Addiction, Recovery, and The Sequester

Terrance Heath

It was only a matter of time. As the debate over the sequester’s damaging, “just plain dumb,” across-the-board cuts ramped up, I just knew someone on the right would attempt to draw the analogy between government spending and addiction. “Addiction specialist” and “Fox News medical A-Team” member Dr. Keith Albow came through when he told host Jonathan hunt that  “America is addicted to entitlement spending. We can’t afford it, and we’re drugging ourselves.”

Dr. Albow may think the sequester is just the “no frills” detox America needs. But the sequester does the most harm to the most vulnerable, and it will do a great deal of harm to the population Albow supposedly specializes in helping.

Addiction and recovery are issues near and dear to my heart. Last summer I celebrated 20 years of continuous sobriety, but that celebration was tempered by the sobering reality of how many Americans are struggling with addiction, and how few have access to treatment. In  the 2011 National Survey on Drug Use and Health:

  • 20.5 million Americans were classified with substance dependence or abuse
  • 21.6 million Americans needed treatment for illicit drug or alcohol abuse
  • Of those needing treatment, just 2.3 million (0.9 percent) received treatment at special centers (hospital inpatient, drug or alcohol rehabilitation, or mental health centers)
  • 19.3 million needed treatment for substance but did not receive it

Before the sequester was more than just a bad idea, less than 10 percent of Americans who needed treatment for addiction actually got treatment, despite efforts — their own and their families’ — to get treatment.  If the sequester continues, and cuts trickle down to the state and local level, according to HHS about 200,000 Americans will lose access to addiction treatment, due to a 2% cut in Medicare.

In the 2011 NSDUH, most of the 0.9 percent who did get into treatment either used their own savings and earnings (46.4 percent), had health insurance that covered some part of the cost of treatment (38.5 percent), received funds from family members (26 percent), or used some combination of these. Some who qualified for programs like Medicare and Medicaid were able to find treatment programs that accepted one, the other or both. Most of those who did not get treatment either had no health insurance and could not afford the cost (37.3 percent) or had health insurance that did not cover the cost of treatment (10.1 percent).

With the cost of treatment running anywhere from $14,000 to $20,000 for an average 28-day stay, those without their own means or access to government assistance are already out of luck. The sequester will simply make it even harder for addicts to find help, or families of addicts to and pay for an open bed in rehab for a son, daughter, father, or mother.

The hardship of sequestration will fall large on low-income and middle class families. Low income families and addicts will simply find what meager public resources were available have become even more scarce. Middle class families who are either “too wealthy” to qualify for state or federal subsidies and “too poor” to pay out of pocket when insurance claims are denied, will be in much the same boat. (Despite laws like the Mental Health Parity and Addiction Treatment Act and the Affordable Care Act,  intended to make treatment more widely available and stop insurers from discriminating in their coverage, insurance companies still frustrate families seeking addiction treatment.)

The most common response to all of the above is often “So, what?” After all, we’re talking about addicts here, and addiction is one of the few diseases for which we righteously blame the victim, and treat addicts as criminals rather than people with a chronic — and potentially deadly — illness. The addict “brought it on themselves,” should develop the willpower to “just say no.”

Our approach to addiction is both deadly and costly. Scientific research is providing more and more evidence to support the disease model of addiction; uncovering brain differences that suggest a predisposition to addiction in some people, and gene mutations that make us more or less sensitive to alcohol. As we often say in recovery, we’re as sick as our secrets, and our secrets are keeping us sick. Treating addiction as a crime rather than a disease is keeping millions of us sick, and killing too many of us. Drug overdose deaths have been increasing for years, and drug-related deaths have outpaced traffic fatalities.

And if none of that matters in when it comes to slashing budgets, how about this? Untreated addiction is expensive. Addiction treatment is a good investment.

Untreated addiction leads to higher costs in other areas. Emergency room visits and increased hospitalizations due to addiction lead to increased health care spending. About 1/3 of hospital admissions are the result of risky drug use and addiction. Untreated addiction causes more than 70 diseases — like liver disease, hepatitis, HIV/AIDS, Fetal Alcohol Syndrome, etc. — requiring medical care.  All of that gets added to tab picked up by taxpayers. Since 1986, hospitals and emergency rooms have been required to treat all patients regardless of their ability to pay. Those costs get passed on to the rest of us, as addicts who land in emergency rooms and hospitals beds with addiction-related conditions are usually among the uninsured.

Untreated addition has costs far beyond health care. Because we treat addiction as a crime rather than an illness, we spend money on police, courts, and incarceration as we move addicts though the criminal justice system. In our prisons and jails, 86 percent of inmates are there for substance-related issues, and two thirds meet the criteria for addiction. We pay about $25,000 per year to keep each of them locked up, but often fail to treat the addictions that landed them there in the first place. Other consequences of untreated addiction — unemployment, homelessness, child abuse, domestic violence, mental illness, etc. — has expensive ramifications for our welfare system.

Altogether, federal state and local government spend about $467 billion per year on problems related to untreated addiction, accounting for 10% of the federal budget and 10 percent of most state budgets. Split the bill between all of us, and that comes to a yearly cost about $1,500 for every person in America. Just 2 cents of every dollar spend goes towards prevention and treatment. The other 96 cents goes to pay for the consequences of failing to prevent and treat substance abuse.

Providing treatment actually saves money. Every dollar spent on treatment saves $7 to $12 spent on the consequences of untreated addiction. According to a UCLA study, every $1,583 spend on addiction treatment is offset by $11,487 in savings — money that we would otherwise spend on the costs of medical care, mental health services, incarceration, unemployment, and public aid related to untreated addiction.

The sequester means that at least 200,000 more Americans will not get the substance abuse treatment they need. Any supposed “savings” will be obliterated by the cost of the consequences for denying treatment. The human cost to communities, families, and addicts themselves is incalculable — and unconscionable.

Comments