We Can Close the Treatment Gap. Will We?

[The following text is reposted with permission from the Join Together blog, where it first appeared on May 25, 2010. --Ed.]
 
The Rhode Island Closing the Addiction Treatment Gap initiative released its report this morning. They asked me to speak at the event. That got me thinking.
 
Why do we have this enormous gap? Why is such a complicated but treatable brain/behavioral disease treated mostly in a separate and unequal system where care is provided almost entirely without physicians by individuals with relatively modest formal training?

 
Well, I am afraid the answer is painfully simple. For almost 100 years federal and state policy has said it is OK to discriminate against people with addiction. In the early 1900’s negative and hateful stereotypes about who used heroin, cocaine, marijuana and alcohol were codified into law, and it seems to me these stereotypes continue to drive policy. Doctors were actively discouraged from treating people with addiction. Almost any mention or teaching about addiction disappeared from medical training and practice. Since 1914 federal policy has discouraged doctors from treating addiction by placing restrictions on the medications they can use; requiring special reporting and licensing procedures; and threatening to inspect their records if they prescribe too much pain medication.
 
As a result, an entirely separate paradigm emerged to help individuals with alcohol and drug addictions, largely driven by individuals and leaders who themselves had recovered from the disease. They created AA meetings and free-standing specialty treatment centers that have helped millions of people regain sobriety and their lives, but they reach only about 15% of the people in need. 
 
Now we are at an exciting point. Insurance coverage for addiction treatment is the law of the land—though insurance companies are fighting hard to continue their discriminatory practices. The new national drug strategy includes bold proposals to integrate addiction screening and treatment into the regular medical care system. Many state governments are so broke that they are beginning to rethink the stupidity of incarcerating people whose principal crime is having a disease. We can close the treatment gap. Will we? 
 

David Rosenbloom is Director of Join Together, a project of Boston University School of Public Health. Since 1991 Join Together has been the nation's leading provider of information, strategic planning assistance, and leadership development for community-based efforts to advance effective alcohol and drug policy, prevention, and treatment. Join Together believes that problems associated with alcohol and drugs can be best addressed at the community level.
 
Photo at top of post: limaoscarjuliet.