After the U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act (ACA) last week, many experts have weighed in on the practical implications of this legislation regarding the prevention and treatment of addictive disorders. From federal entities such as the Substance Abuse and Mental Health Services Administration (SAMHSA) to national mental health organizations such as the American Psychological Association, the statements issued clearly examine the overall impact of the ACA on mental health treatment. How does this historic ruling relate the field of addictions? The experts suggest the answer lies in three applications: integration of services, enhancing prevention initiatives and a new model of recovery services.
According to Dr. A. Thomas McLellan, pioneering addictions researcher, both health care reform and the Mental Health Parity and Addiction Equity Act (MHPAEA)[1] will foster the integration of addiction as a health problem into the larger health care system."Until now, there has been no provision for benefits, training, teaching or development – or even recognition that care for substance use disorders is part of general health care,” said Dr. McLellan (Addiction Treatment Forum, 2010). Dr. McLellan, CEO of the Treatment Research Institute and former deputy director for the White House Office of National Drug Control Policy, will cover some of these implications during his keynote address at the 13th annual NCRG Conference on Gambling and Addiction.
Second, the ACA will increase support for prevention and early intervention initiatives, such as encouraging primary care providers to frequently administer screening and brief interventions for addictive disorders. This could ultimately result in more referrals for addiction treatment programs. Because of the ACA, an estimated 32 million Americans who are uninsured will now have access to such services. Various provisions of the law will require benefit packages to include treatment for mental health and substance use disorder services, prescription drugs, rehabilitative and prevention and wellness services (SAMHSA, 2010a).
A third result of the ACA will be the promotion of recovery-oriented systems of care (ROSC), a model that provides “a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness and quality of life for those with or at risk” of developing a disorder (SAMHSA, 2010b). Through the legislation, Substance Abuse Prevention and Treatment block grants will be awarded by SAMHSA to fund implementation of ROSC throughout the U.S.
Currently, many public health officials are trying to understand where prevention and treatment of gambling problems fit inside the ROSC structure. The 13th annual NCRG Conference on Gambling and Addiction will address this issue with a session on how the Iowa Department of Public Health successfully integrated the treatment of gambling disorders as they implemented the ROSC model throughout the state. The NCRG Conference also will feature speakers such as Drs. Alexandre Laudet and H. Westley Clark who have been vital to the development and promotion of this new model of recovery. For more information and to download the NCRG Conference brochure, visit www.ncrg.org/conference.
Note: The NCRG is a nonpartisan organization and does not lobby for or against any types of legislation. The mission of the NCRG is to help individuals and families affected by gambling disorders by supporting the finest peer-reviewed research into pathological and youth gambling; encouraging the application of new research findings to improve prevention, diagnostic, intervention and treatment strategies; and advancing public education about gambling disorders and responsible gaming.
References
Addiction Treatment Forum. (2010). How Health Reform Will Affect OTPs — An Interview With A. Thomas McLellan. Retrieved from http://www.atforum.com/newsletters/2010fall.php
SAMHSA. (2010a). HealthReform: Overview of the Affordable Care Act. Retrieved from http://www.samhsa.gov/samhsanewsletter/Volume_18_Number_3/AffordableHealthCareAct.aspx
SAMHSA. (2010b). Recovery-Oriented Systems of Care (ROSC) Resource Guide. Washington, DC: Substance Abuse and Mental Health Services Administration.
[1] In 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was signed into law. This legislation requires group health insurance plans (those with more than 50 insured employees) that offer coverage for mental illness and substance use disorders to provide those benefits in no more restrictive way than all other medical and surgical procedures covered by the plan.
