As we transition from outgoing CEO & President Doug Tieman to incoming CEO & President Brad Sorte, interviewer Oliver Picher sat down with the two of them to get their perspectives on the transition, what has been accomplished during Doug’s tenure as CEO, and the challenges and opportunities that lie ahead for both Caron and the addiction treatment community in general. Here is a transcript of their conversation:
You each took very different paths to get to your role today. What do you think is the common thread between your two paths? Let’s start with you, Doug.
I would start with purposefulness. Becoming CEO of a significant nonprofit treatment center became a goal of mine in my early 30s, and I really began to develop a plan to get there. Knowing something about Brad's career since I had a hand in it and was able to watch from the sidelines, I saw a similar purposefulness and planning for him to get to the position as well. To me, that is a common thread.
Brad, what's your take on the common thread between you and Doug and the path you've both taken in your lives.
Doug and I spoke about this when we began working very closely together six years ago, when I was interviewing to oversee the Caron Florida continuum. It was a concept that I believe in, and something that was in Doug's book: Great leaders are great because they want to be leaders. It's that desire to take one's ability to unify people behind a shared vision to create a rising tide that helps carry an organization, something that I think both the both Doug and I feel very passionately about.
The other part of it is the idea of really being driven by a mission and the recognition that there's a responsibility, especially at Caron, for us to chart the course for the future, not just for the organization but also for the field. People look to Caron as the standard bearer, and what we do really does have an important effect on our colleagues in the field, shining a light forward in terms of leadership, as well as helping to shape the way that we are going to help our mutual patients as a field in the future.
Doug spoke about setting a goal in his 30s to become to become a CEO of a major treatment center. Brad, you’ve spoken recently about also being very intentional in your career path as well, having both a clinical background and a business background. Can you speak to that a little bit?
I decided I was really very interested in the clinical side of substance use disorder treatment as an undergraduate studying psychology. Then, as I was going through graduate school and my first couple of jobs in the field, I realized there seemed to be a great deal of opportunity in the healthcare administration space for people who understood both the clinical side as well as the business side.
I'd seen too many organizations that were run by senior clinical people who had kind of been promoted out of seniority but didn't understand how to run a sustainable business, and, as a result, the organization would suffer. Then conversely, I saw the flipside – professionals who had a keen understanding of how to run a business but didn't really understand the nuanced and complicated dynamics of helping people with substance use disorder – and the clinical care suffered. I felt if I were able to become an expert in both of those disciplines that there would be a great opportunity for somebody like that in the field, and both were areas of significant interest and passion for me. The niche that I sought to carve out for myself was to be that clinically astute healthcare business leader.
Doug, what's your perspective on that?
Brad recognized the opportunity and realized there was a gap in the skill sets that he had if he wanted to be a CEO. And so he intentionally went about getting the necessary skill sets he needed.
My own path was similar. My background was in fundraising, so I was a real anomaly when I became CEO of Caron in 1995. I don't know of any treatment center that had ever hired someone as CEO who started their career as a fundraiser, but I had worked carefully to address all the skill gaps I needed to become CEO. I was fortunate that the organization I was working for sent me to get an MBA in healthcare administration from University of Minnesota and also gave me an opportunity to run one of its clinical facilities, so that I had experience in clinical oversight.
That's part of the intentionality of position like this. We all come with certain attributes and skills and expertise, but to be a CEO you have to broaden yourself. It requires planning to do that, and you have to have some good mentors that can help you build a comprehensive skill set.
Turning to larger issues, we're coming out of the pandemic, and we seem to be in a unique and sensitive time in history. The state of mental health has been broadly impacted by pandemic, and it’s critical that we be taking appropriate steps to return to health. Where do you think we're going to be a year from now, as a society? What do we need to do for the next one to three years to rebound from this impact on our mental health?
We have seen over the course of the past year that the dual epidemics of substance use disorders and the mental health crisis in this country didn't go away because of the pandemic. In many ways, they got worse even as they were overshadowed. The year 2020 saw the highest number of overdose deaths ever, an alarming shift upwards to the highest numbers we've ever seen. We've also seen much greater incidence of co-occurring disorders in the people coming into Caron's care – a 30% increase in anxiety disorders alone – and the majority of people admitted to one of our programs having a co-occurring mental health along with a substance use disorder.
Things are beginning to open up and life is beginning to return to normal, but a year from now we're still going to see the lingering aftereffects of the disruption that occurred in the past year. We're going to see people who have meandered into an active phase of substance use disorder and are now trying to manage that, get into recovery, and get their life back on track. We're going to see the same with mental health. For those who were already in an addictive process prior to COVID-19, they are in many cases dealing with multiple confounding issues that are making recovery more challenging and the treatment necessarily more multifaceted.
I also think we're going to see a bifurcation of our society to some degree – those who are not at risk will very much be moving on from the effects of the past year, while those who have been greatly impacted by it will continue to deal with the lingering aftereffects for quite some time.
Let me just share an interesting observation about that. The more the world changes, the more it stays the same. When I became president of Caron 26 years ago, the field of addiction treatment was in a period of contraction. Half of the residential treatment centers had gone out of business between 1990 and 1995. Had we cured addiction, that probably would have been a good thing, but, unfortunately, we had not. At a time when we had an increasing number of people needing help, there was a diminished number of resources available to provide help. While things are very different in some ways today, we still face those same issues – an enormous need with not enough financial resources available for people who need the help. That’s the big dilemma going forward. How do we get more financial resources to get the care that people need? I find it really frustrating, because when people get good help, they get well, at a much higher rate than any other chronic illness. Just as it was a challenge in 1995, it is still a challenge today. It looks different, and feels different, but at the end it's still the same: Getting enough resources to get people the help they need.
We do seem to be in a pivotal time of transition for the addiction treatment space. A lot of Caron's peers are changing leadership as well. What do you think is to be gained by this change in leadership and the new energy and perspective that's coming with it?
I think it's a very exciting time. But any leadership change also has its challenges. If you study leadership transitions, some organizations do it well, while others plateau for a while before they resume growing, and still others regress.
I have great optimism that we did it [the CEO transition] the right way, and that Caron will see continued momentum. This was a very deliberate, thoughtful process, both in when I would step down and how we would go about selecting the next leader. We were very deliberate in developing someone internally, who knows our culture, knows our organization, and is already in love with the organization. There’s no learning curve here. Brad already knows Caron. The employees and the larger community also already know him. I'm really quite excited for Caron, because Brad will bring, as you used a great word, new energy, new creativity, new thoughts, new way of thinking for a population of younger people who will need Caron’s services in the future. I'm very excited for Brad, and I'm very excited for Caron.
I'm excited as well, most significantly because the Board's decision to move forward with me as Doug's successor is a validation of the direction of Caron has been taking, which is something that's very important and personal to me. I’m very fond of Caron, the organization that we are, and our efforts in outcomes and research, specialty programming and increasing access through our unique insurance contracts. The Board has given a mandate to continue pursuing those goals, and I feel strongly this is the direction the organization should be taking.
The addiction treatment segment is in an interesting transition as well. Many of those now moving into leadership roles are people like me, who came of age in our professional careers when the integration behavioral health and the treatment of substance use disorders had already begun. The recognition that co-occurring disorders and the treatment of substance use disorders both had to be approached in a behavioral health setting was very much well underway, and this understanding will be critical as we enter into the next era.
We must also acknowledge the immense amount of trauma – developmental and complex trauma specifically – that our clientele has usually experienced. Hopefully, we will begin to rapidly break down the silos that continue to exist in our segment. It is time for us to recognize that any evidence-based treatment modality has the possibility to be the right approach for a particular person. The sector as whole must become person-centric in deciding which combination of approaches that individual needs.
Doug, what do you hope your legacy will be for the Caron community, and for those it reaches?
There are a number of areas that are important to me. One is that substance use disorder is a medical condition. When I came to Caron 26 years ago, we had a part-time doctor who was here one hour a day, and now we have well over a dozen full time physicians. We have gone a long way towards integrating ourselves into the mainstream of healthcare. In fact, that's one of the visions we have, that someday this illness will be detected and monitored in the primary care physician's office just like any other chronic illnesses.
The second is research and the difference it’s making in treatment both in the short and long-term. In my monthly lecture to patients and parents, I would tell them that the good news is, we know a lot more today than we did five years ago. The bad news is, we're going to know much more five years from now. In other words, we don't know it all. Caron's quest to continue to raise the bar through research is something that I'm particularly proud of, and that we are extremely committed to. What I refer to as my "land on the moon" vision is that someday we will know all the key ingredients to get a 100% cure rate, and it will take research will get us there. That's something that Caron and the sector should continue to focus on.
Increased access is also something that I'm very proud of. Initially, increased access was through scholarship funds for patients. Now it's a combination of scholarship funds and insurance, but it’s insurance contracts under our conditions, on our grounds.
I also think of leadership, with Caron continuing to be a humble leader in the field. The beauty of being a nonprofit is we are eager to share what we learn with what might normally be considered our competitors so that the entire field of addiction treatment benefits.
Finally, I weave all that together with philanthropy. We're proud of being a fundraising organization. We raise more money than any other treatment center in the United States, and we're proud of giving our alumni and our communities an opportunity to invest in making the world a better place, as it relates to substance use disorder.
Brad, you're on now. What do you hope to achieve in the next year, and what are your plans for five years? Doug mentioned that we'll know more in five years. What do you think we'll know?
Next year is the last year of Caron’s current five-year strategic plan, so we will soon be entering into our strategic planning process. This is an absolutely critical year for setting the stage for the next five years. For me, the focus is on pulling together our various stakeholders, internal and external, looking at what we've been able to accomplish over the past couple of years, and honing in on the initiatives that will be critical for Caron as it moves forward into the future.
One of the cornerstone pieces of that effort will be the development and growth of the Research Center and our overall research efforts. That research, combined with the continued sharing of our outcomes data, validates that the right treatment really does have a transformational benefit on people and their ability to get into recovery and stay sober. We're going to continue to build upon the foundation that Doug has built in his 26 years as CEO: The integration of medicine, mental health and treatment of substance use disorder into a more holistic approach which recognizes that individuals are dealing with maladies in multiple dimensions. We must meet the needs of individuals by taking an integrated approach to treatment in a specialty environment.
What is the treatment landscape going to look like five years from now? I think that research and outcomes will truly become much more the norm in the field. Research is the foundation, so that we understand the disease of addiction and know what outcomes are meaningful to someone in treatment. The addiction treatment community is just beginning to understand the importance of using outcomes – the long-term impact treatment has on a patient’s substance use, family life, mental health and physical health – as the best measures of the success or failure of a program. We're also going to see a greater integration between the discipline of substance use treatment and the rest of the healthcare system, so that there will be less of a chance for people to fall through the cracks when they have complex medical issues.
Doug, any parting advice to the addiction treatment community?
One of the things I'm proud of at Caron is that, as much as we have changed and brought in all of the sophisticated elements I’ve discussed – medicine, research, access – the values of the organization remained solid. As our sector continues to evolve and become more integrated with mainstream and behavioral healthcare, we must also retain our values, our compassion and our dignity.
We need to continue to raise the bar on research and outcomes. When I began as CEO 26 years ago, Caron was a small, niche organization, and most people within the healthcare industry did not even pay us any mind. Now we are on top of mind for every healthcare system, because they have come to understand that an untreated substance use disorder leads to so many other healthcare costs. But with that, as more dollars flow into our field, there will be much higher expectations on compliance, outcomes and licensing. We must really raise the bar in all of those areas, but we need to do so with dignity, grace and compassion.
Brad, any perspective on the opportunities and challenges facing the addiction treatment community?
The biggest challenge in front of us, first and foremost, is the number of people who will need our help as a result of the challenges in the past year. That will need to be on the radar of every organization for some time to come, from specialty programming for very niche populations all the way out to publicly funded programs.
The other great challenge for the country is how to serve the other 85% of people who meet the criteria for substance use disorder, but don't feel that they need help and don't identify for treatment. Too long the field has spent an inordinate amount of time and energy treating about 15% of the over 20 million people in this country who need help, but we have yet to find a message that reaches that other 85%. As we begin to shift our mindset to be more holistic in how we look at medical, mental health and substance use disorders – including the language and the labels we use to characterize what people are experiencing – I believe we have a great opportunity to meet the needs of the rest of that population.
This doesn't mean that every one of those over 20 million people are at the level of severity we see now in our care continuum, but they are individuals who are both at-risk and experiencing consequences in their day-to-day life. For far too long, they've gone without the resources and help they need to put themselves on a different course. I think that that needs to be a guiding star for us in the industry: How do we expand our reach to the vast majority of people who currently aren't getting help with a substance use disorder, who may not even yet realize that they need help?
Any concluding thoughts?
It's been a real privilege to be CEO of Caron for the past 26 years. The values and the culture put in place by Dick and Catherine Caron when they started Caron way back in the 1950s are sacred to all of us at Caron. I am humbled by the incredible growth and transformation of Caron over the last 26 years, but yet those values and culture remain intact, and that is something that I'm extremely proud to be able to hand over to Brad. I'm also privileged to hand off a strong organization that is fiscally sound, clinically solid, and truly committed to continued growth. It feels like the right time to hand the baton off to a leader and humanitarian capable of taking this organization to greater heights, ultimately helping even more people.
I would like to thank Doug, not only for his contributions to Caron over the past quarter of a century but also for his contributions to the treatment sector. He is a living legend, who has been a source of direction and hope for an industry that was looking for leadership as it went through its many challenges. Doug, your leadership as the head of Caron for the past two and a half decades has always served as a centering point for all of us in the field.
I know that you will continue to have a role at Caron and in the industry, being there for people who seek your counsel and wisdom. You’ve had immeasurable impact not just on Caron – growing Caron into the amazing organization it has become – but also on the field and, most importantly, on countless families. On behalf of all of us, thank you.
Thank you, Brad, and thanks for letting me continue to be involved, too. That's something I'm really thrilled about. While I won't be CEO, and I won't be here on a daily basis, I will continue to be involved with Caron in the years ahead, first as a consultant and perhaps later as a volunteer. I love this organization, I love the people, and I'm delighted to still be involved in any way I can.
By Doug Tieman