By Diane Hague, LCSW, CADC
I shared with a colleague that I was writing this piece and asked his advice. He said, “Tell them addiction treatment works. Ask folks if they’re willing to pay for it. Tell them we all pay in one way or another –we can either fund treatment or see increasing productivity losses, workplace injuries, more expensive healthcare, family violence and more.”
His response was, in part, a reaction to the ongoing disparity in how private and public insurance covers addiction treatment, which is significantly different than how insurance covers treatment of other chronic illnesses.
Absent From Dialogue
With all the issues being discussed around prescription drug abuse in our state and our nation, a major part of the solution appears absent from the dialogue—treatment. Addictions are illnesses. The most effective thing we can do is treat them.
News media focuses on the societal problems associated with prescription drug abuse—the arrests of pain clinic employees, investigations into questionable practices of prescribing narcotics, the rise in drug overdose deaths and attempts at greater criminal law enforcement. This leaves little room for the stories of promise and recovery that come from effective treatment. But these illustrate how treatment is a major part of the solution.
Drug addiction is a chronic illness which means there is no cure. But like other chronic illnesses, like diabetes and hypertension, there is effective treatment. The treatment of addiction is a recognized medical specialty. Our region has several licensed addiction treatment facilities which provide the standard of practice in addiction treatment, including the center I direct—the Jefferson Alcohol and Drug Abuse Center in Louisville.
As with other chronic illnesses, the treatment for addiction consists of education about the chronic illness and the self-care necessary for a stable recovery. Through treatment, individuals with addiction admit to and accept their medical condition and commit to the self-care necessary for a drug-free life. (In our region, we have 400 weekly 12-Step meetings which provide the majority of self-care for people with addictions.)
Contrary to the popular “celebrity” coverage that dominates national news on addictions treatment, the majority of addictions treatment occurs in an intensive outpatient format (two to five days per week for two three hours) or in short-term residential or rehab (10-15 days). Before education or counseling can be beneficial, however, the person with addictions must be thoroughly withdrawn from the drugs they have been abusing.
This often requires medical detoxification, particular with the two classifications of drugs that are receiving attention inKentucky: narcotics/opiates and benzodiazepines. Both are physically addicting and have noticeable, fairly long periods of withdrawal. With benzodiazepines, medical inpatient detoxification is advised because of the risk of seizures. The withdrawal from narcotics/opiates is not dangerous, but most people with this addiction have difficulty being successful with an outpatient detoxification. The standard of practice for an inpatient medical detoxification from benzodiazepines or opiates is eight to 12 days.
To me, the bad news about prescription drug abuse is that we don’t invest in sufficient treatment to assure persons with addictions can recover. If insurance policies don’t cover sufficient treatment, it is difficult for the person with addictions to stabilize. The average insurance authorization for detox from benzodiazepines and narcotics is eight days. As a result, many patients are not clear of withdrawal symptoms when their insurance authorization ends.
As with all chronic illnesses, relapse is common in people with addictions. But the term “relapse” is often misunderstood. Persons with addictions don’t “relapse” until they first stabilize. And they can’t stabilize until they’ve successful cleared withdrawal. Without adequate treatment, they don’t relapse—they are still actively ill. So, the cycle of effective treatment begins with sufficient treatment—and that is often lacking.
Almost 80 percent of true relapses occur within the first six months after stabilization. People with addictions who relapse after stabilization do so at no higher rate than people with diabetes or hypertension. After a relapse, the amount of treatment necessary for the addicted person to get back to stable recovery is usually short-term.
The good news is that there are quantifiable and significant positive results. Studies show that when persons with addictions receive the treatment they need, other healthcare costs drop by 55 percent; workplace problems, including absenteeism and injuries fall 75 percent; and arrests are reduced by 68 percent.
I urge all readers of Medical News to consider this: Addiction treatment is a major piece of the solution to the prescription drug epidemic. So, what can you do? Become familiar with the addiction treatment and recovery resources in the community. Examine your workplace benefit coverage for addiction. Discuss the need for adequate addiction coverage with your board or employer.Supportyour relatives, friends and co-workers who are ill and need treatment.
Diane Hague, LCSW, CADC, is director, Jefferson Alcohol & Drug Abuse Center vice president of addiction services, Seven Counties Services.