Dear Mr. President: A Modest Proposal - Page 2
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Public opinion, while conflicted, is somewhat more advanced than public policy. This nation has a long history of isolating and stigmatizing individuals with health problems that were not well understood, from tuberculosis to cancer, depression and HIV-AIDS. Once scientific understanding of the condition is solidified and the information permeates public understanding, public attitudes towards the condition and those who have it often change. The availability of effective treatments also can have a profound impact on driving this change. Addiction is a prime example of a disease where public attitudes have yet to catch up with the science, although attitudes are shifting. Recent national polls reveal that while there is still significant stigma attached to this disease, approximately eight out of 10 people recognize addiction as a chronic disease.
The main challenge we face to addressing addiction as the disease it is involves integrating its prevention and treatment into routine health care. Addiction treatment today is largely disconnected from mainstream medical practice. Most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction. Many of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services. There are no clearly delineated, consistent and regulated national standards that stipulate who may provide addiction treatment in the U.S. The standards for treating this serious illness vary by state and by payer, and most treatment providers are unable to provide effective, evidence-based care. Moreover, insurance coverage of these treatment practices is often inadequate and based on a misunderstanding of this disease; for example paying for detox only but not comprehensive treatment and disease management.
We now have a solid understanding of the nature of the disease; we know many of the risk factors. We have screening and intervention tools of proven efficacy. We have a broad range of effective behavioral and pharmaceutical treatments to deliver in the context of routine health care. We need to use this knowledge.
Clearly, health care providers must step up to the plate and educate themselves on how to prevent risky use and how to effectively treat addiction. And, insurance companies must cover costs of effective prevention and treatment rather than paying a much larger tab to treat resulting diseases. But perhaps the greatest leverage can be found within the U.S. government. To reduce costs to government and improve health, safety and productivity, the federal government should require that health care providers receiving federal funding (including Medicaid and Medicare) offer comprehensive and evidence-based screening, intervention and diagnostic services for all manifestations of addiction as well as provide treatment and disease management or connect patients with specialty care as appropriate as is done for other health conditions.
The federal government also should require that addiction treatment programs and facilities be licensed as health care providers, require adherence to national accreditation standards based on the science of addiction and its treatment and immediately work to expand the addiction medicine workforce. And, it should identify patients at risk in government funded programs and services where costs of our failure to prevent and treat addiction are high and assure that patients receive the prevention, intervention, treatment and disease management services they desperately need.
Although making a cost-benefit argument for saving lives and reducing suffering is not a threshold requirement for any other area of health care practice, study after study has shown that the benefits of addiction treatment outweigh the costs. We all agree that the so called war on drugs has failed, but the answer is not legalization. The answer lies in understanding what we face—a public health and medical problem—and responding accordingly. It makes good sense to keep dangerous and harmful substances out of the public marketplace, but enforcement alone will not treat a disease. Providing preventive care and effective medical care will, and it will save us all a lot of money and heartache.
No matter what side of the political spectrum you are on, addiction is a disease that touches virtually every family and circle of friends in America. I urge both President Obama and Governor Romney to part the smoke and mirrors of the health care debate and agree on this one fundamental change.
Susan E. Foster is Vice President for Policy at The National Center on Addiction and Substance Abuse at Columbia University (CASAColumbiaTM).