Excess and Access: The Continued Struggle of the American Addict to Find Treatment

It is no longer any secret or surprise that the United States is in the midst of a fierce and desperate drug addiction epidemic. Nearly 44,000 people are killed by overdoses each year[1], accounting for over 100 people per day and making the problem more deadly than automobile accidents. Perhaps just as tragic as the hundreds of thousands of lives that have been lost to drug addiction is how these tragedies could have been prevented, if only with access to the right resources. Unfortunately, there exists in the United States a real and widespread disconnect between many of those who seek treatment for drugs and alcohol and the amount of adequate resources available to them. This lack of access has translated into real-life problems for families and communities across the country.

The “Lucky” 11 Percent

The Substance Abuse and Mental Health Services Administration estimates that of the nearly 23 million people that needed treatment for drugs and alcohol in the year 2013, only 11 percent actually received it.[2] This is not solely due to addicts being too caught up in their substance abuse to see that they needed care. Sadly, too many individuals who actively want to recover from their addiction are being denied: at least 316,000 people that tried to enter a treatment program were turned away. Many American addicts are more or less trapped in an environment in which drugs are abundant but where treatment is scarce. Although the evidence and research regarding the need for more care options is there, resources and public action have not yet caught up to these findings.

The Agonizing Waiting Game

Addiction-related overdoses have doubled from 1999 to 2013, according to the CDC. These enormous increases have created a need for treatment and intervention resources that communities just aren’t ready to provide. And those that are providing treatment services simply do not have the resources available to accommodate for this growing need. All over the country, detox centers are packed with addicts looking for assistance managing their withdrawal symptoms.

Despite the fact that many, if not most, of these facilities have the best intentions, they simply lack the room and the personnel to keep up with the demand. It’s not uncommon for addiction sufferers to wait weeks to get into a bed at a detox facility. By the time they can actually be admitted into a program, many succumb to their withdrawal symptoms and wind up abandoning the idea of recovery altogether.

As much as they want to get better, addicts become victims to their altered (and destructive) brain chemistry, which makes having to wait for treatment an incredibly dangerous ordeal. The fact is that if the addiction care community wants to see reduced fatalities and relapse rates, they need to do their part by offering quality treatment immediately when patients need it – and not two weeks after they come asking for help.

The Costs of Falling Behind

When society fails to take proactive and meaningful measures to provide treatment to those in need, it creates an increasingly larger opening for poverty and subsequent crime to infiltrate affected communities. Aristotle wrote that poverty is the parent of crime, but he failed to mention crime’s sibling, addiction. There is a clear link between poverty, substance abuse and criminal activity. Americans living below the poverty line are 132 percent more likely to be addicted to drugs than those with incomes exceeding two times the federal poverty threshold.[3] This economic-related substance abuse, in turn, severely erodes the quality of life in the communities it affects. It is estimated that 50 to 75 percent of all incidents of violence involve drugs and/or alcohol. This includes child abuse, domestic violence, homicide and rape.

While it might be too lofty of an undertaking to try and solve the problems of every economically vulnerable community, the addiction treatment industry must make room and develop the proper resources for those who find themselves the victims of their own cultural circumstances.

What Is Stopping People from Getting Treatment?

The unfortunate reality is that many voluntarily choose not to get help. They’ve either convinced themselves that they don’t need it, are too scared of withdrawal or are opposed to the idea for other reasons. For those who do want to get help, however, it’s not always as easy as contacting a facility and making arrangements. There are institutional roadblocks all over that make it incredibly difficult for people of all ages to enter a program. For example, although the senior population has become increasingly vulnerable to prescription opiate addiction, where hydrocodone has become the most commonly prescribed drug under Medicaid, Medicaid programs in at least 17 states don’t pay for long-term methadone treatment.

The Affordable Care Act was supposed to make addiction and mental health treatment more accessible; however, data from the National Alliance on Mental Health[4] indicates that prospective patients are still being denied care for substance abuse more than most other conditions. According to testimony in the organization’s 2015 report A Long Road Ahead: Achieving True Parity in Mental Health and Substance Abuse Care[5], many are being denied adequate coverage from their insurance companies for substance abuse and mental health-related issues.

“Fail First” May Mean Fail Forever

Many loved ones of addicts claim that it is the practice of their insurance carriers to adopt a “fail-first” policy with regard to addiction treatment.[6] In an effort to keep costs down, they say, their insurance will refuse to cover their loved one’s inpatient substance abuse treatment until they first “fail” in an outpatient program. It is common knowledge that most outpatient programs are incapable of providing the resources, oversight and level of care provided by their inpatient counterparts. To subject a patient to this policy is tantamount to intentionally triggering relapse in order to save money. There is enormous risk in this approach. Many patients never recover from their first relapse and remain addicted.

It is critical, particularly in the most severe instances of chemical dependency, that care providers and insurance companies work together to provide access to quality treatment immediately without first making a patient enter a program that is ill-equipped to address their care needs.

Lack of Trained Physicians

Another roadblock that addicts face is a severe lack of addiction-trained doctors.[7] Although chemical dependency has long been designated as a bona-fide medical condition, most doctors still possess no formal training in substance abuse. In a recent survey by Columbia University’s National Center on Addiction and Substance Abuse, 80 percent of physicians felt they were qualified to identify substance abuse, yet only one percent was able to render a correct diagnosis after hearing patients’ histories. The widespread perception of addiction as a lack of will power has had a real and measurable impact on clinical treatment. While chemical dependency is a legitimate medical problem, most addicts are treated by personnel with no medical training for substance abuse.

Investing in Recovery

While there may be many obstacles to getting your loved one the treatment they need, there is always help. At Behavioral Health of the Palm Beaches, we do whatever we can to work with patients and their families to expedite their entry into treatment. At the end of the day, the most important thing is facilitating your loved one’s recovery. Don’t become a casualty of a misguided system. There is hope. We can help.