Is a Wisconsin heath profession dying?

If you weren't on the inside you wouldn't know anything was wrong. I am on the inside and I know something is very wrong with our Wisconsin addiction profession and its traditional advocate and support associations.

Yes, addiction treatment is still provided as usual for alcohol and 11 of the 12 substance use disorders. Nicotine dependence is excluded. Patients are being admitted in hospitals for detox and inpatient treatment. Some are treated in residential treatment in state-licensed programs. Various levels of outpatient treatments are available. Halfway houses and other long-term residential programs are operating in some communities, mostly urban. Every Wisconsin county offers some level of addiction treatment, or AODA as we call it in Wisconsin, either by county staff or contracted services.

Everything is working as the system was designed and our state and federal governments funds it. There are AODA programs in the private sector; most are in the public health system. Will it continue and who will provide the leadership and consumer/provider oversight AODA needs?

Wisconsin has a long history of providing alcohol and other drug abuse treatment. Four advocacy and support associations have championed the development and support of that prevention, intervention and treatment system. These associations are all in trouble and are disappearing, in fact 3 of the 4 are already gone or going. The fourth is trying to gain enough membership and support to survive. The main hub of Wisconsin AODA advocacy, the Wisconsin Certification Board is long gone.

These are the four traditional advocacy/support associations:

• Wisconsin Association on Alcohol and Other Drug Abuse (WAAODA.) WAAODA's mission is to assure that the people of Wisconsin know and believe that alcohol and drug addiction prevention, treatment and recovery work. WAAODA provided training, education and other support. This year after 46 annual statewide AODA conferences WAAODA cancelled the 2013 conference and closed its doors. Their future is unknown.

• Many in the AODA field would agree the Wisconsin Certification Board provided networking, technical assistance to AODA counselor, prevention and supervisor candidates that provided a central service to all regions of the state. The WCB provided the path to AODA certification, support, networking, advocacy and employed a full time staff. The state joint finance committee eliminated the WCB from Wisconsin's AODA system during the Thompson era. The field has not recovered from its loss.

• Wisconsin Alcohol and Drug Treatment Providers Association was a trade association advocating for the private and non-profit AODA programs serving Wisconsin's residents with substance use disorders. WADTPA was a vibrant, active advocacy association in Wisconsin for decades. WADTPA has not met for more than 2 years.

• WAADAC, the Wisconsin Association for Addiction Professionals has represented AODA counselors, supervisors and other addiction practitioners for decades. WAADAC is a state affiliate of NAADAC, the National Association for Addiction Professionals.

There are more than 2,000 AODA practitioners in Wisconsin. WAADAC has a membership of slightly more than 100 including students. Efforts to expand membership to all those employed in the AODA field have not been successful. Recently WAADAC changed its name to Recovery and Addiction Professionals of Wisconsin – RAP-WI.

A new advocacy association was formed in 2012 created to reduce the stigma associated with alcoholism and other addiction and promote support for recovery and its positive achievements and potential. WIRCO, Wisconsin Recovery Community Organization, remains in the early development phase. It is planned as a statewide association but currently is unfunded but has an active board of directors.

The cumulative loss of these advocacy/support associations means there is no longer credible AODA leadership as the field faces major pending changes in AODA and related services. Upon us is the Affordable Care Act, the new Scope of Practice Guidelines for clinicians, the Diagnostic and Statistical Manual (DSM-V) and parity. Who will represent the interests of the treatment providers, the clinical services providers and most of all the consumers of AODA services?

If there is no infusion of leadership, energy and commitment from the AODA field to re-vitalize the state's advocacy associations who will assure that wise policies will be developed? Maybe it is too late. Efforts over the past 3 years to unite Wisconsin's AODA advocacy associations have failed. Those of us that were part of this re-organization process are demoralized and discouraged. Most have abandoned the issue because of the lack of support and resources to begin again.

So, the decline of Wisconsin's advocacy associations has perhaps reached the point it is too late to save what once was so impressive and reassuring. We once fought hard to provide the effective treatment and recovery services our people suffering from substance use disorders and their families deserved. Maybe we forgot we needed to focus on "what's in it for them"; them being our patients and clients in need of our services. We have focused too much on "what's in it for me" and forgot we were all in this together.

Have we lost the glue that once made us a community of providers and consumers? If so, the people we came here to serve will be worse off because we did not preserve the associations that once led us and protected our profession, providers and consumers.

David "Mac" Macmaster, CSAC, PTTS

City Life

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