Seeking Help with Substance Abuse
By: Kian Lawler and Caroline Ambrose
Fig. 1. Spilled Pills. "New drug crisis: More Doctors Must Be Trained in Substance Abuse." Pittsburg Post-Gazette, 14 March 2020.
Should substance abuse rehab be covered by healthcare?
Why you should care …
There are 15.4 million Americans working full or part-time jobs whilst under the influence of various drugs. This affects our economy and society! Helping individuals with overcoming drug addiction has proven to have positive side-effects on the workplace— for example, decreasing healthcare claims, absenteeism, and the overall productivity of the workers. There is also a major problem with people who are trying to get over their addiction but are not able to because of the overwhelming cost of approximately $25,000-$30,000 per month for a private residential rehabilitation center. Some insurance companies will pay for the first 2-4 weeks of rehabilitation/detox, but the recommended stay in order to actually see results is 6-12 weeks. These patients will then be kicked out of the rehab/detox mid-treatment if they are unable to pay, and they are left fighting their addiction on their own again. Only 1 in 10 people suffering from substance abuse get the proper care they need. If we want to better our society as a whole, this needs to change!
Conflicting Ethical Principles
Autonomy: We have an obligation to respect the autonomy of other persons, which is to respect the decisions made by other people concerning their own lives.
Beneficence: We have an obligation to bring about good in all situations.
Justice: We have an obligation to provide others with what they are owed or deserve. In public life, we have an obligation to treat all people equally, fairly, and impartially.
Why Do They Conflict?
The conflict between the three main ethical principles comes down to people's initial choices and who later becomes responsible for them.
The principle of autonomy manifests itself in choice. The choice to start taking the drug rests responsibility on the user. However, in certain cases in which drug abuse stems from medication prescribed by a doctor, the responsibility for the user falls on the hospital. This principle could negate healthcare providers' responsibility to cover addiction rehabilitation, as it was the user's initial choice to take drugs.
The principle of beneficence, which means to do good, works best for the abuser. Helping them conquer their addiction positively affects those friends and family around them, their productivity, their ability to have a normal fulfilling life, and their feeling of worth to society.
The principle of justice works for both the abusers and healthcare. This is because the application of justice could mean to pay the price for committing an illegal crime, such as drug use, and thus justice would be incarceration. However, justice could be seen as rehabilitation because they would be "serving their time" in order to become better citizens, able to re-enter society. Also, violent offenders are incarcerated for their drug use. This second stance of justice has slowly become more accepted, as addiction has been seen as a treatable disease in recent years, versus being seen as a crime in the past.
Stakeholders
Who is impacted by the decision?
Individuals
They are the most vulnerable and most impacted, as they are the ones in need of help. The potential of being disciplined or terminated from their job because of their drug abuse is always looming. The things that affect them also affect their family, most importantly their children, putting them in the predicament to continue using and provide for their family or to seek rehab and financially abandon their family. They are the ones who may suffer physically from their addiction, such as lung cancer from smoking, liver disease from drinking, or any negative effects from drugs. They could possibly be fined, punished, or jailed by law enforcement and the judicial system.
Healthcare Providers/ Health Insurance
They are affected by having to care/pay for the addicted individuals. Many privately owned healthcare providers aren’t required to cover drug addictions, but the few that are must supply addiction evaluation, brief intervention, addiction treatment, medication, clinic visits, alcohol and drug testing, home health visits, family counseling, and anti-craving medication. All of this can can add up to a tremendous cost. Health care providers may provide care for those addicted to controlled substances and don’t have to share information with employers or law enforcement.
Depending on the deductible and type of insurance, the addicted person may not have to pay large amounts out of pocket.
Employers
Employers are affected by the individuals who consume drugs because the employee directly affects their business’s productivity, profits, and reputation. They have a role in society to fill as a group that provides a useful service, so when drug abusers weaken their business, they also have a negative effect on society. The employer has the capability to fire their employees, while abiding by the ADA’s guidelines that protect those addicted to nicotine and alcohol, when handling drug use among employees. Employers would benefit if jobs are in high demand, but they may have some leeway to fire/punish employees who abuse drugs if they state their stance on drug-use previous to the employee's hiring.
Information to Consider
ACA (Affordable Care Act)
The Affordable Care Act (ACA) is a system that requires most insurance companies to cover addiction treatment, such as addiction evaluation, brief intervention, addiction treatment medication, clinic visits, alcohol and drug testing, home health visits, family counseling, and anti-craving medication. Even though the ACA required this of most insurance/healthcare companies, it is not always covered, and there are often loopholes. The Affordable Care Act (ACA) also now requires most insurance companies to cover some of the cost of substance abuse rehab or detox, yet some companies still require the customer to cover some of the copay and even some of the total cost. Where you purchase your insurance/healthcare plan can also affect whether or not they are required to help with the cost of rehab/detox and can cause issues for people seeking help.
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The Science of Addiction
Fig. 2. Cocaine's effect on dopamine receptors. "Drug Misuse and Addiction." National Institute on Drug Abuse, 13 July 2020.
Someone who is a victim of substance abuse experiences rewiring in their brain's “reward circuit,” which is what controls the release of the chemical dopamine, which induces euphoria, which is what causes the user to become persistently motivated to continue abusing substances. Drug addiction is a chronic disease, which is often very hard to control, and it is not related to the lack of moral principles, which is often a misconception about substance abusers. Repeated use of drugs can lead to changes in the brain as well as the response to many things that are hardwired into the brain, which are difficult to change without proper help.
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The Rehabilitation Problem
Fig. 3. Drug rehabilitation Cycle: Nicholas D Zaller. "Crossing Bridges: Transitioning HIV Care From Corrections Into the Community." Medscape, 2009.
Insurance plays a key role in the hunt for affordable substance abuse rehabilitation/detox centers for addicts seeking help, but getting insurance converage is just the start of the challenges they will face. Even if an addict who is seeking treatment receives coverage from insurance/healthcare, getting a bed at a rehabilitation center is often very complicated. Rehabilitation centers often have high requirements for people they take in; for example, they can deny you help if you are a minor, there is domestic violence on your record, or even if you have mental illness like depression. There is also the issue of payment because some insurance companies are attached to people's employment, and once they enter rehab, they are no longer allowed to work and, therefore, would lose their insurance as well as their ability to pay for rehab. This will result in most centers discharging the patient who is unable to continue payment, even if they are mid-treatment, and then it's back to square one.
In Conclusion:
Drug-Rehab is a necessary step in getting people drug-free, and without it, abusers are more likely to relapse. However, the lack of availability for drug rehab is a real problem that prevents abusers from seeking help. The financial cost, the risk of punishment, and the lack of coverage for drug-rehab all play a large role for people to not seek help for their substance abuse issues. Substance abuse in individuals spreads to affect others, such as friends, family, colleges, and, ultimately, society in negative ways, leaving lasting impacts on everyone. If healthcare were to cover the cost of drug rehab, which is very costly, then more individuals could enter their programs, and more drug abusers could enter long-term recovery, benefiting everyone involved.
Before you go ...
Test Your Knowledge
This short quiz will give you an introduction to some information regarding substance abuse as well as treatment options.
Further Learning
Still curious about the struggle to access rehabilitation centers?
This CBS show segment provides a view into the world of an addict who wants to enter drug rehabilitation, and what hurdles he/she must jump over to get to rehab. Behind every statistic, is a person.