04/30/13 Doug McVay

Tue - Doug McVay: medicare = more treatment with less availability

4:20 Drug War News
Tuesday, April 30, 2013
Doug McVay
Drug War Facts
Download: Audio icon 420043013.mp3


Associated Press reported that health care reform could dramatically expand the number of people receiving treatment for alcohol and other drug abuse problems. According to the AP analysis, an estimated three to five million Americans with substance abuse disorders will become eligible for health insurance coverage that includes substance abuse treatment. Specialty facilities in the US are currently providing treatment services to an estimated 2.3 million people. So this means potentially more than doubling the number of people receiving treatment services.

That's great, right? Reformers have argued for years that treatment works, that we need to expand treatment availability. What could be the problem?

The problem is in the word availability. Sure, the number of people eligible to have their treatment paid by insurance will increase. Treatment capacity, on the other hand, hasn't increased. Sure, it's always possible to put together more all-volunteer self-help, AA-style support meetings and encounter groups, but those have a very low success rates. Specialty facilities, physicians, methadone clinics – these cost money and resources to set up and to operate, resources we just don't have.

If we're not careful, the gap could be filled by cheap hustlers and fly-by-night operators who promise the moon but deliver nothing except hot air. Of course, that never happens with government programs that expand too rapidly. Right? Yeah.

According to the drug czar's office, the feds spent about eight billion dollars on substance abuse treatment last year, and are spending about the same this fiscal year. That's out of a total drug control budget of about 24 and a half billion dollars.

Some time ago, the states altogether were estimated to spend a combined total of about 2.1 billion a year on treatment. Now quick caveats about that state number. The estimate was released by the Center on Addiction and Substance Abuse, CASA, in 2009, and refers to spending in 2005. So the current numbers are unknown, could be higher, could be the same.

That CASA report also estimated that the feds spent between 2.4 and 2.5 billion dollars in 2005, whereas ONDCP says that the feds spent about $6.75 billion that year. That sounds like a pretty big discrepancy, yet actually, at the time the feds used a different accounting method to report on drug control spending, so back in the GW Bush administration his drug czar also said that in 2005 the feds spent between 2.4 and 2.5 billion on treatment. So it's tough to say what we're really spending, we only know that our spending is paying to treat about 2.3 million people.

The annual National Survey on Drug Use and Health includes a short set of questions intended to screen for substance abuse disorders. The NSDUH screening questions show that as many as 19.3 million Americans may be in need of treatment and not currently receiving it.

For the Drug Truth Network, this is Doug McVay with Common Sense for Drug Policy and Drug War Facts.