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Despite the current scientific consensus on the importance and effectiveness of substance abuse treatment, barriers persist to providing it to all who need or want it. A number of creative national initiatives and many other efforts on a local and individual level are breaking down these barriers. Current Knowledge Leads to Conclusions about the Usefulness of Substance Abuse Treatment Thirty years of research on the biological, genetic, molecular, and social aspects of addiction and on substance abuse treatment strategies have resulted in some clear messages about addiction and treatment:
A Big Gap Exists Between Need for Treatment and Availability of Services A gulf exists between the number of people who want or could benefit from substance abuse treatment and the number of people who actually receive services:
Efforts to Close this Gap Face Policy Challenges Negative attitudes and limited understanding give substance abuse treatment a low priority. Public, provider, and policymaker attitudes and perceptions about drug use and users shape the importance given to substance abuse treatment versus other possible responses to drug use. A national inclination to respond punitively toward drug users, mistaken beliefs about the nature of addiction and recovery, and bias against drugs users and professionals who provide services to them have resulted in:
Substance abuse treatment's low priority is reflected in limited insurance coverage. Despite the fact that managing addiction is similar to managing other chronic diseases, most employer-provided health insurance policies place greater burdens on patients of substance abuse treatment programs in terms of cost-sharing, co-payments, and deductibles. At the same time, many plans provide less coverage for the number of visits or days of coverage and annual dollar expenditures for treatment. Many health insurance companies have lower lifetime limits on amounts that can be spent on drug and alcohol treatment than on other illnesses. Public and private funding for substance abuse treatment is far less than what is needed. Limited funding is an important reason why the availability of substance abuse treatment is restricted:
Substance abuse treatment has historically operated outside the health care mainstream. Substance abuse treatment facilities and programs have evolved separately for several reasons. One is that many programs have been created by individuals who have overcome their own addiction and gone on to build systems to help others. For example, individuals in recovery have been key to the formation of successful "12-step" groups and therapeutic communities. Peer support has long been an important therapeutic strategy. Lack of insurance coverage for treatment, stigma attached to substance abuse and addicted individuals, and lack of training and expertise in substance abuse issues on the part of mainstream medical practitioners also contribute to the isolation of substance abuse treatment from other health care services. This lack of integration with other health care services and providers is a problem because so many individuals who need substance abuse treatment services also need other services. For example:
This problem is particularly severe for vulnerable groups who have limited or no contacts with health care providers or who have no health insurance. Many of these individuals need primary health care services as well as care for particular health problems. A Number of Initiatives are Addressing These Policy Challenges Across the country, federal, state, and local agencies and organizations are recognizing the value of substance abuse treatment and the importance of expanding its availability to all those who need it. Here are just a few of the initiatives underway to change the policy environment. Choosing treatment over incarceration. In
November 2000, California voters approved a measure that requires substance
abuse treatment, not jail, for drug possession or use. It also provides
for treatment instead of prison for non-violent parolees who test positive
for drug use. For details, visit: "Legislative
Analyst's Office Analysis of the 2001-02 Budget Bill". In June 2001, the Louisiana legislature passed a measure that permits judges to allow probation or sentence suspension for more than a dozen non-violent crimes, including theft, simple possession of small amounts of drugs, bribery, and prostitution. Jail time for more serious drug distribution convictions remains mandatory, but sentences are shortened. In an editorial praising the legislation, The Advocate newspaper urged the state to focus on substance abuse treatment: "If there are significant savings under the new rules, they ought to be spent on the programs that prevent offenders from returning to a life of crime: more probation and parole officers, and drug-treatment programs." Revamping methadone maintenance treatment (MMT)
regulations. In May 2001, the U.S. Department of Health and Human
Services (DHHS) announced a fundamental shift in the federal government's
role in regulating and monitoring MMT. The new system relies on accreditation
of substance abuse treatment programs that use methadone and other medications
by independent organizations and states, in accordance with treatment
standards that have been developed by the Center for Substance Abuse
Treatment (CSAT) over the last 10 years. The standards are based on
"best practice guidelines" and emphasize improving quality of care in
areas such as individualized treatment planning, increased medical supervision,
and assessment of patients. In December 2001, DHHS announced the selection
of four accreditation organizations that will be used in this new approach.
For details, visit: SAMHSA
What's New Improving the scientific underpinnings of substance
abuse treatment. In 1999, the National Institute on Drug Abuse (NIDA)
established the National Drug Abuse Treatment Clinical Trials Network
(CTN). The CTN provides a research infrastructure that allows investigators
to conduct rigorous multi-site clinical trials to test whether new treatment
approaches are effective in community settings. The CTN currently includes
14 research centers, each of which is linked to a number of community-based
programs representing diverse treatment settings and patient populations
in that region of the country. This network structure allows effective,
science-based behavioral and pharmacological treatment approaches to
be rapidly disseminated across the country. For details, visit: National
Institute on Drug Abuse. Increasing parity for substance abuse treatment.
Beginning in 2001, the Federal Employees Health Benefits Program, which
covers 9 million people, requires coverage for substance abuse and mental
health services equal to that for medical, surgical, and hospital services.
Both types of coverage will have the same cost-sharing features, such
as deductibles, coinsurance, and copays. For details, visit: "Mental
Health and Substance Abuse Parity Questions and Answers." Improving opportunities for collaboration across
health care, public health, and substance abuse treatment settings.
Since 1998, CSAT, the CDC, and the Health Resources and Services Administration
(HRSA) have sponsored a series of cross-training workshops across the
country. These workshops give providers who work in a variety of settings
(such as sexually transmitted disease/HIV prevention, substance abuse
treatment, primary health care, mental health services, and criminal
justice) an opportunity to improve their ability to respond to the interwoven
health and behavior problems of their drug-using patients. The training
also fosters personal connections across agency disciplines, cultures,
and bureaucracies. These connections encourage staff to develop regular
communications and collaborative working relationships with other agencies
and organizations. For details, visit: "Substance
Abuse and Infectious Disease: Cross-Training for Collaborative Systems
of Prevention, Treatment, and Care." To Learn More About This Topic Read the overview fact sheet in this series on drug users and substance abuse treatment - "Substance Abuse Treatment for Injection Drug Users: A Strategy with Many Benefits." It provides basic information, links to the other fact sheets in this series, and links to other useful information (both print and web). Visit websites of the Centers for Disease
Control and Prevention and the Academy
for Educational Development
Check out these sources of information: Amaro H. An expensive policy: the impact of inadequate funding for substance abuse treatment. [Editorial] American Journal of Public Health 1999;89:657-659. Leshner A. Addiction is a brain disease. Issues in Science and Technology 2001;17(3). Leshner AI. National
study offers strong evidence of the effectiveness of drug abuse treatment. National Center on Addiction and Substance Abuse
at Columbia University (CASA). Shoveling
up: the impact of substance abuse on state budgets. National Institute on Drug Abuse. Principles
of drug addiction treatment: a research-based guide. National Institutes of Health. Effective
medical treatment of opiate addiction. Schneider Institute for Health Policy, Brandeis
University. Substance abuse: the nation's number one health problem. White House Office of National Drug Control Policy. National Drug Control Strategy 2001. Chapter 3. Report on programs and initiatives, Part 2. Treating addicted individuals. Substance Abuse Treatment Fact Sheets | Previous | Next
This CDC Web site is no longer being reviewed or updated and thus is no longer kept current. This site remains to assist researchers or others needing historical content. |
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