The Problems with the U.S. Addiction Treatment System
Did you know that most addiction treatment specialists have little formal education or training in addiction? Fourteen states require only a high school diploma or a GED to become an addiction counselor; 10 require only an associate’s degree.
But it gets worse — fully 20 states in the U.S. don’t require any degree, or don’t even require addictions counselors to be certified or licensed in any way.
Is it any wonder then that many addiction or rehab programs still rely on an outdated model that’s directly dependent upon how long companies are typically reimbursed for treatment — 30 days? Or that many programs still use treatment methods largely unchanged from the 1950s — not research-backed, modern approaches to treatment?
A groundbreaking report published last year from Columbia University lays out the sad facts of addiction treatment in the U.S. As the report notes, “Some [treatment programs] promise “one time” fixes; others offer posh residential treatment at astronomical prices with little evidence justifying the cost. Even for those who do have insurance coverage or can pay out-of-pocket, there are no outcome data reflecting the quality of treatment providers so that patients can make informed decisions.”
These eye-opening facts come from a report published last summer by the National Center on Addiction and Substance Abuse at Columbia University. The New York Times has the story, including noting that one of the most popular myths about effective addiction treatment is that you have to go to an addiction or rehab center in order to be treated:
“The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually,” she wrote.
Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”
Just over 43 percent of addiction treatment spending is spent at those specialty addiction treatment centers — the ones that inevitably discharge patients after 30 days, whether they’re successfully treated or not. That’s the biggest chunk of the addiction spending pie.
Successful addiction treatment is difficult — just 42 percent of those who seek out treatment for addiction complete it. That’s not surprising given the characteristics of addiction, and the fact that more often than not, an actual addictive substance is involved. But a system that focuses on evidence-based treatments could do a better job and substantially increase that number.
This profound gap between the science of addiction and current practice related to prevention and treatment is a result of decades of marginalizing addiction as a social problem rather than treating it as a medical condition. Much of what passes for “treatment” of addiction bears little resemblance to the treatment of other health conditions.
Much of what is offered in addiction “rehabilitation” programs has not been subject to rigorous scientific study and the existing body of evidence demonstrating principles of effective treatment has not been taken to scale or integrated effectively into many of the treatment programs operating nationwide.
Addiction treatment in the U.S. is yet another orphan system in the overall health care system — kind of like the mental health system’s little, sometimes neglected brother. One of the report’s recommendations is to bring the addiction treatment system into the larger mainstream health care system — mainstream it, if you will.
That’s a recommendation I can get on board with. Effective addiction treatment needs to be brought out into the spotlight in order to highlight what research shows actually works and is effective. We’ll highlight some of those findings in the coming months.
Read the full New York Times article: Effective Addiction Treatment
Grohol, J. (2018). The Problems with the U.S. Addiction Treatment System. Psych Central. Retrieved on April 1, 2020, from https://psychcentral.com/blog/the-problems-with-the-u-s-addiction-treatment-system/