According to Webster’s Dictionary, an advocate is “one who supports or defends a cause,” and “one who pleads on behalf of another.” As advocates, we support the cause of therapeutic communities and we plead on behalf of addicts who need treatment or are recovering.
A part of Treatment Communities of America’s mission is educating policymakers on the importance of controlling substance abuse through effective treatment and prevention services.
Health Reform and Substance Abuse Prevention and Treatment as Partners
TCA believes in a partnership of primary health and public health systems of care with the substance abuse prevention and treatment system of care for the mutual benefit of patients. Americans need lower medical costs, access to affordable evidence-based services that can be sustained and thrive. Quality addiction services must be secured as part of any health care reform and be consistent with the Institute of Medicine Quality Chasm aims of being safe, effective, patient-centered, timely, and efficient.
Principles for Substance Abuse Prevention, Treatment and Recovery as Part of Health Reform
TCA recommends the Principles of Drug Addiction Treatment – A Research-Based Guide, National Institute on Drug Abuse, National Institutes of Health’s, Publication No. 00418 should be considered as part of the health care reform discussions for access, coverage, and management of care for both public and private financing and provision of addiction treatment services.
- No single treatment for substance abuse disorders is appropriate for all individuals and effective treatment attends to multiple needs of the individual, not just his or her drug use. Treatment should be comprehensive and offer a continuum of quality services for the client/patient and his/her family.
- Remaining in addiction treatment for an adequate period of time is critical for treatment effectiveness. Recovery from substance abuse can be a long process and frequently requires multiple episodes of treatment and should be treated as any other chronic disease.
- Substance abuse prevention and treatment programs should be constructed and funded on evidence-based methodologies that are outcome based and meet performance measures.
- A skilled service provider, with specific training in addiction, should conduct an assessment and referral of each individual for addiction treatment and addiction prevention, and treatment programs and their staffs should meet recognized certification, accreditation and/or licensing standards.
Substance abuse must be better coordinated with our overall public health and primary health systems, yet coverage should not be made to be minimized to fit a reform system that does not allow for evidence-based comprehensive services based on a continuum. One issue is the need to reshape Medicaid for effective patient outcomes, as well as to ensure that Medicaid eligible Americans get evidence-based treatment services.
Medicaid benefits must be comprehensive in scope and predicated on evidence-based practices to include:
- Individual and family substance abuse and/or psychological counseling and services of no less than a 6 month duration (based on assessment standards set by national experts such as the American Society of Addiction Medicine).
- Intensive case-management to ensure that appropriate services are received and those clients are progressing toward employment and/or independence.
- Life skills training, coaching, and community integration services.
- Medically appropriate Medicaid services for residents/clients within a substance abuse treatment program or through other community services for acute and chronic medical conditions.
- After-care support for individuals in recovery and their children that focus on family and community support, counseling, and continued recovery.
Medicaid funds are not available to certain alcohol and drug addiction community-based residential treatment facilities for services provided to individuals between the aged of 21 to 64 for facilities of 17 beds or more. Specifically, the Title XIX of the Social Security Act restricts Medicaid reimbursements to Institutions for Mental Disease (IMD) [42USC 1396d].
Therapeutic communities are unintentionally impacted by the 1965 IMD exclusion because substance abuse treatment services are not distinguished from mental health services in statute or regulation.
If the IMD Exclusion were corrected, many Americans already enfranchised in the public health, social service, and criminal justice systems could be identified and treated for the disease of substance abuse, which may be their greatest barrier to self-sufficiency. Therapeutic communities also support the inclusion of quality addiction services for children in federal programs that provide primary health care services.
Access to Substance Abuse Treatment For Returning Veterans and Their Families
TCA believes that returning Veterans and their families should have ready access to appropriate substance abuse treatment, co-occurring screening, and other treatment services. Public policy should demonstrate coordinated and available resources for all Veterans to include, and anticipate the increase of, newly returning Veterans to their communities whom might seek or need substance abuse treatment.
Resources – Expanding Research and Treatment Services
TCA recommends that federal funding for substance abuse and co-occurring illnesses be increased to reflect the social cost savings that the evidence-based substance abuse treatment programs demonstrate.
TCA supports outcomes research and the science to service research sponsored by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.
Our country is on the verge of a crisis: there is an inadequate supply of workers trained in substance abuse treatment, including those specializing in the therapeutic community philosophy of treatment.
Treatment Communities of America (TCA) believes the substance abuse treatment workforce shortage must be addressed to avert the loss of effective programs accessible to those suffering from addictive disorders.
Several government-funded studies have concluded that there is a positive correlation between the length of stay in a treatment center and drug use improvement outcomes. Research has also shown a correlation between reduced criminal activity and increased employment as successful outcomes of evidence-based treatment.
A recent study from the University of Chicago confirms that improvement is greatest when clients are in long-term residential treatment. The study also suggests that the higher costs of long-term residential treatment “offers tangible value” over other types of treatment. TCA supports public policy that expands in-prison and community evidenced-based programs that stabilize offenders re-entering their communities and, thus, decrease the overall recidivism rate.