an acute care model (when emergencies arise) and no organization has positioned itself nationally to take a comprehensive and sustainable approach to systems change around addiction. Kevin is breaking down stigma, in part through a public education campaign, but mainly by pointing out the economic incentives for employers to become part of the solution. Not only is his approach bringing a new ally to this cause, it is creating an environment of trust where employees, often for the first time, hear about addiction as a chronic disease from none other than their boss. The model provides value to the private sector, primarily employers, in return for a sustainable, stable funding stream for this work, ensuring long-term sustainable growth. (The majority of addiction services are funded through government monies, making them vulnerable to changing priorities and budget cuts.)
Kevin and his team are beginning their work in Sioux Falls, South Dakota. They are in the early stages of spreading to other communities in South Dakota and the Upper Midwest. Since 2008, they have reached more than 40 percent of Sioux Falls’s workforce, reaching several hundreds of new people per month.
In 2012, Kevin established Face It TOGETHER as the national headquarters of which Face It TOGETHER Sioux Falls has become an affiliate. The plan is to increase the number of affiliates across the country and to do for addiction what Susan G. Komen for the Cure has done for breast cancer.
According to the US Department of Health and Human Services, in 2005 an estimated 22 million Americans (7 percent of the US population) struggled with alcohol and drug problems, and of those about 95 percent were considered to be unaware of their issues. Among those who recognized their problem, many made unsuccessful attempts to obtain treatment.
Addiction is a primary, chronic disease that contributes to other chronic diseases as well as other serious, tertiary and end-stage conditions. In addition, about one-in-four children under the age of 18 will at some point live with a parent with an addiction problem. These children are at substantially greater risk of being maltreated by their parents, failing in school, struggling with mental health and behavior problems and addiction.
Addiction has been found to be the number one cost driver in both the social service and criminal justice sectors. The cost of excessive alcohol and illegal drug consumption alone in the US in 2000 reached $346 billion. It is estimated that every man, woman and child in the US pays nearly $1,000 a year for unnecessary healthcare, extra law enforcement, auto crashes, crime and lost productivity as a result. Addiction costs employers $200 billion annually due to lost productivity and higher turnover, accidents and healthcare costs. Perhaps contrary to popular beliefs, among adults classified with a serious alcohol or drug problem, about 60 percent are employed.
The obstacles to initiating and sustaining recovery are significant. These include stigma, shame, financial and employment barriers, and well-documented failures in the current system of addiction care. In addition, the field is so fragmented that progress is stagnating. Kevin has identified three main players in the field: treatment providers (i.e. 30-day residential programs, intensive outpatient initiatives); addiction specialists (i.e. researchers and scientists teasing out best practices); and recovery organizations (a budding field focused on both medical and non-medical aspects of recovery long-term). Sadly, these players have not collaborated and often work at cross-purposes. Although the medical and scientific fields have long recognized addiction as a chronic disease, it continues to be treated like an acute health crisis in nearly every community across the country. Because of the mismatch between the chronic nature of the disease and today’s predominant treatment approach, there is little emphasis on education and early intervention, and people with addiction don’t get the continuing services and supports needed to sustain recovery over the long-term. In addition, the recovery movement, which Face It TOGETHER belongs to, has been very limited in scope and sustainability. Combined, these three sectors are able to reach only 10 percent of the people who need help.
The failures in today’s system of addiction care are also inextricably linked to the way healthcare is delivered and paid for in America. The current “acute” model of care is due in large part to decades of regulations and public policy that have created a healthcare payment system which incentivizes service volume rather than value or outcomes.
Kevin initially began his commitment to the field of recovery by becoming a service provider. In remission himself, he decided to bring a proven transitional living facility model from Minneapolis/St Paul to his community. He founded the Transitional Living Corporation LLC in 2003 and built it up from the ground. The organization quickly became a self-sustaining citizen organization (CO) with a strong track record. While there were none when Kevin started, there are now five transitional homes in South Dakota as a result. From the beginning, Kevin wanted to do more than “just” provide transitional living and peer-to-peer support to people in recovery—he wanted the organization to be the leading advocate for recovery. This decision set Kevin’s career path. He spent six months intensively researching addiction to understand the treatment, recovery, and addiction industries. He came out of that process with a large dose of disbelief about the size of the problem and the blatant inadequacies of existing solutions. It was clear to him that the Transitional Living Corporation, a service provider, would not be able to create the sort of movement he now understood to be needed. He transitioned the leadership of this organization into very capable hands and set out to build what would eventually become Face It TOGETHER Sioux Falls.
To be successful Kevin intuited that he would need the community to co-create the vision with him. The level of stigma surrounding addiction was too high for him not to engage community leaders from the beginning. Kevin and his co-founder Charlie Day decided to embark on a long town hall process. They galvanized everyone from the mayor to service providers, the healthcare industry, schools, universities, and law enforcement to help them understand the problem, get them to buy-in to a solution and contribute to a movement of recovery care. This process not only paved the way for success and unlikely alliances, it led to the conclusion that aggressively targeting employers as part of the solution could drastically broaden the reach and sustainability of recovery efforts.
Influenced by his business background, Kevin found it critical to find partners who would have a financial stake in the solution. Given that employers have a critical vested interest in ensuring their workforce is healthy and productive, he targeted them first. Employers bear a significant portion of the costs that accompany their employee’s addiction problems in the form of turnover, absenteeism, low productivity, and hidden healthcare costs. A study commissioned by Face It TOGETHER found that every dollar spent on addiction treatment and recovery in South Dakota delivers over $8 in benefits, the majority going to employers. Kevin is therefore targeting CEOs and their Human Resources departments to address addiction within their employee wellness programs. By doing so, he creates a channel for companies to be part of creating a recovery-oriented community. He’s also creating a predictable revenue stream for his work.
Through the employer initiative CEOs publicly declare to their employees that they understand that addiction is a chronic disease, and that there will not be negative consequences for admitting to needing help. They also bring in to the workplace a person in remission from Face It TOGETHER’s speaker’s bureau whose role it is to share their story of addiction and recovery: the good, the bad and the ugly. The message hits home very effectively and paves the way for employees to seek help.
With each employer, Face It TOGETHER undertakes a baseline survey of attitudes and behaviors toward addiction. Typically, the baseline confirms that people are deeply uninformed and ambivalent about those who suffer from addiction. By tracking changing attitudes, knowledge and beliefs, Face It TOGETHER aims to see how they are faring on their goal of destigmatizing the disease. The organization partners with a professional evaluator to measure these changes. In addition, participating employers are defining their own metrics to help show return on investment in the program, including changes in insurance claims data, Employment Assistance Program usage, and the number of employees and families contacting Face It TOGETHER Sioux Falls for help. More qualitative measures include the development of peer-to-peer support processes in the workplace and the engagement of senior management.
So far, Kevin has attracted 23 employers in Sioux Falls to become part of the movement. They represent the largest employers in the community and employ close to 40 percent of the local workforce. One of the companies saw nearly 5 percent of their employees come forward with serious questions about addiction. They know of 11 employees of theirs who subsequently sought treatment. Though Kevin has mainly targeted the largest employers in town as first adopters, his team is beginning to attract smaller businesses that may not have an HR department, or have less sophisticated wellness programs.
Awareness alone would be grossly ineffective, so Face It TOGETHER has also created a community-level clearinghouse for addiction recovery and support. It is thus removing a colossal information barrier, and connecting people and families to each other, to information, and to resources according to their needs. They help individuals navigate the recovery process. This includes referrals to treatment facilities, peer-to-peer support groups, housing, employment, transportation, etc. The clearinghouse serves as a resource to HR departments of partner companies. Its services are open to anyone in the community, free of charge. The recovery clearinghouse also provides a wide range of peer-to-peer recovery support services. These are nonclinical services and activities to help individuals and family members enter and stay in recovery from addiction. These work in concert with traditional treatment by filling important gaps. These services aim to eliminate personal and environmental barriers to recovery and enhance quality of life. Provided by trained peers in recovery, the ongoing services include telephone recovery support and recovery coaching.
The employer strategy is also combined with broad public awareness campaigns about the disease of addiction through TV, radio, and billboard campaigns. They have led to a noticeable increase in public dialogue, understanding and demand for treatment. Face It TOGETHER is thus increasing the odds that people will overcome the psychological barriers keeping them from accessing recovery services by combining awareness with access to the clearinghouse.
The next stage of Kevin’s work is to replicate Face It TOGETHER’s early successes across the country. Face It TOGETHER Sioux Falls (the clearinghouse and the employer initiative) is now officially the first affiliate of Face It TOGETHER (the national umbrella organization responsible for replication). So far, the national organization is launching another affiliate through a recovery community organization in Aberdeen, South Dakota. They also have demand from another ten communities across the country to bring their model there.
Kevin is looking to partner with organizations that can help them infiltrate many markets at once. He is targeting integrated healthcare providers to accomplish this networked spread strategy. Because medical institutions are having trouble keeping up with the escalating costs of healthcare, the industry is getting massively consolidated to create economies of scale through a few, large integrated care providers. These organizations are rapidly gaining important market shares across vast regions of the US. In addition, they are being held to new levels of accountability as a result of the Affordable Care Act. Healthcare providers are now eligible for reimbursements from insurance providers (public and increasingly private) if they are able to show that the care provided led to improved health outcomes. With chronic diseases, including addiction, integrated care providers are becoming aware of the need for community-based support of the kind Face It TOGETHER is providing to sustain health outcomes. The organization’s work with integrated health providers will essentially build an addiction chronic care model within a community—providers and a community organization working together to improve health outcomes, enhance patient experience, and lower provider costs.
The team is therefore targeting a few enlightened providers that understand that it is in their best interest to partner with an organization that can help build the necessary community resources to begin managing addiction as the chronic disease it is. The plan is for these integrated care providers to take a leadership role in organizing community stakeholders to contract with Face It TOGETHER to build out this component of recovery care. By partnering with integrated care providers like Sanford Health, Avera Health and others, Face It TOGETHER hopes to quickly gain access to large markets across the country in a financially sustainable manner. Face It TOGETHER’s partnerships with integrated health providers will also include a robust evaluation model for measuring shared outcomes.
Face It TOGETHER Sioux Falls is sustained mainly through revenue from employers and the United Way. It is the first recovery organization to ever become a United Way agency—this precedent setting partnership bodes well for the sustainability of future affiliates across the country.
Kevin is a survivor of addiction and has been in remission for just over twelve years. Prior to beginning his long-term recovery, he seemingly had it all—a solid education in finance and law, a successful business career as an entrepreneur, a wife of twenty-five years, three wonderful kids with whom he was very engaged, stature in his community with years of experience as a philanthropist and as a leader of just about every large civic organization, and a long career as a professional corporate director both in the for-profit and non-profit sectors.
Over the span of two and a half years, Kevin got treatment for his addiction, during which time he received eight and a half months of residential care at four separate in-patient treatment facilities, plus numerous visits to behavioral health facilities, detox, emergency rooms and intensive care units. Throughout that period, he experienced suicidal ideations and made one unsuccessful attempt. Kevin also experienced immense amounts of shame, first as a nearly insurmountable barrier to getting the help he needed and, second, as a tremendously negative force each time he relapsed. His life was fundamentally transformed by his experiences recovering from addiction.
Today Kevin has a serenity of purpose that he never knew was possible. That purpose is to carry the message of recovery to as many people as possible. Ever since he first started learning about the magnitude of addiction in this country, the well-documented barriers keeping people sick, the disconnect in today’s service delivery system and the vacuum of leadership in the fields of addiction, recovery and treatment, it was as if he had no other choice than to create an organization capable of successfully solving these problems.
Kevin is convinced that during his lifetime he will live in a nation in which addiction has been eliminated as a major public health issue. Face It TOGETHER is the way he plans to get there.