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

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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.”

28 Responses to this article

  1. angelena nelson / August 13, 2014 at 11:13 am

    Suboxone is my topic. regretfully to say, i have delt with 3 adult children in our family for addition. mainly pain meds. The upside is the suboxone program has been wonderful for them, they are back to leading normal lives. The down side is that medicaid and all health insurance will not pay for office visits, $400, and then medicaid controls the amount of meds they will pay for then they decrease that is half after 6 months. So when they were not ready for a decreased dose, they have to pay cash to get the meds that thier doctor is still perscribing, because he knows they still need that amount. Yet when they were perscribed pain meds from the pain clinic. Medicaid paid for visits, and all the meds, Even the pharmacy is dishing out a extreme prejudice to filling the suboxone, complete oppisite of flling the pain meds, all day every day. The pharmacies are the worst about suboxone, they have told us they are not filling these perscriptions at all, or if your established, they will tell you, at any given time that you have to wait a week for them to order, after you made a history of what time every month that you are in there. FYI, unlike medicaid, or insurance, or even doctors, where there is a course of action to complain about not being treated fairly. With the pharmacies, they are the judge and the jury. they can profile you, crap on you, and you are at thier mercy to get your meds. I just dont get the different set of rules about suboxone, when it has such a proven record of addition recovery. Also we all need a tool of action, against the pharmacies, that profile you, and treat you with cruel predudice.

  2. Kristina / July 14, 2014 at 5:44 am

    I can’t really speak to the Methadone debate that appears to be going on here but I can tell you that all the talk about Medicaid covering inpatient treatment is incorrect. My brother is a herion addict. He has lied, cheated, stolen, become violent, and has had terrible problems with infecton in his arms including one the migrated to his chest and nearly killed him. He has finally reached the point where he is ready to quit. He is crying out for help. I don’t know if it is just the Medicaid program in my state (which is Wisconsin by they way, eff you Scott Walker) or if this is a universal experience but we have not been able to find a place for him to be treated that the insurance will cover. He’s done AODA, individual counseling, twelve step meetings, intensive outpatient and nothing works. He has finally admitted that he needs inpatient treatment. He is ready and willing to try, for his family, his son, and most of all himself. After a week that has included dozens upon dozens of phone calls and hundreds of miles driven he has still not been able to be admitted. He found a place that he can go to for long term care, and insurance will not pay for it. We found a way to come up with the money for him to go there, but he can’t be admitted until he has proof from a doctor that he is medically detoxed. There are very few places in the state that actually house patients for opiate detoxification. My brother went to one that did and when they called the insurance company for preapproval, the facility was told they would not cover it because it is “non-life threatening”. A doctor that has never seen my brother, never spoken to him, never seen his mecial records is making this decision. This was after I had taken the time to call the insurance company myself to ensure that the services would be covered. I was told because there was no “in network” facility that would cover his inpatient treatment he could go “out of network” and they would cover it. I was assured there was a note in his file to that effect. And still, a denial. So we jumped through more hoops. Tried several other facilities only to be turned away over and over again. So my brother went to out local hospital and had blood drawn (which is excruciating for him because of years on the needle), had urinalysis done and got a referral from the doctor and the PA there stating that inpatient detoxification WAS MEDICALLY NECESSARY. He went back to the facility that had told him to do this and they started the admitting process. Half way in the nurse made a comment saying she didn’t know if insurance was going to cover his stay. So my brother had her call the preapproval line…again. She came back after the doctors had their talk and once again, he was told that insurance would not cover his detox. This is after being seen by a doctor, getting the referral they asked for and gonig through all of the pain, frustration and disappointment up to that point. He was turned away again. My family is at a loss. We aren’t wealthy and were barely managing to scrape together the funds which would allow him to go to the long term inpatient facility. The insurance company for everyone’s information is Anthem Blue Cross/Blue Shield. They are administering Wisconsin’s Medicaid program now. I hope that there really are changes coming. Right now the theme seems to be deny, deny, deny. It’s shameful when someone has the desire for treatment, a medical referral and INSURANCE and still cannot receive the help they so desperately need.

    • Crystal / August 4, 2014 at 10:29 pm

      Call an interventionist who can professionally confirm your insurance and suggest long term inpatient addiction treatment, They have the answers and the connections.

  3. Kathleen / June 23, 2014 at 4:54 pm

    I have a sister who has suffered from chronic substance abuse and mental health issues for over a decade. She is currently in the hospital (as she has been many times before) being treated for substance abuse related health problems, specifically affecting her liver and pancreas. After speaking with her physician and the hospital social worker, I have been told that because she is not an immediate physical threat to herself or others she will at some point be discharged after she is stable. I have lost count of the number of times this scenario has occurred. The bottom line is that unless she agrees to undergo treatment voluntarily I as a concerned family member have no recourse. I do not expect her to volunteer for treatment even though she is dangerously close to becoming fatally ill (if she is not already). She has been admitted to various hospitals who treat her treat her symptoms but have no positive effect on solving the deeper issue. I’m not entirely sure why I’m sharing this since the outcome despite any effort on my part seems inevitable, but I guess I want to put out there that while people’s individual rights are important and no one should be abused by the system, the system also doesn’t work to help people who are not in the correct state of mind to make the right decisions about getting help. I am forced to sit back and watch her disappear slowly and painfully.

    • Cry / August 4, 2014 at 11:03 pm

      There is hope, I have been through similar episodes. If u offer a long-term inpatient rehab for dual diagnosis, they may be “wiling.” If not, call an interventionist. Call treatment facilities that offer free insurance confirmation of coverage, send them far away from peeps, places & things! Give them no choice once you have done the tedious task of muddling through an almost impossible to comprehend web of information. Have a place lined up (bed waiting), clothes packed, and a love and supporting heart. May u find peace and pray that ur sister has an opportunity for a better life. Anyone who is addicted to harmful substances cannot make decisions that are healthy!!! They do NOT have to hit rock bottom, I could write forever…what a journey it’s been. God bless. Heal the body mind and soul together – no choice!

  4. Avatar of julie morelli
    julie morelli / April 19, 2014 at 2:48 am

    hi i got put on the methadone program via drug court. i’ve been on a 50 milgram dose for two years. i decided a month or so to get off the program due to them saying my ua was possitive for benzo,,,,i dont know what abenzo is and told the clinic they madea mistake and took my weely carries. i live far from wher ei was dosing .so i walked off on 25 mil.evreyone said its a bad idea however i was upset for there mistake and cant afford to drive 45 mil one way considering wasnt my fault. what im trying to find out is i have never felt the way i do by coming off of anything. it is the worst thing i have done. the way i just thought i havent been on it for alot of years ;but two years was a goal for me to and i set a date and its up. so my questions is does it mess with your bones and legs and give you insomnia becasue these are all happening and the pain i have is un bearable and hard . i was wondering if i could get on suboxone and does washington apple have a doctor who takes apple insurance/medicaid and if noot can someone refer me to a doctor that does thank you

    • Jonathan / July 17, 2014 at 12:56 pm

      I empathize with your situation as your post touches on many issues that I myself have had to deal with. Please anyone, email me so we can begin speaking about how to best move forward with your recovery. I believe that some of my experiences could help you in deciding how to best improve your life. Always remember that “this” is something that did not begin in a day and you cannot solve it in a day. If I never speak to you please take this away, you should remain on a stable dose for at least two years while rebuilding your understanding of a “normal” life and settle into a positive routine without the people in it that you used drugs with ever, and replace any bad habit with another good habit.

      • Stacey / August 14, 2014 at 12:43 pm

        Hi, I’m am currently on 55mg of methadone, and have been for a couple of months I feel like my dose is right for me. I have heard that its almost impossible to find a private doctor for methadone. I’ve tried suboxone & it didn’t work for me. But what I keep wondering is with all the change that has happened is there maybe a way that I can find a doctor to prescribe me methadone? I have been told that the most a VA doc can prescribe is 5 pills a day 50mg a day. and ive taken the pills before and didnt need as much as with the liquid. the clinic that i go to keeps increasing the cost and on sept. 1st it goes up again from $12.25 to $13 a dose. this time increasing by .75 cent and its the second price increase inside of a year. i can barely afford it now and sumtimes wonder what i will do if i cant afford it anymore. I mean i know sum people say that its alot cheaper than their habits were but its not the case with me. I dont mind the rules at the clinic i enjoy the groups and counseling but the cost is a big delima for me and i wish i could find a private doc. to prescribe me methadone or sumting to help me get off it without going through terrible withdrawls. I live in North Carolina, just hoping for sum advice. thanks and hope you have a blessed day.

        • brad cain / August 25, 2014 at 5:14 pm

          I live in GA. Cost is ALWAYS an issue! Private physicians should be able to deal w/this in every state; it’s a medical issue(after a certain point it is ONLY a medical issue). this is the solution.

  5. Avatar of charles manning
    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.

  6. Avatar of Kevin
    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.

  7. Avatar of michelle
    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.

  8. Avatar of b
    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. 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.

  10. Avatar of Alberto
    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.

  11. Avatar of blaze
    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.

  12. Avatar of Maria Carlsen
    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?

  13. Avatar of Kytrina Neubert
    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!

    • brad cain / August 25, 2014 at 5:24 pm

      so group therapy will help cure cancer, but chemotherapy won’t?

  14. Avatar of Terri
    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!

  15. Avatar of Brenda Elkins
    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.

  16. Avatar of Matt
    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.

  17. fleet420 / April 23, 2014 at 2:44 pm

    When someone has spent the best part of their life addicted, having no..and I mean absolutely NO control..Then, by the grace of God they find a drug that stops that behavior, stops the lying, stealing, cheating and most importantly the drug use. A drug that helps them become a tax paying, job working, loving and caring person, why would you find fault with the drug. What do you care, it cures many, many people that, for the most part, may as well be dead. Their lives are crap. This is how you think we choose to live? It’s an addiction and for someone that’s never had a medical addiction to think they have a right to deny that drug, makes about as much sense as taking insulin from a diabetic. How about we take the air you breath, because that’s how important it is that I remain on Methadone. It’s helped me stay off…completely off, heroin since 1996, and you think I should be detoxed…’cured’ of my addiction? I was cured of my addiction when I took that first dose of Methadone. An addiction that led me to prison 7 times, the final time for 7 1/2 long years, yet when I came out…I was addicted within 72 hours of release. It’s a sickness..once addicted there is no choice involved. Anyone that believes that addicts like to be addicts are not logical thinking people. As for Methadone being diverted, yep, just like most any drug, this too is a drug that is traded…many times people that indulge in experimentation with it never wake up after a night/day using it….and when this happens the drug is the culprit-the killer…not the person that should’ve never have had it in the first place, not the person that knew it was not prescribed to them, the person that was abusing…the drug didn’t jump into their hands, or down their throats, they made that choice. And many times,…they pay with their lives. Then the folks that love them say how bad this drug is, not how bad their loved one was when they illegally took the drug. It makes a drug that saved and continues to save millions of peoples lives on a daily basis appear to be bad. I honestly believe that many people work with, sit next to, are friends with or even live next door to people that take Methadone, either for pain or for addiction. In the end, the pain patients of today…………..are the addicts of tomorrow. If you take it for pain, in the end the pain will seem like a drop in the bucket when the onslaught of those withdrawals begin, when will that happen…either when their insurance is lost…job loss, OR when the pain clinic/doctor they go to starts getting asked about all the prescriptions they’re writing for opiates, that’s when they tell them they can no longer treat them…that’s when they realize that not only are they still in pain…but now, they have a whole different pain…addiction. Who knows why pain medicine addicted persons believe they’re above other addicts, if there were no Methadone clinics they would very quickly become the picture of addiction that we all envision. The very clinics they hated, did not want in their towns, fought so hard against……but in the end, when they are puking, crapping their shorts and doubled over, they’ll stand right behind or in front of me at a Methadone clinic…just another addict.
    Addiction is not choosy it doesn’t care about race, religion or how much you have, after all it only wants one thing…just one, that’s all…Your life.

  18. Avatar of Dave
    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…

  19. Avatar of betty
    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.

  20. brad cain / August 25, 2014 at 5:30 pm

    My life story, different felonies! I agree! My need for psychosocial services is over; if I need to talk, I will. But I need to SLOWLY detox from methadone(2+ yrs) in order to be successful .

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