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Covering health reform's effect on addiction treatment Date: 06/20/13

Carla K. Johnson
Carla K. Johnson

By Carla K. Johnson

An exclusive tip led me on a two-month journey through the U.S. system for addiction treatment. The tipster wanted a story about how President Barack Obama's sweeping health care overhaul would transform addiction treatment for the better.

Once I began my reporting, looking at both data and talking to patients and mental health care providers, I uncovered a more likely scenario: The neglected and underfunded treatment system would be overwhelmed when millions of newly insured addicts and alcoholics showed up at the door seeking help getting clean and sober.

The numbers told the story. I analyzed several sets of federal data to find the current capacity of the addiction treatment system and the number of possible new patients. I found that 3 million to 5 million addicts would be newly eligible for insurance under the Affordable Care Act in 2014, numbers that would more than double current levels. Armed with the data, I did another round of interviews.

Addicts, their families and their treatment providers described a two-tiered system, for haves and have-nots. Those who have an insurance card get a bed immediately. Those who don’t get put on a waiting list (or worse – some end up in jail or family court). Those waiting lists are likely to grow. Squeezed by government budget cuts, treatment centers have been cutting staff instead of ramping up for the health law's expansion of coverage.

“It's the chance to clean up and not use anymore, so I could live a stable life," said 30-year-old Ashley Lore of Portsmouth, Ohio, who was jailed and lost custody of her 4-year-old daughter as a result of her heroin addiction. "If I get into treatment, I get visitation to my daughter back. And I get her back after I complete treatment.”There’s so much at stake for those who know they need help. I talked to people in several states and in many walks of life: drug addicts, alcoholics, low-income and middle class. All needed help for themselves or a family member. Here’s what one young mom told me:

The Associated Press published my story in April.

There are good opportunities to localize the story in a community or a state. Here are resources to get you started:

  • How many people currently need and receive treatment for addiction in your state? See Table 2a at this link to find the data. In Alabama, for example, 281,000 need treatment and 45,000 now receive treatment. The numbers come from the National Surveys on Drug Use and Health.
  • How many addicts needing treatment will be newly insured in 2014 in your state? That depends on whether your state will expand Medicaid or not. You can see estimates at this link. Click on a state. Scroll through the slides and find the slide titled "Prevalence of Substance Use Disorders Among Adults Ages 18 - 64 by Current Medicaid Status and Eligibility for Medicaid Expansion of Health Insurance Exchanges." The chart shows estimated prevalence of addiction among the Medicaid expansion population and the health insurance exchange population.
  • Here are some possible sources for expert interviews: American Board of Addiction Medicine, Office of National Drug Control Policy, the Substance Abuse and Mental Health Services Administration, Treatment Research Institute, National Center on Addiction and Substance Abuse at Columbia University, State Associations of Addiction Services, Arapahoe House (treatment center in Colorado), Haymarket Center (treatment center in Chicago) and community health centers in your state.
  • I found addicts and their families through treatment centers, community health centers and advocacy groups.  One of the best things I did was tour Haymarket Center, a crowded treatment center in Chicago. As always, getting out of the office and meeting the real people is essential to writing a comprehensive story.

Carla K. Johnson, a medical writer at The Associated Press, has covered health and medicine since 2001 and has been an AHCJ member nearly that long. In 2003, she joined the board of the organization and has worked as the board's liaison to AHCJ's local chapters. A 1980 graduate of the Medill School of Journalism at Northwestern University, she has worked as a copy editor and covered the education beat. She worked many years at the daily newspaper in Spokane, Wash., before returning to her native Illinois to join the AP. You can follow her at @CarlaKJohnson.