The financial impact of addiction is staggering. In a recent report by healthcare improvement company Premier, approximately $1.94 billion in annual hospital costs were attributable to patients who experienced an opioid overdose and that care in the emergency department alone totaled over $632 million (LaPointe, J., 2020). How can we tackle the treatment of substance use disorders (SUDs) and reduce these costs?
In this article, we break down the latest statistics on how SUDs are affecting healthcare costs for both patients and providers. We also take an honest look at addiction treatment in terms of efficacy and limitations, and how treating the whole patient through better diagnostic tools and new approaches in cognitive-based therapies can save on healthcare costs and lead to long-term, sustained addiction recovery.
Addiction and Healthcare Costs – How Bad is it?
According to an article in Science Advances, in the U.S. alone, there are more than 16 million heavy alcohol drinkers, 50 million illicit drug users, and more than 10 million people who misuse opioids (Xu, B. and LaBar, K., 2019). How are these numbers affecting healthcare costs and treatment?
Cost to Patients:
- More than 10 million full-time workers in the U.S. have a substance use disorder – a leading cause of disability (Surgeon General).
- Addiction-related healthcare cost in the U.S. is more than $11 billion (National Drug Intelligence Center, NDIC).
- About 100,000 people in the U.S. in 2018 needed drug addiction treatment but never receive it because their insurance either didn’t cover treatment costs ($6,000 for average 30-day in-patient rehab stay), according to the National Survey on Drug Use and Health (NSDUH). Additionally, insufficient networks of qualified providers and long wait times for in-network care add to this issue – forcing people to seek out-of-network care, resulting in higher out-of-pocket expenses.
Cost to Healthcare Professionals:
Substance use disorders are strongly linked with other medical conditions and mental health disorders, making an integrated approach to care essential. Unfortunately, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are challenges to such an alliance, including:
- Insufficient training and licensing of health care professionals on how to identify and treat SUDs.
- Poor financing and reimbursement mechanisms that support the use of new treatment options.
- Addressing addiction and physical health together improves both physical health and SUDs – yet, 54% of addiction treatment programs have no physician.
Is Rehab Working?
Yes and No. In the short term, rehabilitation centers and programs are necessary for treating drug and alcohol disorders. Here are recent statistics from the National Institute on Drug Abuse (NIDA) on how addiction treatment programs are helping to reduce medical and societal costs:
- The average cost for one year of methadone treatment is approximately $4,700 per patient, whereas one full year of imprisonment costs around $24,000 per person.
- Every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, court costs, and theft. With healthcare savings added, total savings can exceed costs by a ratio of 12 to 1.
- Savings to the individual and society also stem from greater workplace productivity and fewer drug-related accidents, overdoses, and deaths.
However, in terms of long-term efficacy, current SUD care programs are still seen as insufficient. “Even with valuable medications and other treatment options, the effectiveness of addiction treatment remains inadequate, as extensively reviewed by the leading experts in a SAMHSA study (Xu, B. and LaBar, K., 2019). Current drug and alcohol treatment programs have their place in the short term – but we also need to examine its limitations when it comes to long-term, sustained recovery.
Addiction Treatment Limitations
Even with all of the advances in SUD medication and addiction care programs, substance misuse and addiction cost our nation over $800 billion annually, and the need for better drug and alcohol assessment and treatment is critical. One major factor affecting the efficacy of current addiction care starts right as the patient enters the facility – their diagnosis.
Physicians use criteria in the Diagnostic and Statistical Manual of Mental Disorders to determine a substance use disorder. However, many physicians lack the proper training to even recognize if their patient is at risk for a SUD. Additionally, most patients are reluctant to disclose their substance use issues with their primary care doctor in fear of stigma and/or potential loss of employment. Instead, patients often turn to rehab facilities. Addiction treatment centers do their best to diagnose their patients effectively; however, many rehab employees lack the correct training/certification to properly evaluate if a person has a co-occurring mental health disorder. This issue can lead to ineffective long-term treatment and patient relapse.
Need for Better Diagnostic Tools and Personalized Treatment
Addiction clinicians who do have training may try different addiction diagnostic tests/tools to assess patients. However, many tools are based on “yes/no” answers, and are not considered adequate. An article in Medscape addresses the limitations of one test called the Cut-Annoyed-Guilty-Eye or CAGE tool, stating “The CAGE questionnaire by itself is not an adequate screening for alcohol problems and is not useful for diagnosing hazardous drinking (Thompson, W. et al., 2016).” Another flaw in current screening/assessment tools is they do not look at a patient’s cognitive orientation or his/her perception of the world. Understanding an individual’s unique cognitive orientation and how he or she makes decisions based on certain beliefs and thoughts, as well as their environmental and inherent factors, can help pinpoint the root cause of their stress or mental discord. By identifying all these factors, we can better understand the cycle of drug and alcohol use from initiation to relapse.
Looking at an individual’s perception, conception, and behavior holistically creates a more individualized treatment plan – leading to the higher success of addiction recovery. The benefits of personalized diagnostic tools can lead to more effective long-term treatment outcomes – reducing relapse rates, potential overdose, ER visits, recovery stays, and overall societal and healthcare costs.
References:
LaPointe, J., (2020). “Opioid overdose care totals $1.94B in annual hospital costs.” Retrieved from https://revcycleintelligence.com/news/opioid-overdose-care-totals-1.94b-in-annual-hospital-costs
National Drug Intelligence Center (NDIC). (2011). National drug threat assessment 2011. Retrieved from https://www.justice.gov/archive/ndic/pubs44/44849/44849p.pdf
National Institute on Drug Abuse (NIDA) (2018). Principles of drug addiction treatment: a research-based guide (third edition). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost
Substance Abuse and Mental Health Services Administration (SAMHSA). Integrating addiction and primary care solutions. Retrieved from https://www.integration.samhsa.gov/about-us/esolutions-newsletter/integrating-substance-abuse-and-primary-care-services
Substance Abuse and Mental Health Services Administration (SAMHSA). (2018). 2018 national survey on drug use and health. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2018R2/NSDUHDetTabsSect7pe2018.htm#tab7-65a
Surgeon General, n.a., (n.d.). Time for a change. Retrieved from https://addiction.surgeongeneral.gov/vision-future/time-for-a-change
Thompson, W. (2018). What are the limitations of the CAGE questionnaire for alcohol misuse screening? Retrieved from https://www.medscape.com/answers/285913-41533/what-are-the-limitations-of-the-cage-questionnaire-for-alcohol-misuse-screening
Xu, B. and LaBar, K. (2019). Advances in understanding addiction treatment and recovery. Science Advances. 5:10.