tag:blogger.com,1999:blog-6154923121857389373.post3012063841889431107..comments2023-07-07T05:11:26.707-05:00Comments on Substance Matters: How Will the Election Affect Treatment for Addiction?Mark Willenbring, MDhttp://www.blogger.com/profile/10556707753571367243noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-6154923121857389373.post-60348726952249883652012-11-17T03:36:39.838-06:002012-11-17T03:36:39.838-06:00I agree with your point, for the most part. Don...I agree with your point, for the most part. Don't get me wrong - until we move away from managed care and toward a single-payer, universal health care system, we will always be doing a disservice to addiction and behavioral health patients. <br />However, in a choice between better-than-the-status-quo and worse-than-the-status-quo, I take the former every time. Anonymoushttps://www.blogger.com/profile/02083530358646742701noreply@blogger.comtag:blogger.com,1999:blog-6154923121857389373.post-14275473710750988412012-11-15T22:55:13.259-06:002012-11-15T22:55:13.259-06:00I doubt that the ACA will do much for the treatmen...I doubt that the ACA will do much for the treatment of addiction. I was at a panel discussion of this very topic at the APA meeting in Hawaii a couple of years ago. I asked the panel: "What would prevent a managed care company from handing out some type of rating scale (like they do in Minnesota for depression right now) and calling that a chemical dependency assessment? The answer of course was nothing. <br /><br />I think people make a mistake when they think that expanded coverage will magically expand treatment for the mentally ill or the addicted. There is a clear pattern of discrimination over the past 25 years that would need to be reversed and there is not sign that will happen. In fact, I consider it a very bad sign that the SAMHSA web site is now touting the advantages of managed care. It is the first time that the government is explicitly backing managed care despite their behind the scenes backing for a long time.<br /><br />I have posted this example on this blog in the past as a case in point. If you are a middle aged man or woman with chest pain from probable esophagitis - it is not too difficult to get admitted to the CCU overnight and end up with a $20,000 - $30,000 expenditure for Cardiology services and consultations. On the other hand if you have an addiction and get sent to the ER, and entirely different set of scenarios is likely to unfold. The range may be being sent to a county detox facility for "social" or non-medical detox to being sent out of the ER with a bottle of benzodiazepines and told to detoxify yourself at home. There is rarely any acute care for addictions and that includes current members of managed care organizations. <br /><br />There are also institutional biases against people with mental illnesses or addictions. There has been some writing here about how some 12-step recovery seems to blame the person with the addiction. I would say that the odds of that happening are much lower than encountering institutional attitudes against those with addictions - frequently disguised in the form of cost containment. Remind me again of why a managed care company is sending anyone to a county detox facility?<br /><br />It takes more than a law that clearly favors big business to change these attitudes and the likelihood that Addiction Medicine is practiced at the same level as Internal Medicine or Cardiology in these systems. I will believe it when I actually see those resources move and I am not expecting that they will.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.com