The Treatment Chasm


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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.


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