Beyond the Affordable Care Act: Looking at the Bigger Picture

On Saturday, February 10, 2017, the New York Times ran a front-page article weighing how the repeal of the Affordable Care Act may affect those now getting treatment for substance abuse disorder under the law’s Medicaid expansion. The title and crux of the article asked the question – Now What? It’s a critical question that I’ve been discussing with those in recovery, communities, families, legislators, media and other industry professionals as our nation struggles with an exploding addiction epidemic. It’s time we expand beyond societal “band-aids” and enact long-term, comprehensive solutions to this public health crisis.

The 2015 National Survey on Drug Use and Health (NSDUH) data indicate that 8.1 percent or 21.7 million people aged 12 or older needed substance use treatment that year. However, only an estimated 2.3 million received treatment at a specialty facility. Meanwhile, admissions to treatment for prescription opiates have increased 500 percent and the CDC reports that 144 people die every day of drug overdoses.

These harrowing statistics and the New York Times article highlight the need to find a solution to the woeful lack of available resources and effective treatment options for those suffering from addiction. Despite a limited expansion of some services through the ACA, lack of funding for treatment remains the number one reason that people who want treatment cannot get it. In addition, for those dependent on Medicaid, Medicare and insurance to pay for treatment, funding does not pay for the long-term counseling, medication and support necessary to achieve and maintain sobriety. Instead, patients are put into a system where detox has become a treatment plan and prescriptions are written without the necessary clinical support. This inadequate cycle of insufficient treatment caused by lack of funding can lead to relapse and dramatically increases the likelihood of incarceration and death. These facts are especially distressing when the most successfully treated chronic illness is addiction – when it is treated appropriately. Addressing this treatment gap must be front and center as we answer the question of what steps to take next.

Earlier this month, I participated in the Addiction Policy Forum’s Congressional Briefing as part of a panel of thought leaders in the field of substance abuse treatment. As the only representative of a treatment center on the panel, it struck me that one of our collective goals is to continue to shift significant misperceptions about addiction, treatment and recovery. Improving access to care is a direct result of understanding that not only will someone likely die from an untreated addiction, but also that an individual’s addiction will also impact society in significantly detrimental ways from lost productivity to violence.

To provide real solutions, we need to treat addiction as the behavioral, psychological and physical brain disease that it is. Like any other chronic illness, we must tackle addiction on multiple fronts – through education and prevention, research, and evidence-based treatment. As a nation, we currently spend about $46 on research per patient diagnosed with substance abuse disorder, more than 7 times less than the $338 spent on research per patient diagnosed with cancer. In a field with no industry standard and where centers are not required to adhere to best practices, we must fund research that defines and supports what centers of excellence look like. We must hold all treatment centers accountable for meeting high quality standards.

Health care policy impacts addiction treatment. However, we also need to look at the bigger picture of the many other areas that need to be addressed. To truly create lasting change, we must ensure best practices in addiction education, prevention, research and treatment.