Improve Access to Quality Treatment Programs

Introductory Paragraph

Over 20 million Americans ages 12 and older are addicted to drugs or alcohol, but only about 11% receive treatment. There is an increasingly important need to provide options for individuals who may benefit from quality and affordable alcohol and drug treatment programs. The demand for treatment is met with a shortage of quality recovery centers in America, which makes it difficult for individuals to receive the care they need. The small populations in rural communities, for example, cannot support the specialized treatment or trained primary care practitioners who are willing to treat individuals living with addiction. This leads many individuals to either go without care or join waitlists for treatment.

Those living with substance use disorders are among the highest cost of healthcare users. Overdose patients in particular place a heavy burden on first responders, emergency departments, and the foster care system. Some options to solve this issue could include innovations such as expanded use of online tools and assessments, integration of primary care treatment, and virtual reality.

Key Information

Most recovery support services fall under the Recover-Oriented Systems of Care (ROSC) model which is based on the idea that severe substance use disorders are treated most effectively through chronic care management which involves outpatient care, recovery housing, recovery coaching, and management checkups. These are meant to be culturally sensitive and easy to navigate. ROSC follows recovery-related values and beliefs which include the following concepts:

• People who suffer from addiction have essential worth and dignity.
• The stigma related to addiction is something that prevents many people who are addicted from seeking help and this must be combated.
• There are many paths to recovery.
• Access to treatment is a human right, even though recovery might mean something more
• People who are in recovery, as well as their families, have valuable experiences and support to offer to those who are still struggling with substance abuse.

Treatment Options

Many treatment programs are based on the 12-Steps of Alcoholics Anonymous (AA), but there is little scientific evidence showing that the AA process is effective. Dr. Lance Dodes stated in the documentary The Business of Recovery that 12-Step programs are typically only helpful for 5-10% of people who partake in them, meaning that they are largely ineffective for the vast majority of people. Treatment programs that are based on AA's 12-Step program, therefore, are not necessarily providing effective treatment, but are still charging exorbitant prices, especially considering that AA is a fellowship that is free to participants outside of treatment programs.

Other treatment programs include recovery coaching, recovery housing, recovery management, peer-led recovery community centers, and recovery-based education. Medication-Assisted Treatment (MAT) is available in accredited and certified private and public clinics across the United States. A combination of medication, counseling, and behavioral therapy is regarded as the most effective in treating opioid dependency. The Substance Abuse and Mental Health Administration (SAMHSA) is responsible for overseeing the certification of opioid treatment programs which use Buprenorphine, Methadone, and Naltrexone.

Implementing treatment in the Primary Care Setting

Primary care providers are highly likely to come in contact with individuals who are struggling with substance use disorders however, only about 3,600 physicians are board-certified in treating addiction. Approximately 4% of all physicians nationwide are certified to prescribe medication for opioid use disorder. A majority of individuals must obtain their medication from Methadone clinics. While these clinics are helpful in assisting people in getting their medication, it is difficult for specialty clinics to meet the demand for services. This calls for more primary care providers to obtain the training and certifications to treat complex cases of substance use disorders. One possible solution for getting more primary care physicians to assist in this issue is to incentivize the screening and treatment of addiction. There are many challenges that primary care providers may face when choosing to treat addiction patients, including stigma, the complexity of this population, and reimbursement for services.

Relevant Research

This article provides a review and meta-analysis of treatment services for patients with alcohol use disorders. The research found that pharmaceutical interventions when used with psychosocial co-interventions, resulted in better outcomes. This supports the advantage of the strategy of adding medication to treatment programs for opioid users.

Cost/Benefit Analysis. Drug treatment programs are known for being expensive and difficult to find. Current research suggests that when people are able to enroll in treatment, the benefits impact not only on individuals living with a substance use disorder but also healthcare administrations, law enforcement, and the criminal justice system. Recent data suggests that every dollar spent on substance use treatment centers saves $4 in health care costs and $7 in criminal justice and law enforcement involvement. Over $8,200 can be saved on health care and productivity costs per individual who spends at least 60 days in a quality substance abuse treatment program. Thus, it is effective to invest taxpayer dollars and government resources to implement accessible, affordable, and quality treatment centers -- regardless of access to insurance or financial status.

Impactful Federal, State, and Local Policies

California. The Safe Neighborhoods and Schools Act (Proposition 47) reclassified certain theft and drug charges from felonies to misdemeanors enabling focus on more violent crimes and serious offenses. This resulted in monetary savings being directed to school programs, victim services, and mental health. The creation of new drug treatment programs offered a way to decrease recidivism and to support those with newly classified misdemeanor drug possession charges to have more options for recovery.

Available Tools and Resources

SAMHSA hosts FindTreatment.gov -- a website that allows users to search for treatment centers while filtering for treatment type, location, and payment options to include private health insurance, Medicaid, or free or no-cost care. There are also filters for special populations such as veterans, LGBTQ+, differently abled individuals, age groups, and language preference.

SAFE Project administers a treatment locator based upon awareness that the first challenge a person or loved one faces after deciding to accept treatment is finding an effective and affordable treatment center. Treatment locators may help those to find an appropriate center that is suitable for the individual based on their insurance, ability to pay, type of addiction, ability to address co-occurring mental illness, distance from home, and other factors. The SAFE Project Treatment Locator was developed with the University of Maryland to provide a platform that is easy to navigate and that provides the ability to search the SAMHSA database using more criteria to help find the best options available.

American Addiction Centers has a website that describes how and where to locate free or low-cost drug rehabilitation programs. It highlights options for state-funded drug treatment programs, who qualifies for services, and how to local find state-funded treatment options. It also gives information about other possible payment options for treatment such as scholarships, loans, insurance, and how to ask friends and family for support.

Advanced Recovery Systems is a behavioral health company focused on helping people on their path to recovery from substance abuse and mental health issues. It operates a network of inpatient and outpatient addiction and mental health treatment facilities and hosts a website that provides a assistance in navigating insurance for treatment. and a tool that checks if your insurance provider covers addiction care.

Pew Trusts 10 Ways That States Can Improve Substance Use Treatment.

Apps and Online Resources:

• Life Recovery Program is an online program that could be a useful option for people who live in rural areas or for people who are incarcerated. The program consists of bi-weekly online video/audio workshops and practical tools, along with homework exercising, grounding techniques, and supportive emails. It is designed to last 3 to 6 months.
• myStrength is an online and smartphone platform that can enhance the capacity of mental health service providers by enabling them to serve more people more effectively. It can also provide tools to support people between professional consultations. There is solid and growing research on the value and effectiveness of the platform.
• reSET-O. Digital Therapeutics Alliance developed this eFORMULATIONS treatment tool for opiate dependence. It is a mobile medical application that is used in conjunction with pharmaceutical therapies to treat opioid dependence. Clinical trials have shown reSET-O to be a promising solution to opiate dependence, showing that reSET-O plus pharmacotherapy achieved enhanced abstinence from opioids, reduced drop-outs in treatment, and reduced required clinical intervention when compared to traditional face-to-face therapy.
• ShoutOut is an app developed by Recovery Centers of America Telehealth. It delivers comprehensive and evidence-based outpatient treatment for addiction and co-occurring disorders. There are three available levels of treatment available to serve each individual’s needs. Group, individual, and family options are implemented into the program.

Promising Practices

Kentucky. In Kenton County, the prison has become an important treatment facility. Instead of focusing on punishing or just locking up people with substance use issues, the Kenton County Detention Center focuses on turning a time of incarceration into a time for much-needed treatment. Leaders in Kenton County believe that jail may be the best place to initiate recovery. People often end up in jail for minor crimes, long before they commit more serious crimes that warrant a prison sentence. Kenton County is one of over 20 Kentucky county jails that have started full-time therapeutic communities that focus on rehabilitation within their walls, providing inmates the type of services that private treatment centers offer on the outside.

Maryland. The Baltimore County Health Department provides treatment through community providers for substance users and their families, and develops, coordinates, and monitors a countywide network of substance use prevention and disorder treatment services. It operates a dedicated phone line staffed with clinical social workers with specialized training in helping people with substance use issues move toward recovery.

Massachusetts. Boston Medical Center opened its Faster Paths to Treatment Opioid Urgent Care Center in August 2016. This center, which is specifically for treating patients addicted to prescription painkillers, is located next to the hospital emergency room, giving patients immediate access to comprehensive care including counseling, case management, home visits, and transportation to detox.