On average, private insurance payments for substance abuse treatment fell 1.6 percent each year. In 1986, private insurance paid $2.8 billion for drug and alcohol treatment; by 2003, it funded $2.1 billion in treatment - a 24 percent decline. The share of total substance abuse treatment costs paid by private insurance declined from 30 percent to 10 percent.I was surprised by the out-of-pocket spending drop. I would have expected out-of-pocket to be a small, but growing share of spending to compensate for reductions in private insurance spending.
The shift from private insurance to public funding is troubling for a lot of reasons. Anecdotally, treatment seekers in the public system often fall into one of the following categories:
- People who have never had much recovery capital.
- People who once had private insurance and were unable to get help. They've lost private insurance (Usually attached to their job.) and are now seeking help with a much more advanced AOD problem and less recovery capital.
- They will require higher intensity treatment, in a larger dose for a longer time.
- They probably won't receive the treatment they need.
- They will relapse in large numbers.
- Many of them will seek help again.
- They still will not get the treatment they need.
- They will relapse in large numbers.
- They will require more expensive care, like medical detox and hospital admissions for AOD related problems.
- Professional helpers and the public observe this cycle and conclude that these people can't be helped, or that they don't want to be helped.
- Professional helpers and the public conclude that treatment is a waste of money.
- Efforts to facilitate drug-free recovery are characterized as Quixotic and moralistic. There are calls for more pragmatic solutions.
- Societal responses to addiction will shift from facilitating recovery to mitigating the societal damage, primarily crime and disease.
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