Parity for Drug Addiction Treament – A Distant Dream

Cc photo by Bohringer Friedrich 398px-AchdammSport

Creative Commons photo by Bohringer Friedrich

Under the current healthcare system, quality affordable healthcare for addiction treatment is not a reality for most families in the United States. Only premium healthcare providers cover state-of-the-art treatment for addiction, including long-term residential programs based on the latest brain-based research.

While the Affordable Care Act is vastly superior to what we had before, it still creates a system that discriminates against low-income or no-income patients, that is 99% of people suffering from severe, long-term addiction disorders.

Expanded Medicare will pay for some treatment for the destitute, but it does not include residential programs, nor many of the state-of-the-art therapies available to the 1%.

Recently a brave but grieving family spoke at a briefing held by the House Caucus on Addiction, Treatment, and Recovery. Bill and Margot William’s full story and statement can be read on their website HERE.

They tell of how their 24-year-old son William died of “acute and chronic substance abuse” which caused “complications of acute heroin intoxication”. And how they donated his body to the Columbia University’s College of Physicians and Surgeons for research, to help others suffering from substance abuse disorders.

Bill writes:

William’s cause of death could have been listed as “Institutional Indifference”.  Failed insurance, clumsy coordination between health care providers, and antiquated treatment practices doomed him.

In another time, in a better era, William might have entered the College of Physicians and Surgeons, not as a cadaver, but as a gifted and talented young man, prepared to serve others.

He continues:

Ignorance about substance use disorder remains the order of the day. It is the plague of our time. Anything we say that is repetition bears repetition until it manifests itself as policy change and practice of substance and consequence.

Parity is about more than receiving equal health care insurance for substance use disorder and mental health issues.

Parity means an individual can say, “I have a substance use disorder,” without discrimination, judgment or censure.

Parity is when family members can stand beside the afflicted and say, “…and we are all getting counseling and support to aid in our loved one’s recovery.”

Here is his list of what parity means:

  • Parity means that substance use disorder is recognized by laymen and professionals alike as a brain disease.
  • Parity means that funding for research for substance use disorder is on the same level as that for heart disease, cancer, or diabetes.
  • Parity means that people with substance abuse disorder are treated with the same compassion and understanding, treated with the same urgency, accorded the same dignity, as any other patient with any other medical or surgical need. 
  • Parity is when physicians, not health insurers practice addiction medicine, when physicians, not actuaries determine the best course of treatment.
  • Parity is when physicians are trained to recognize and treat substance use disorder in medical school with the same rigor given to any other disease.  
  • Parity will be when physicians in any specialty can recognize, treat, or refer patients to a proper source of treatment. 
  • Parity will be when there are sufficient numbers of physicians board certified in addiction medicine.
  • Parity will become practice when more than a mere 10% of the 23 million plus Americans who suffer from substance abuse disorder are properly diagnosed and treated.
  • Parity will come about when rehabilitation facilities have medical doctors on staff, all the time.
  • Parity is when physicians, politicians, school principals, police and parents all realize that not only are they responsible for helping to treat this disease, but also that they and their families are as susceptible as anyone else to being afflicted by the disease.
  • Parity will arrive when we stop pretending will power is a cure for a neurological problem.  Will power needs to be exercised, not by the afflicted, but by policy makers who can help change the course of this epidemic.

I would add to that list:

Parity means that all who suffer from substance abuse disorders receive the same quality healthcare options for treatment, regardless of their income or ability to pay.

Thank you, Bill and Margot, for speaking out and sharing your story with us.

I hope that all of us reading this will stand with them in this fight for parity.

 

Kicking People out of Drug Addiction Programs – A Travesty!

Kicking%20ImageMy son was recently kicked out of a drug treatment program.  I can’t tell you how long and hard we had to work to even get him into the program.  But only two months after entering, they kicked him out, apparently for a relapse.

He begged them not to kick him out. “Give me any other kind of punishment to make me pay for my relapse, but please don’t kick me out!”

But out he went. He had no place to go, and the shame and fear and depression of having been kicked out overwhelmed him and he went downhill, losing his job. Soon he was living on the streets again.

They said he could come back in a week–if he tested clean!  How crazy is that!

By then he’d had two overdoses. Finally he was arrested–thank God!  He’s “safe” for a little while longer.

But I am so angry at those who claim to provide drug addiction “treatment.”  How could they do this to him? They kick him out for having the very condition he went there to get help for?

I don’t understand this system of “treatment.” They were supposed to treat his addiction, not kick him out for being being an addict! If he hadn’t wanted to be there, I could understand that. Maybe. But when he was still desperate to recover, when he still wanted “treatment,” how could they do that?

Am I crazy to think this was wrong???

I don’t think so.

Here’s a great article at WilliamWhitePapers.com on this very point, “Stop Kicking People Out of Addiction Programs.”

18% (288,000) of all persons admitted to specialized addiction treatment in the U.S. were administratively discharged (“kicked out”) prior to treatment completion.  Those persons whose treatment was terminated in this manner were often those with the most severe and complex addictions and the least natural recovery support resources–in short, those most in need of professional treatment.

The most frequent cause for administrative discharge (AD) over the past half century has been continued use of alcohol or other drugs during treatment in spite of threatened consequences, e.g., the central symptom of the disorder.  In our 2005 article, we argued that AD practices were flawed on both theoretical and practical grounds.

They go on to say:

AD practices in addiction treatment are unprecedented in the health care system.  For other chronic health care problems, symptom manifestation during treatment confirms or disconfirms the working diagnosis and provides feedback on the degree of effectiveness of the treatment methods being used.  In marked contrast, symptom manifestation in the addictions field results in blaming and expelling the patient.  It is contradictory to argue that addiction is a primary health care problem while we continue to treat its symptoms as bad behavior warranting punishment.

Expelling a client from addiction treatment for AOD use–a process that often involves thrusting the client back into drug-saturated social environments without provision for alternate care–makes as little sense as suspending adolescents from high school as a punishment for truancy.

The strategy should not be to destroy the last connecting tissue between the individual and pro-recovery social networks, but to further disengage the person from the culture of addiction and to work through the physiological, emotional, behavioral and characterological obstacles to recovery initiation, engagement, and maintenance.

You can read the rest of this excellent article HERE

This was not the first time my son was kicked out of a rehab or sober living home for relapse, and sometimes just for minor infractions, missing meetings, etc.  I understand the need for consequences for “bad behavior,” and the need to protect others in the program. But there’s got to be a better way to work through these set-backs than throwing them out on the street.

No wonder jails and prisons have become revolving doors for addicts.

I realize now that my sense of hopelessness for my son rests mostly on the fact that there is no real help out there for him, for the chronic addict. There is no structured, systematic support and treatment program for addicts, period.

And most of what is available–the sketchy, seriously flawed programs–are either too expensive, or have long, waiting lists for beds, or require patients to subscribe to a particular religion.

I feel like we live in the dark ages when it comes to treating drug addition. Everyone recognizes that addiction is a major health epidemic, and a national tragedy. But nothing is being done to help those who need it most–the chronic addict.

What’s wrong with us?