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Many insurers have been reluctant to provide the same coverage for treatment of substance abuse dependence as they do for other diseases such as hypertension and diabetes, because of fear of costs and ambivalence about the efficacy of treatment. Employers -- who pay the premium for health benefits -- also worry that providing such relief would be too costly. If addiction treatment is covered, often there is a cap on how long or how many times one can receive services. Critics of these policies say that isn't the way other chronic diseases are covered, and isn't fair -- or effective. "No one would say, 'Well, sorry, you've had your chance, and you can't try to quit again [to someone who is trying to quit smoking]; but we turn to the person who is addicted to illicit substances, and there's a tendency to say, 'Well, you're limited in the number of times in which you can try to quit, because if you haven't succeeded after the first or second time, there's something the matter with you,'" says Dr. Lonnie Bristow of the Physician Leadership on National Drug Policy. Addicted people shouldn't have to "jump hoops" to get treatment if they want it, he says. "We've got to bring that same understanding of the human condition that we have for legal substances to the abuser of illicit substances." Norman Hoffmann, who directs policy programs at the Center for Alcohol and Addiction Studies at Brown University, has been assessing addiction treatment outcomes. He says it's a misconception that one-shot treatment alone should be expected to result in lasting recovery. "The duration of maintenance care services immediately following a primary treatment episode has a very marked and significant influence on outcome," Hoffmann says. If a patient doesn't get any maintenance care, the odds of sobriety for a year are less than 40 percent. If they get maintenance care, the odds of being abstinent for a year rise, he says. But coverage that provides for anything less than three months of maintenance, "is essentially useless," Hoffmann says. He says the findings should help purchasers when deciding on coverage for their workers and how to manage addiction treatment services in the workforce. Like any chronic illness, he says, addiction is a disease that requires maintenance therapy. "You don't get aftercare with diabetes, you get maintenance care. It's expected that you'll see a professional from time to time for the rest of your life. To date, we haven't seen that mentality for addictions, even though it's a similar affliction." Managed care has made it harder for addicted people to gain access to treatment, says Dr. Herbert Kleber, executive vice president and medical director of the National Center on Addiction and Substance Abuse (CASA) at Columbia University in New York. Particularly for inpatient care, patients often have to go through a variety of gatekeepers before they can get approved. And, finding effective treatment is another challenge. "Many [programs] have been so decimated by managed care, it's hard to find really good ones," says Kleber. Insurers also typically limit the length and number of treatment services provided. For some hard-core addicts who not only need comprehensive treatment but also training in basic life skills to function in society and avoid relapse, this is a particular problem. "For those people, giving them drug or alcohol treatment is not going to be enough," says Kleber. "They often need intensive, long term treatment." Despite the fact that such intensive treatment has been proven effective in reducing crime and improving social adjustment, Kleber says, society has been short-sighted. "We are often so busy looking at how we can shorten and cheapen treatment that we fail to look at how effectively a really comprehensive treatment can be," he says. |
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