Under The Affordable Care Act The Looming Expansion And Transformation Of Public Substance Abuse Treatment Jeffrey

Public substance abuse treatment services have largely operated as an independent part of the overall health care system, with unique methods of administration, funding, and service delivery. The Affordable Care Act of 2010 and other recent health care reforms, coupled with declines in state general revenue spending, will change this. Overall funding for these substance abuse services should increase, and they should be better integrated into the mainstream of general health care. Reform provisions are also likely to expand the variety of substance abuse treatment providers and shift services away from residential and standalone programs toward outpatient programs and more integrated programs or care systems. As a result, patients should have better access to care that is more medically based and person-centered. I n 2009 nearly 10 percent of the US population age twelve and older were illicit drug abusers, and nearly one-quarter had engaged in binge drinking (five or more drinks on a single occasion) in the previousmonth. Sevenpercent of thepopulation had at least five instances of binge drinking in that month. Excessive alcohol consumption and illicit drug abuse constitute substantial health problems in and of themselves, but they also cause or contribute to other serious health conditions or complicate treatment for other conditions. For example, heavy alcohol abuse is associated with liver disease and coronary heart disease. Cocaine abuse can trigger heart disease, and injectable drug abuse is associated with hepatitis C and HIV/AIDS. Separate System For Substance Abuse Unlike mental health services, where the majority of care occurs in general medical settings, treatment of substance abuse disorders occurs predominantly in a separate specialty services sector. For example, respondents to the 2009 National Survey on Drug Use and Health reporting inpatient treatment for alcohol or drug problems in the US population age twelve and older were 50 percent more likely to identify a rehabilitation facility as their source of inpatient care, compared to a hospital. Outpatient substance abuse treatment in a rehabilitation facility was two-and-a-half times more frequent than treatment in a private doctor’s office. Most specialty substance abuse care is provided by stand-alone nonprofit or governmentoperated facilities, where the typical daily caseloads are fifty or fewer patients. Although most care is delivered in outpatient settings, about one-quarter of treatment providers also furnish nonhospital residential care. These residential programs average thirty-two beds each. More than half of their daily census is composed of people in treatment for more than thirty days. In both residential and outpatient settings, services generally consist of abstinence-oriented counseling and education. Only a small minority of the programs offer treatment using newer medications, such as buprenorphine. What’s more, treatment is typically delivered by staff doi: 10.1377/hlthaff.2011.0480