Substance abuse demand is at an all time high and suddenly addicts needs are being evaluated by politicians and medical professionals.  What has been found by regulators is that there is much need for change, transparency, and improvement in order to effectively overcome the opiate epidemic that is sweeping the nation.

For quite some time the substance abuse treatment industry has operated on the sidelines, seperately from the mainstream medical profession. Some current state laws even prohibit substance abuse rehab from being classified as a medical facility.  This has allowed the industry to adopt non-medical practices as their primary tools for the treatment of addiction.

Due to the lack of standardized medical procedures used to treat addiction until recently, rehabs have over time, become glorified therapeutic communities. Many would think of it as a life skills retreat with extensive individual and group therapy with your peers.  For individuals who have been open to a new way to live and are ready to change it proves successful.  You may ask yourself, if it is successful then what is the problem with it? The answer to that is simple, the cost. The amount of time it takes an addict to change their behaviors and characteristics to a point where they have a solid foundation to build a productive life is many months or even years. Individuals and insurers have a hard time paying for such a long time in treatment. As you can imagine addicts generally have limited resources when they are ready to seek help. The best case has been that they have health insurance that could provide them with substance abuse coverage.  But as expected, health insurance companies have become weary of the amounts they have been paying for such services with high relapse and recidivism rates.

Here is a very direct view that generalizes the two primary substance abuse treatment methods. The first is the commonly known one month program, it is setup as an inpatient rehab center where increased structure and limited real world involvement will likely be found. No matter the types of services offered, the national success rate for continued abstinence with an inpatient stay is dismal. It is known to be less than 5% for continuous years of sobriety. The way that these programs can be successful is to have strong referrals to outpatient programs allowing their participants continued structure and support. Absent additional support these programs quickly become a revolving door for individuals stuck in the rehab cycle until they reach a new found willingness to recover.

Secondly is what came to be knows as the Florida model or long term treatment. It begins with the first type of treatment and then becomes less structured providing a step down approach into an Intensive Outpatient.  This type of treatment has been used as the standard for long term substance abuse treatment for the last decade. The success rates are much greater but there are also many downfalls and issues. The primary bone of contention with this model is the cost.  Keeping someone safe and in a structured or semi-structured environment for months at a time is costly. Most addicts and their families don’t have the finances necessary to support this type of treatment. Addicts and providers have turned to insurance companies to pay for these services. The problem with this is that the definition of medical necessity is quite broad and services can easily be denied accordingly. Furthermore, there is no evidence based research proving that there is a direct correlation to time admitted in a long term program and time remaining clean and sober post discharge.  Participants often perform well when in these structured environments but when discharged face the same obstacles regardless of the amount of time clean they have when discharged.

A majority of extended care rehab facilities are abstinence based programs which rely on therapy and 12 step support to treat their clients. Though this can be effective and is still the most practiced treatment modality it is not the most supported by insurance companies who are the primarily payers for addicts in treatment. The problem with this is that the goal of the extended care treatment facilities is to give clients the longest length of time in treatment. Without meeting the requirements set forth by the insurance companies providers are shorting their clients valuable time they could have had authorized if they had used medication if viewed necessary by their insurance company who is paying for the treatment. Becoming open to the medical components that can increase addicts chances of success and minimize relapse is essential.

AARG View: How can the current models of substance abuse treatment become most effective?  The answers are available but the medical and rehab industries need to embrace each others practices to maximize results. Neither industry can have the best chance of success without the other.  Studies prove that addicts who have well managed medication assistance relapse less and stay engaged in rehab programs longer. Addicts who choose to only take medication from their doctor and do not add any therapeutic components tend to rely on their medication too much which leads to higher chance of dependence, abuse and possible relapse. It is imperative that the standard of care for substance abuse treatment address the need for both tools in treatment plans.  Comprehensive all-encompassing treatment plans will allow addicts relief from cravings in order to stay engaged through therapeutic sessions and gain life skills to overcome their addictions. Being able to stay admitted to treatment will allow addicts to get the most out of their attempt; in essence limiting the maximum amount of time needed in a program before discharging.  This dynamic benefits everyone from the providers, addicts, insurers and the economy as a whole.  Getting an addict back to being a productive member of society for the lowest cost is the overall objective from the standpoint of the nation.  Well composed and practiced treatment and discharge plans using medication, therapy and support groups maximize the chances of reaching that goal.

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