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ACA turns drug, alcohol addiction into chronic disease

By Jennifer Bresnick

ICD-10 and Stage 2 of the EHR Incentive Programs might be rocking the boat in 2014, but one of the biggest impacts of healthcare reform might be something that’s flying under the radar.  Along with the millions of new patients expected to enter the system under the Affordable Care Act (ACA) comes a redefinition of one of the most widespread problems affecting Americans today: drug and alcohol abuse.  Rarely treated as a purely medical condition today, substance abuse will now fall under the category of “chronic diseases”, says the California Health Report, meaning insurance companies will be required to provide coverage for treatment – and providers will be able to bill for it.

“I don’t think there’s another illness that will be more affected by the Affordable Care Act,” says Dr. Thomas McLellan, former deputy director of the White House Office of National Drug Control Policy.  Expenses due to alcohol and drug misuse have reached $120 billion across the healthcare system, a huge opportunity for cost-cutting, and a perfect example of how accountable care is transforming treatment.

By turning addiction into a disease, officials hope to end the marginalization of alcoholics and drug users as social failures, and harness the power of scientific advances in the understanding of the biological basis of addiction to improve overall health and wellness among vulnerable populations.  “The bottom line is having empathy. There’s often a lot of judgment. I’d call it bigotry,” says Leonard Dootson, an RN at Tarzana Treatment Center in Southern California, one of the region’s biggest addiction services providers. “People want to project their own experiences onto the patient because it’s seen as a moral weakness. For people to see it as a real disease, it’s different.”

“[Addiction treatment in California] is this weird mix of self-help, criminal justice, social work and a non-profit peer mentor collection of activities, none of which had anything to do with health care,” added Richard Rawson, a UCLA professor of psychiatry. “The system has not been able to decide if they [addicts] are sick people or bad people.”

As providers hope to continue the downward trend of healthcare spending and increase communication between different stops on the continuum of care, treating addicts before substance problems evolve into cancers, organ failure, or result in excess emergency room visits or injuries to the patient or the people around him is vital to keeping costs down and patients healthier.

Just like keeping a diabetic’s weight and blood sugar under control before the disease produces expensive complications requiring long hospital stays or surgery, the ACA is hoping to nip future problems in the bud. While McLellan says the change in designation was a surprise for the field, the changes will offer more of an opportunity for primary care to identify and combat substance abuse before it produces problems that require costly and difficult interventions to fix.




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