As with most illnesses, prevention and early treatment are the most effective methods for addressing substance abuse and addiction.
Unfortunately, most insurance providers are more likely to cover recovery than steps to keep risky behaviors from deepening.
This means they’re spending far more money than needed. For example, drug abuse education costs about $10 a year per person. In contrast, medication-assisted treatment for addiction runs about $4,700 per year.
Challenges of early addiction services
One of the biggest obstacles in the way of prevention services is that they do not fit the traditional fee-for-service system. Prevention efforts like education are often group-based programs that happen without the patients’ prompting. In other words, you don’t have the accepted system in which a patient develops a problem, the patient seeks treatment for the problem, and then the patient or the patient’s insurer is billed for the problem. As a result, many healthcare providers do not initiate these kinds of programs for their patients because there is nowhere to send the bill.
While the cost difference between prevention and treatment is enormous, it is not simply a matter of trading one for the other. Every $10 spent for prevention services is not going to translate directly into a $4,700 savings for the health care system. Prevention efforts are by no means foolproof, and many people who are diligently educated about the dangers of illegal drug use or excessive alcohol consumption will still go on to suffer from addiction problems.
Benefits of early addiction services
Nevertheless, even small improvements from increased prevention and screening efforts would save insurance providers money overall. And research has shown that screening efforts in particular can make a difference in keeping risky drug or alcohol-related behaviors from becoming addictions.
The National Survey on Drug Use and Health has found that 95% of people who require treatment for substance abuse do not recognize that they have a problem. Too frequently, the people seeking treatment for substance abuse or addiction are those whose illness has become so debilitating that it is impossible to ignore. Regular screening about drug and alcohol use could help to identify many of these people before their problems become severe and difficult to treat.
Unfortunately, relatively few people are regularly asked about these issues by their doctors. For example, in the state of Vermont, surveys have found that only one in 10 people are asked about drug and alcohol use by a doctor every year.
Other addiction treatments also difficult to obtain
Early addiction services are not the only services that are infrequently covered by insurers and therefore infrequently offered by healthcare providers. Medication-assisted treatment with drugs like buprenorphine (Subutex or Buprenex), methadone (Marcan), or naloxone and buprenorphine (Suboxone) is currently available through a limited number of treatment providers, and rarely covered by insurers. Instead, these insurers restrict their payouts to more traditional abstinence-based treatment approaches.
The biggest reason for restricted access to these medications is their cost. Treatment programs that include medication assistance are significantly more expensive than those that do not. However, addiction is a chronic illness with a high rate of relapse, and the true cost of treatment is often much higher than it appears, due to individual patients going through treatment programs multiple times.
Cost-effectiveness depends on the rate of success
There is now a strong body of evidence that addiction-treatment medications are an effective addition to traditional treatment approaches. Patients who use one of these drugs during treatment have been found to be more successful at staying sober and less likely to relapse.
As a result, the immediate cost of medication-assisted treatment may be rather deceptive. This treatment approach is undeniably more expensive in the short-term, but may actually be more cost-effective overall if it means that patients are able to complete a single course of treatment and go on to maintain successful sobriety.