Feb 25, 2020 - Health

America's addiction treatment misses the mark

Illustration of giant legs standing around a small hospital bed.

Illustration: Aïda Amer/Axios

Addiction treatment in the U.S. is critically necessary yet deeply flawed.

The big picture: Drug overdoses kill tens of thousands of Americans a year, but treatment is often inaccessible. The industry is also riddled with subpar care and, in some cases, fraud.

"We have a remarkably fragmented and highly strained treatment system, which has contributed to the shocking rates of overdose that we see," said Caleb Alexander of Johns Hopkins Bloomberg School of Public Health.

  • As Reuters recently reported, only 15% of patients in residential drug treatment centers received medication-assisted treatment in 2015, although it's widely agreed that anti-addiction medicines are the most effective treatment for opioid abuse.

Not only do treatment centers often lack proven treatment methods, but they also often use ineffective ones.

  • As Vox's German Lopez has reported, there's really no way for patients to know whether an addiction treatment program is any good. Insurers don't communicate well about quality, and regulators don't do a good job of monitoring it.
  • "Little in medicine is as ill defined or as anecdotal as addiction treatment. Most rehab centers are not hospitals. The counsellors are often not psychologists. The medical directors can submit instructions from a distance," Colton Wooten writes in the New Yorker, recounting his own haunting experience with rehab.
  • Fraud has also been a problem. For example, in Florida, "sober homes" for people in recovery have been caught scamming insurance companies time and again.

"There is a massive for-profit industry that operates separate and outside of established medicine, relying on group therapy, 12-steps, counseling, etc. while eschewing best medical practices," said Zach Siegel, a journalism fellow at Northeastern University School of Law.

Insurance companies are required to cover mental health on par with their physical health coverage, but have often ignored those rules.

  • That can result in families paying huge out-of-pocket costs for treatment, or people suffering from addiction simply going untreated.
  • Additionally, as Vox's Lopez writes, "insurers often don’t know what good or necessary treatment is, because they’ve remained outside the field for so long, and so much of what is out there is of uncertain quality."
  • That means high-quality treatment centers aren't necessarily the ones that are covered by insurance.

The bottom line: Providers, insurers and regulators all need to do a lot more if we're going to have a functioning addiction treatment system.

Go deeper: How to change treatment for opioid addiction

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