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Future of addiction treatment: New patients, new funders, new partners

September 26, 2011
by Gary A. Enos, Editor
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NCAD closing speaker urges professionals to shed old thinking

The director of training at UCLA Integrated Substance Abuse Programs offered a dose of strong medicine to attendees of the closing plenary session at last week’s National Conference on Addiction Disorders (NCAD) in San Diego.
Covering an array of changes that are expected to result from national health reform, Thomas E. Freese, PhD, advised any audience members who “want things to stay the way they are” to “take up learning” instead. “We’re going to have to expand our services considerably,” Freese said in reference to the specialty addiction treatment community’s tendency to treat only the scant minority of individuals at the most acutely ill end of the spectrum.

Expanding care to incorporate the millions of presently untreated individuals with non-dependent but risky levels of substance use will require strong partnerships with mental health and primary care providers, he said, and at present that level of integration is largely absent in the substance abuse treatment community.

“The healthcare system will be able to provide some our services,” warned Freese. He also advised the addiction treatment professionals in the NCAD meeting room to “get some continuing education in mental health” if they lack training in mental illness topics.

Freese also is the director of the Pacific Southwest Addiction Technology Transfer Center (ATTC). His talk, “Substance Use Disorders Treatment Under Healthcare Reform—Welcome to the Healthcare System,” closed the Sept. 17-21 conference along with a moderated panel discussion on alternative approaches to the 12-Step treatment process.

Freese said that with Medicaid and private insurance reimbursement expected to eclipse the substance abuse block grant in financing treatment, addiction professionals will need to assume a significant effort in helping many of their clients to become Medicaid-eligible. Estimates show that anywhere from 10 to 25% of individuals with substance use disorders will remain uninsured even after mandates associated with the health reform law take effect in 2014.

While indications are that the block grant will not be phased out entirely, its purpose will change to that of providing gap coverage for those not covered by other means, as well as for funding primary prevention and the collection of performance and outcome data, Freese said.

With substance abuse services representing only about 2% of the overall healthcare system, Freese considers it inevitable that professionals will have to learn to work in a larger and more integrated system.

“We’re all going to be in the same pool whether we like it or not,” he said.

An acronym that he suggested attendees immediately become familiar with is “FQHC,” for the 1,000-plus federally qualified health centers that receive support from the Health Resources and Services Administration (HRSA) for primary care and related services for needy populations. These existing facilities are likely to house the “health homes” that are foreseen as the centerpiece of a more integrated healthcare system.

Freese said the ideal in healthcare has been identified as “one client, one place” for treatment, but the addiction community is still a long way from realizing that goal. “Mental health is a couple of years ahead of substance abuse in the integration process,” he said.