Affordable Care Act to Provide Substance Abuse Treatment to Millions of New Patients

The Affordable Care Act (ACA) will revolutionize the field of substance abuse treatment, according to A. Thomas McLellan, PhD, CEO and co-founder of the Treatment Research Institute.

“It will have more far-reaching positive consequences for substance abuse treatment than anything in my lifetime, including the discovery of methadone,” he said at the recent annual meeting of the New York Society of Addiction Medicine. “It will integrate substance abuse treatment into the rest of health care.”

Currently, just 2.3 million Americans receive any type of substance abuse treatment, which is less than one percent of the total population of people who are affected by the most serious of the substance use disorders—addiction, said Dr. McLellan, who is a former Deputy Director of the White House Office of National Drug Control Policy. Most who receive treatment are severely affected, he said.

“If diabetes were treated like substance abuse, only people in the most advanced stages of illness would be covered, such as those who had already lost their vision or had severe kidney damage,” he said.

A. Thomas McLellan, PhD

Dr. McLellan reported that 23 million American adults suffer from substance abuse or dependence—about the same number of adults who have diabetes. An additional 60 million people engage in “medically harmful” substance use, such as a woman whose two daily glasses of wine fuels growth of her breast cancer. The new law will allow millions more people to receive treatment, including those whose substance abuse is just emerging.

Under the ACA, substance abuse treatment will also become part of primary care, and will be focused more on prevention. Substance abuse treatment will also be considered an “essential service,” meaning health plans are required to provide it. They must treat the full spectrum of the disorder, including people who are in the early stages of substance abuse. “There will be more prevention, early intervention and treatment options,” he said. “The result will be better, and less expensive, outcomes.”

By the end of 2014, under the ACA, coverage of substance use disorders is likely to be comparable to that of other chronic illnesses, such as hypertension, asthma and diabetes. Government insurers (Medicare and Medicaid) will cover physician visits (including screening, brief intervention, assessment, evaluation and medication), clinic visits, home health visits, family counseling, alcohol and drug testing, four maintenance and anti-craving medications, monitoring tests and smoking cessation.

Currently, federal benefits, such as Medicaid and Medicare, focus on inpatient services, like detox programs, but do not cover office visits for substance abuse treatments. In contrast, Medicaid covers 100 percent of diabetes-related physician visits, clinic visits and home health visits, as well as glucose tests, monitors and supplies, insulin and four other diabetes medications, foot and eye exams, and smoking cessation for diabetics. “These are all primary care prevention and management services, which are the most effective and cheapest way of managing illness,” he said.

The impact of these new rules will be quite substantial, since an estimated 65 percent of insured Americans are covered by Medicaid or Medicare, and the rest are covered by insurance companies that base their benefits structure on federal benefits, said Dr. McLellan.

As addiction becomes treated as a chronic illness, pharmaceutical companies will be much more interested in developing new medications, he added. “Immense markets are being created,” he said. “Until now, there have been about 13,000 treatment providers for substance use disorders, and less than half of those are doctors. Now, 550,000 primary care doctors, in addition to nurses who can prescribe medications, will be caring for these patients.”

15 Responses to Affordable Care Act to Provide Substance Abuse Treatment to Millions of New Patients

  1. Terri | February 26, 2013 at 12:17 pm

    These things aren’t treatment:
    physician visits (including screening, brief intervention, assessment, evaluation and medication), clinic visits, home health visits, family counseling, alcohol and drug testing, four maintenance and anti-craving medications, monitoring tests and smoking cessation. They may be included in treatment, but alone they don’t equal treatment–how sad that the government didn’t also expand group and individual counseling services!

  2. Betsy Davis | March 1, 2013 at 4:35 pm

    So now we will have more “medication ” available such as suboxone and Methadone and this is a good thing?? NO!! We need more accass to inpatient tx facilities and less “medication”. Primary care physicians are the LEAST prepared to treat addiciton! This provider does not strike me as knowledgable about the subject about which he is speaking.

    • Matt | October 25, 2013 at 8:45 pm

      Look at the #’s they don’t lie. How many people have benefited from Detox’s compared to well managed Methadone programs. They don’t even come close. Rehabs and detox’s work for a very small percent. Methadone has changed my life! Something that years of rehabs and detox could never do for me. I wasted so many years thinking it would, just wish I didn’t listen to ignorant misinformed people like some of the people commenting on here.

      • Dave | January 27, 2014 at 2:29 pm

        Yes Methadone As also changed my Life some much. Before I was homeless and up to no good. People said your are trading one for the other. But that is not true. I have be clean for 2 years almost. I have truck & car & Apartment,I have a career that I love to do & and 1 year old, And a fiancee. I have my Family back and there trust, I wasted Years Also In detox and rehabs…They did not work, I thought it was Hopeless. I thought I was stuck…Then I got into methadone treatment. I worked the program the RIGHT way…If u work the program right it will change your life.BIG TIME…Dont bad mouth it cause some people have done u wrong..Or bad mouth it cause that is what everyone is doing….We are all United as and. We all need to help out fellow Man and women. Even if u does cost a Few extra dollars…Its worth it in the end…

      • betty | February 17, 2014 at 2:37 pm

        matt i agree. yes i was treated inpatient and it did not work. i have now been in a methadone treatment for almost 12 years without one relapse. methadone has changed my life only for the better. it gave me my life back! my only problem with it is the cost. almost 500.00 a month. i am hoping and praying that the new affordable health act will help with the cost. for everyone that is against methadone please take a look at the stats of methadone treatment and how many people it has helped before judging.

  3. Kytrina Neubert | March 4, 2013 at 11:41 am

    I believe that this is a start to tackling addiction, but as Terri stated above, treatment is needed in the form of individual and/or group therapy. Prescribing a medication for addiction will NOT help. Neither will just going to a physician. Without the proper therapy to address the underlying issues of addiction (core beliefs, trauma, ect.)addicts will continue in the cycle of repetition-compulsion. I am grateful that the government is finally seeing that addiction is an issue no different from any other disease!

  4. Maria Carlsen | April 22, 2013 at 5:10 am

    I’m totally agree with Terri. This is not a treatment. @Celia What is your opinion about these reactions?

  5. blaze | October 1, 2013 at 6:24 pm

    How many of you are actually addicts? Methadone saved my life. It gives addicts a chance to get their lives in order, it kills the cravings, it allows addicts to work and lead normal lives and eventually in a year or two, detox off. And if not, life long methadone is a heck of a lot better than running the streets an addict. I know of many people who lead successful lives thanks to methadone and they are currently methadone lifers. They also go to meetings and counseling. I agree that we need more counseling services but dont knock methadone treatment because it is a life save for alot of people. Not everyone can or wants to lead %100 sober lives and if they can function on methadone, it is their choice.

    • Brenda Elkins | October 5, 2013 at 10:29 am

      I have also lived a very productive life on methadone after being incarcerated for bad checks twice. I now own my own home and have a car and do not rely on any handouts or benefits from state or government. It is a wonderful way for long term addicts to stay off illegal drugs and away from crime.

  6. Alberto | October 27, 2013 at 11:33 pm

    I HATE ‘done clinics. They are worse than illicit drug dealers simply cuz u pay 2 perform dog tricks for your window dose. They pretend to have your interests and cut your dose in half or yank the rug out from under you when you’re a day late and a dollar short.

    But medication aside, support via counseling, meetings, and grueling labor supplement that time gap addicts have forsaken chasing dragons and fairies. Like Downey, Jr. said: “Quitting isn’t difficult at all. It’s NOT picking up again that’s hard.” I also find it hard to digest, how addiction is considered a “disease”. I consider it an affliction like a bout of West Nile Fever ( I’ve had it twice inside 3 months). Yes, lung cancer can be self-inflicted as well as a disease, but I don’t perceive addiction to be in that nomenclature. My $0.02 anyway.

  7. Brenda Elkins | November 3, 2013 at 2:48 pm

    In case some of you do not know about methadone clinics, they do have counseling and they do have therapists to talk to, they do have urine analysis done at least once a month at random, sometimes more, depending on clinics. They do have rules and you work for priviledges for take homes or travel bottles they are earned, not just given. Anyone who thinks it is not closely monitored or regulated is very ignorant of the laws behind the methadone clinics and the treatment. Their is a few bad apples like every program but the majority of the clients are very serious about their recovery. I have 19 years of stability due to methadone and the help I received from all aspects of treatment there.

  8. b | December 2, 2013 at 7:25 am

    Anyone who thinks addiction is not a disease has obviously never became or known some.one who is .and splitting hairs about what’s hard either quitting or not picking it back up is absolutely ridiculous! Look guys, people are different, period, some can , some can’t some do some don’t some will some wont, ya kno? Methadone works. Methadone does not work, get it? It all depends on the individual in question, your experience will differ from everyone else’s, so what’s the point. In bashing someone else’s opinion? If they don’t get it, they’ve never been there., luckily never will

  9. michelle | January 7, 2014 at 5:28 pm

    Anyone who would refer someone to inpatient, but wont allow methadone to be an option is obviously very ignorant of the way a heroin addiction works.. I agree methadone isnt for people who arent ready to stop using. It saved my life.. I had a rope around my neck, literally, a week before i.decided to get on methadone. I did the rehab thing, it doesnt work, its a disease that u are never cured from. Only a lucky few who take their sobriety seriously and are willing to work hard and follow the rules will live. without methadine, id be dead, and i have 3 years clean, recently enrolled in the best art school in nj, and i did it, because im stable on methadone, and i do the work, and i dont screw around. So dont judge about something youknow nothing about. Im praying affordable healthcare will cover methadone, but its because of ignorance and bad attitudes towards the disease of addiction that forces us to be shoved off to the backburners. NO ONE chooses or wants to become an addict, it isnt a moral decision. Its a disease that obviously isnt being treated properly, and methadone should not cost me 350 dollars a month.

  10. Kevin | January 12, 2014 at 11:06 am

    Its unfortunate that the compartmentalization of medical specialties such as the specialty of taking care of addictions, becomes a tertiary and separated service from primary care. Patients are branded and vilified from mainstream medical care. When this happens, medical professionals forget about the small fraction of patients that require dual care, such as a minority of patients requiring both pain control and addiction treatment. and, when the longevity of being on methadone negates the use of any other pain medicine, doctors treating for addiction seem to loose their senses that pain control must take a greater degree of care for a comfortable life for the patient. So many problems are not addressed because not being able to go a primary care physician. Returning addiction services to the mainstream will greatly help. Many patients whom must endure an addiction clinic are afraid to say they are in pain for the fear of being let go and the options becoming less.

  11. charles manning | January 14, 2014 at 4:08 pm

    Does the ACA allow insurance companies to charge higher premiums to people who are addicted to legal or illegal drugs? I know it allows higher premiums for smokers, although some states can exempt the extra charge.

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