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Adapting proves key when reporter's story on addiction treatment doesn’t go as planned

Topics in Health: Lessons From The Field

Adapting proves key when reporter's story on addiction treatment doesn’t go as planned

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[Courtesy photo by Nicholas McVicker/KPBS]

If you're pitching a story that’s going to take you off deck for dailies — and, in my case, pull you more than 100 miles from your desk — it helps to have two things: a great character with strong emotional appeal, and a clear wrongdoer.

When I decided to look into a shortage of residential addiction treatment facilities in California’s Imperial County, I thought I had those ironed out.

As I saw it, the “wrongdoer” was an archaic Medicaid reimbursement rule that pushed larger rehab facilities out of business in favor of more small centers, and the NIMBYs that rejected those small centers. For my character I would find someone who had to travel more than 100 miles to San Diego — away from his or her support network of family and friends — to get well.

The problem? As I learned on my first reporting trip to Imperial County, it turns out counselors actually recommend you get out of town, away from bad habits and triggers, to get clean.

As if to rub my "duh” moment in a bit, a source also pointed out, "Who wants to get sober in triple-digit heat?" When given the option to complete rehab at a local facility, where high temperatures prevail, or one in San Diego, people almost always choose balmy San Diego.

I finished Reporting Day 1 with the sinking feeling that I didn't have a story. That's when I learned lesson No. 1.

Talk in person early on (and leave your storyboard at home)

I had talked with multiple people over the phone before pitching my story, and all of them seemed to agree with my premise. I don't know if they were distracted during those calls, or agreeable because a reporter wanted to cover their program, or maybe I wasn't explaining it well. But in person, those niceties fell away and the conversation became more honest and productive.

Plus, talking in person better lends itself to tangents.

When I started to get the hunch that my original story pitch was all wrong, I asked the head of behavioral health in Imperial County what he thought the story was. The conversation splintered into several tangents and we followed each one to their end.

That question — and the flexibility to let someone talk, as opposed to trying to get scenes on tape — saved me.

As he talked, I scribbled down at least a half-dozen new angles. One of them became my story.

Imperial County would soon participate in a Medicaid pilot to better fund comprehensive mental health care for people struggling with addiction, and that could turn the current, largely faith-based model on its head.

It was timely. It had tension. It told us something bigger about our perceptions and trajectory as a society.

The next challenge was reimagining who would tell the story. I wanted someone who could lay out for people why intervention by mental health care professionals could lead to dramatically better outcomes. I had dreamed up my ideal character: someone who tried all of the traditional recovery routes but was ultimately helped by a psychologist's diagnosis and treatment.

I called psychologists, psychiatrists, mental health advocacy groups and addiction counselors — everyone who might know this person. None of them did, or if they did, couldn't put me in touch with him or her because of privacy rules.

This is where I learned lesson No. 2.

Your perfect character doesn't exist, but there is one out there

One of those I called during my search was Susan Ireland. I met her early on in my reporting when I visited a SMART Recovery group meeting.

I was there because the program was halfway between what is and what could be when it comes to addiction treatment. It’s heavily focused on group meetings and is typically led by former addicts, but it employs cognitive behavioral therapy. I wanted to talk to Ireland's boss about whether incorporating psychology was showing any promise.

I had written my third or fourth email to Ireland pestering her for contacts when I realized that she was my character.

She had tried everything — getting sober on her own, Narcotics Anonymous, Alcoholics Anonymous, a faith-based recovery home, SMART Recovery, a perinatal program through behavioral health, seeing a psychologist, and taking medication.

She couldn't say that it was mental health care alone that got her sober — she said it was a combination of everything — but she could tell me exactly what she took away from each intervention and how they were different. And she had already shown me she was reliable and open.

The other thing I liked about her brings me to lesson No. 3.

Gray is good

I believe the resulting story was fairer and more helpful than it would have been had my main character come down squarely on the side of addiction treatment by mental health professionals.

“Lots of different people use drug for lots of different reasons.”

That's what Imperial County Behavioral Health Director Michael Horn told me while explaining why it makes sense to fund psychological assessments for people with substance use disorders. And it’s the exact same reason why he and others told me we should preserve faith-based providers and drug counselors.

The bottom line is that choice is good when you're trying to solve a public health problem that's also deeply personal.

And this story had one other shade of gray I wanted to talk about.

When I started, I wanted to zero in on a distinct policy or rule that would explain Imperial County's addiction treatment gap — that “wrongdoer” I mentioned up top. Instead, I circled around something a little mushier. Horn summed it up this way:

The problem we've had historically is that down deep inside nobody really believed that people could recover from substance abuse. A lot of people would go in and out of recovery, so there wasn't a lot of faith in any systems. So they weren't funded real well. I think (the Medicaid pilot) shows we have a lot more confidence in mental health treatment in general now.

I think the story ended up telling us something about where we've been and where we're going as a society, and I feel pretty good about that.

Courtesy photo by Nicholas McVicker/KPBS.


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