Regional fiefdoms.
In GOT, Westeros is divided into
seven kingdoms that, while united, are always fighting over territory and
treasure. The American addiction treatment space is similar. Many centers have
a strong regional footprint. If a potential competitor attempts to move in, the
local provider might push back with lawsuits related to certificates of need or
even quietly foster NIMBY concerns in the community (such behind-the-scenes maneuvering
befitting Lord Varys). It would be wise for all of Westeros to come together,
however, as the White Walkers of the north are threatening doom to all, and we’ve
known for years that the addiction treatment field would accomplish much more
behind a united front rather than our current alphabet soup of associations,
affiliations, and credentials.
A nation awash in
alcohol. Everywhere you turn in Westeros, just like the United States, you’ll
find alcohol—and lots of it. Those who don’t drink are often viewed
suspiciously (although notably sober Roose Bolton’s treachery at The Twins certainly
enhances that stereotype). Not surprisingly, alcohol consumption ruins both
fictional and real lives all too often, likely playing some role in the
downfall of Robert Baratheon and another Westerosi king (no spoilers!).
The importance of brand identity. Each house in Westeros has a unique sigil that communicates a message. The Tyrells of Highgarden fittingly feature a rose as their emblem. The Targaryens display their affiliation with dragons. Similarly, addiction treatment centers have developed a whole range of logos to illustrate their connections with the oceans, mountains, deserts, etc.
The Wall. A
700-foot-high, 300-mile-long ice wall separates magical, mischievous Northern
Westeros from the seven southern kingdoms. In America, the wall isn’t physical
but virtual—as in the wall providers have to climb to be fairly reimbursed for
services. Few are able to cross The Wall, and treatment centers of all types
struggle with negotiating fair contracts with third-party payers.
The haves and the
have-nots. Westeros has a strong caste system—lords, ladies, and knights
live well, while just about everyone else struggles from day to day. In the
addiction treatment market, we have a similar dichotomy. Private-pay
opportunities allow the well-to-do access to cutting-edge care and long lengths
of stay, while limited, if any, third-party and government reimbursement hampers
the care that everyone else can access. Thankfully, our country is blessed with
excellent providers at all points of the socioeconomic spectrum, but the rich
certainly have easier access to treatment.
Hope. The winds
of change are blowing through both Westeros and America. Daenerys Targaryen
aims to restore justice and order to a largely lawless and corrupt nation, and
advocates have fought hard to ensure parity legislation and the Affordable Care
Act provide greater opportunities to access care for millions of Americans. But
it’s not just princesses and princes (don’t discount the potential of Tyrion
Lannister!) that can make a difference. As we’ve seen with John Snow in GOT, everyone has the potential to change
the world.
