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[ Opinion ]

The TRICKLE  Down Effect of Addiction Treatment

The insurance industry is in the business of saving money when it should be in the business of helping to save and rebuild lives.

I can tell you from my personal experience as both a NICU nurse and the mother of a man who suffered from Substance Use Disorder that if this disease was treated comprehensively from the first admission that both lives and money would be saved.

Addiction is the only chronic, treatable disease that is limited in receiving long term life saving treatment. I referred to the years during my son’s battle as the revolving doors of recovery. Rather than allowing Matt to remain in treatment until he was strong enough to remain clean he was forced to leave before he was ready, setting him up for a relapse and another too short admission either to the same facility or which ever one had an available bed. Matt was given 30 days per year. Matt is dead. I ask you what other chronic disease gets this limited treatment? Where is the Parity when it comes to Substance Use Disorder?

I witnessed the same discrimination when speaking to the mothers who’s infants became my patients in the NICU. Infants born addicted. These mothers reached out for treatment prior to becoming pregnant or early in their pregnancies only to becoming members of the revolving door club. The insurance companies refused to allow these mothers to stay in treatment long enough to stay clean. Rather than spending the money helping these mothers get and stay clean, Medicaid pays out thousands of dollars per year in hospital stays for addicted infants. According to the AMA, in 2009 hospital care for an NAS infant cost $53,000. With the rising cost of healthcare that cost has likely doubled in 2016. 

At any point in time my NICU received up to 14 NAS babies. Many of these infants required months of care. Imagine the money Medicaid would save if those mothers were treated properly and those infants were born healthy. Medicaid also pays for Methadone Maintenance treatment during the pregnancy. Keeping these mothers dependent on yet another highly addictive, dangerous drug. Some of these mothers remain on Methadone for months after delivery as weaning this drug is a process and most detox facilities deny admission to anyone on Medication Assisted Treatment. Continuing to spend money when the initial investment into treatment would have saved so much more.

Let’s look at the effect of addiction on the Foster Care System. This system is already over saturated with children in need of a safe home. Many addicted parents lose custody of their children due to their disease and behavior associated with the lifestyle. These children are ripped away from the parents they love and either placed with another family member or placed with total strangers. Imagine the emotional impact on these innocent victims of addiction. Yet, this is the nation wide solution for children of addiction. Money is now spent on paying strangers in this Foster Care System. Why not spend that money toward rehabilitation of the parent. Spend the money in long term comprehensive treatment and work toward reuniting families. Cost effective for the insurance industry. Psychologically safer for the child.

Let’s explore another aspect of addiction and cost. Unemployment. Imagine the impact on this overburdened system if the Insurance Industry covered longer term in-patient treatment. Those suffering from Substance Use Disorder would have the time to recover, receive vocational job training and counseling preparing them to return to becoming a productive member of the workforce. Contributing to the system instead of taking from it.

Drug related crime would also decrease. Most addict’s steal to maintain their habit. According to NADCP, approximately 60 percent of individuals arrested tested positive for an illicit drug at arrest. Imagine the impact on the crime rate if those who were living this lifestyle were treated comprehensively. Investing funds into Drug Courts rather then incarceration. This system provides comprehensive treatment and close supervision keeping offenders in treatment long enough to get them well. 

To be successful in this war against opioid addiction, we must change our mindset. We must acknowledge that 30 day treatment programs are failing. We continue to lose 129 people daily nationwide to this deadly epidemic. We must also acknowledge the medical research that has proven Substance Use Disorder to be a brain disease. Understanding that at minimum those suffering from this disease must receive at least 90 days in treatment followed by months of extended follow up. Allowing a transition from a safe clinical setting to a partial out patient setting which includes the outside recovery community and family support.

According to the The National Institute of Drug Abuse (NIDA), “The threshold of significant improvement is reached at about 3 months into treatment, however treatment that lasts longer shows better results”. Every addict suffers from more than just drug addiction. Many issues such as mental and physical trauma, anxiety, depression and similar co-existing disorders go hand in hand with addiction. Limiting in-patient treatment sets those suffering from this brain disease up for continuous failure and possibly death. Research has shown that successful recovery takes place over time. The brain has changed due to long term damage from Substance abuse. Depending on the drugs used and the duration of the addiction healing could take approximately 3 months to 1 year.

The brain must reset itself, thought processes must return to a normal, healthy state. This doesn’t happen in the current 30 day model of treatment. During the initial 10-14 days detox and stabilization are taking place. My son was just beginning to feel human again after the first 2 weeks in treatment. Sadly, his insurance provider refused to cover additional days and he quickly relapsed.

Until the insurance industry recognizes Substance Use Disorder as a chronic, treatable brain disease we will continue to lose our loved ones to this mistreated, misunderstood disease. This industry must take responsibility for their part in the epidemic we face today. Addiction is the only chronic, treatable disease that is limited in receiving life saving treatment. In all my years of nursing I’ve never heard of a cancer patient or infant born suffering from withdrawal be informed that you’ve reached your limit on treatment days. Goodbye and good luck. This is exactly what I experienced with my son, Matt. He was bounced around like a ping pong ball. Never given long enough in treatment to give him a fighting chance at recovery.

The solution to saving lives is simple. It requires the Insurance industry to recognize Parity allowing long term treatment to be available for those suffering from Substance Use Disorder. Those making decisions regarding treatment coverage must attend mandatory education in the disease of addiction. Education leads to understanding. Understanding leads to changing the model that continues to kill our loved ones. Saving lives taking precedence over saving money. Making recovery not just a possibility but a reality.