Over 20 million Americans struggle with substance use disorders yet only 10% receive treatment in any given year. Research that I've conducted as well as past work suggests that some of the biggest impediments are related to shame, stigma, lack of good information and the fact that drug users don't always want to quit (more on my views about that here). But the biggest hurdle by far is cost, and my research suggests that this roadblock lasts even when interested patients keep searching for months.
In 2007, we were supposed to get some relief from the painful costs associated with treatment in the form of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“Parity Act”). Everyone was excited and the research team I was working with at UCLA spoke of a massive change in the accessibility of addiction treatment.
But nothing changed. Insurance companies found loopholes and coverage for substance abuse treatment remained one of the most expensive forms of treatment in the United States.
And now there's ObamaCare, otherwise known as the Affordable Care Act. Once again, the promise is great and the talk of a massive change in everywhere. That same group at UCLA is making the rounds and speaking about how Medicare and Medi-Cal will change the face of addiction treatment in this country; entire treatment systems are gearing up, hiring consultants to advise them on billing changes and choosing staff based on billability and such. There's even a new conference (called AXiS) that includes hours upon hours of panels specifically dedicated to helping Addiction Treatment professionals navigate what the ACA will change. Man do I want to believe.
But I don't.
Maybe I'm jaded from the last hopeful experience (I was drinking the coolaid in 2008) but I am getting a sense that the disenfranchised are going to end up still being able to access either inferior treatment or no treatment at all. I think it's hard for a system that is driven by profit to do much work to help those in need and the reality of our industry is that publicly funded facilities are working at capacity with little in the way of resource while higher end treatment providers offer $5000 a month wolf-therapy packages.
It's not fair but I don't believe it's going to change any time soon. But I sure am hoping that Obamacare proves me wrong.