Santa Monica-based CLARE Foundation hosted a panel titled “State of Addiction 2014: Implementing and Understanding the Affordable Care Act and The DSM-V” on Wednesday, Jan. 29.
Bringing together the leading minds in policy, treatment, and research, the panel examined innovative and controversial new theories about diagnosing addiction, and explored the ways in which parity and healthcare reform will affect substance abuse treatment provision.
The “State of Addiction 2014” panel was held at the Santa Monica headquarters of Conscious Recovery, CLARE Foundation’s new mid-market treatment program that offers premium, customized, evidence-based morning and evening Intensive Outpatient and Day Treatment services.
The event also marked the official opening of Conscious Recovery in Santa Monica.
Prior to the panel, CLARE’s Executive Director welcomed the audience of 50 of Los Angeles’s leading addiction, mental health, and primary care treatment providers, and introduced panel moderator Matthew Healy, CLARE Foundation’s Clinical Director.
Healy moderated presentations from three illustrious panelists, as well as a post-panel Q&A session. Key points from each presentation follow.
H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM, Director, Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMSHA)
• Especially with the advent of the Affordable Care Act (ACA), substance abuse treatment providers need to broaden focus and play a more substantial role in the healthcare delivery system.
• CLARE is to be commended for its proactive efforts to meet the challenges of healthcare reform, including opening Conscious Recovery to address the increasing demand for substance use disorder treatment under the Affordable Care Act and the large and growing treatment gap for mid-market clients.
• Substance abuse is a chronic condition that can require treatment from medical, behavioral health, social service, and pharmacological professionals—treatment is not one-size-fits-all.
• Under the ACA, substance abuse is one of 10 Essential Health Benefits that must be covered by every insurance provider. As a result of the Mental Health Parity and Addiction Equity Act (Final Rule passed November 2013), substance abuse must be given parity with other health conditions.
• From October to December 2013, Covered California enrolled more than 500,000 people, more than 424,000 of whom received subsidized insurance.
• In addition, more than 548,000 individuals became eligible for MediCal, and an additional 630,000 transitioned to MediCal from low-income health programs.
• Of these new MediCal enrollments, almost 200,000 are expected to need substance abuse treatment services.
• “In the absence of system re-design for at risk populations, these populations could continue to experience barriers to service access, poor treatment outcomes, and high utilization of costly services such as EDs and inpatient care.”
• Patient care will become increasingly integrated, and substance abuse treatment and behavioral health service providers must be ready to be a part of that network in order to be effective.
Margaret Fetting, Ph.D., clinician, author, and professor at the University of Southern California
• Along with the intricate new treatment delivery system defined by Dr. Clark, there is emerging an intricate new treatment system for substance abuse.
• The Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) has excised the terms “substance use” and “substance dependence.” It has also declared that “addiction” will not be applied as a diagnostic term in the current publication.
• The bilateral terminology has been replaced with a spectrum of “substance use disorder” that ranges from “non-pathological” to “severe”.
• This spectrum approach encourages individuals and clinicians to examine the relationship with the substance rather than just undergoing a behavioral intervention like treatment or sobriety.
• Historically, treatment professionals have been good at taking care of the extremes—addicted and not addicted. We now need to develop expertise in all phases of the spectrum.
• There are four times as many problem drinkers as there are alcoholics—yet we provide fewer services for problem drinkers.
• Dr. Fetting then provided an overview of her mapping of the spectrum of healthy and unhealthy substance use behaviors among adults and adolescents.
Diana Cho, PsyD., Clinical Director of Conscious Recovery
• CLARE encourages personal growth. In order to live that philosophy, the organization has spent much time expanding its expertise and program offerings.
• CLARE is increasing its focus on screening and treatment for co-occurring disorders.
• In 2009, 20.8 million people abused substances, and 42% of this number—8.9 million people—had a co-occurring disorder.
• Co-occurring disorders worsen a patient’s prognosis and make both the substance abuse and co-occurring disorder more difficult to treat.
• CLARE is moving from a social model to a biopsychosocial model that includes medically and clinically sound processes, including screening for co-occurring disorders before and throughout treatment.
• Substance abuse is the most common cause of psychiatric relapse, and mental health issues are a common cause of substance use.
• This fact makes integrated treatment principles and cost-effective treatment like that found at Conscious Recovery vital to clients in need.
• Conscious Recovery is rooted in CLARE’s 40 years of success, and will offer a much-needed resource for mid-market clients in Los Angeles.
Dr. Clark also commended CLARE for its proactive efforts to meet the challenges of healthcare reform, including opening Conscious Recovery to address the increasing demand for substance use disorder treatment under the Affordable Care Act and the large and growing treatment gap for mid-market clients.
“CLARE is a real-life example of an organization that is listening to the news about healthcare reform and the Affordable Care Act and doing what needs to be done,” Dr. Clark said during his presentation. “I urge all of the providers in this room to think similarly. People are depending on us to care for them.”