The Treatment Chasm
In the world of substance abuse treatment today there exists a
great chasm separating profitable in-patient programs and
struggling outpatient programs. The problem however is more than
just a profitability problem, it is a social problem that leaves
a huge void in the front lines of the war against substance
abuse.
Personally I am very much an advocate of our free market system,
although probably everyone would agree there are some
significant problems related to heath care. Although the topic
is somewhat less popular, at the leading edge of the healthcare
issue resides substance abuse treatment. There are some
tell-tell attitudes about substance abuse that are less than
healthy. I have had occasion to speak with many parents that say
something to effect that they had sought professional help for
their addicted child only after they had tried all other
options. I spoke with one father who told me that he did not
live far from the treatment facility where I worked and that
before he found out that his son was addicted to heroine he had
passed a petition around his neighborhood in an attempt to shut
us down. There has been some improvements in the community, most
of which unfortunately have been forced due to substance abuse
symptoms experienced.
The way the system is set up is not necessarily a bad idea, the
problem is that we are unable and unwilling to stick to the
plan. An addict should first of all be recognized early on in
the addiction and receive the appropriate treatment, but they
don't. The addict should receive an assessment from a real
therapist, but they don't. The addict should be admitted into an
in-patient facility regardless of bed availability or affluence,
but they are not. The addict should receive General Out-patient
treatment when needed and not when they have the ability to pay
or six months down the road when the County finally has an
opening.
Let me paint a familiar scenario for you. We will start with a
well known Methamphetamine addict who has racked up a bunch of
felony possession and theft charges. This guy has been in and
out of jail for years and has charges out of multiple courts.
Now usually what happens is that he gets put in jail, the Public
Defender relates to the Judge that this individual has a
crippling addiction and they work out some kind of plea
agreement and the defendant is ordered to get an assessment and
follow the recommended treatment. The addict gets the assessment
which recommends in-patient followed by intensive out-patient
and then general out-patient. This guy has been an addict for a
while and there is no way he is coming up with $ 30,000.00 plus
to attend a private in-patient facility, so he gets on the
waiting list behind hundreds just like him for the county, or
state ran in-patient facility. In the meantime he is still an
addict and amazingly he was not instantly cured when he entered
the criminal justice system, so in the six months or so it takes
to get into the county treatment system he of course continues
using and steeling etc. Inevitably the addict ends up getting
arrested several more times and never makes his appointment for
the in-patient treatment he needs.
Some Judges have caught on to futility of this disturbing trend
and in an attempt to brake this criminal justice system cycle
will order people who need in-patient treatment to a private
General out-patient facility. The general outpatient treatment
provider will generally do as the judge orders and provide the
treatment as best they can. I do not want to lay the blame on
our Judges, they are just reacting the best they can to a
problem that is largely out of their control. The private GOP
facility is obliged if not obligated to follow the Judge's
order, if they don't there is another ready and willing to pleas
the court and get all those referrals. Most GOP facilities that
are not subsidized by the State are just scraping by and they
can't afford to turn down a single referral even if they belong
in an in-patient facility.
The obvious solution to this problem is for more people to offer
in-patient treatment. Well that all sounds great but in-patient
is expensive to run and although most in-patient programs are
not struggling financially they are still expensive programs to
run and you can't get away with bringing the price low enough
for the average addict to benefit from it. The only people who
make it into a private in-patient facility have some kind of
wealthy benefactor, unfortunately this exclude our long time
meth addict who has lost everything and burned every bridge.
The short and long term solution to the problem is to show
people the truth about substance abuse. As soon as enough of our
kids die from heroine overdoses, soon as the epidemic effects
enough of the decision making population then I expect we will
do as we have done in the past with all catastrophic problems,
that is throw a bunch of federal money at the problem and wonder
why things got so out of control. It would be nice if we could
show the public what the future holds if we continue on the
currant track, and get the help for the people who really need
it but cannot afford it. Eventually society ends up paying the
price for the un-helped addict. We pay for them in prison, we
pay for their children's care, we pay when our kids die. So lets
pay now and pay less and maybe even save a lives in the process.