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Dying for Substance Abuse Treatment: There's Just No Room at the Inn

Evidence-based, patient-centered treatment along a continuum of care provided in the patient's neighborhood is the answer to successfully managing the chronic disease of addiction, just as it is for heart disease, cancer and diabetes.
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I'm not the first one to say it, and I know I won't be the last: Our country is in the midst of a fatal drug epidemic that knows no boundaries regarding who, where and why.

From young to old, from every race, from every socioeconomic group, from prescription painkillers to heroin, from alcohol to prescription sedatives, we have a major problem on our hands.

The Centers for Disease Control reports that drug overdose deaths have been rising steadily over the past two decades and have become the leading cause of injury death in the United States, surpassing even auto accidents. Every day, 120 Americans die as a result of unintentional drug overdose, and another 6,748 are treated in emergency rooms for the misuse or abuse of drugs. Almost 20 percent of them (over 1,000 every day) are under the age of 21.

Evidence-based, patient-centered treatment along a continuum of care provided in the patient's neighborhood is the answer to successfully managing the chronic disease of addiction, just as it is for heart disease, cancer and diabetes.

Yet unlike the latter three conditions, insurances tell people with even severe substance use disorders to "fail first" at a "reduced dose" of treatment (outpatient treatment) before receiving more substantial services via residential care. When is the last time insurance companies said, "We want you to fail at chemotherapy before we approve and pay for surgery for your cancer"? Have insurance companies ever said to someone diagnosed with diabetes with dangerous blood sugar levels, "We'd like you to try fixing this disease with diet and exercise and if that doesn't work we'll approve an oral medication and if that doesn't work, maybe then we can get you an insulin prescription but only if you fail at the low-level of care first"? Of course not, this country would be outraged at something like this. Yet it happens to people in desperate need of substance abuse treatment every day.

At the same time, communities aren't shy about holding rallies and storming city zoning meetings to protest the opening of addiction treatment facilities near them. Yes -- the NIMBYs (Not In My Back Yard) are out in full force. Experts say addiction is a disease, but sadly, in this country, it's treated more like a plague.

SAMHSA data states that in 2013, 323,200 people acknowledged that they had a substance use problem and tried to get treatment but couldn't. This may seem like a relatively small number in comparison to the millions who need it, but you might not feel that way if it was your child or loved one who tried -- and could not get the help they needed.

Some of the major reasons they can't get treatment: lack of available beds, no treatment available in close proximity to where they live, they don't know where to go or they can't afford it. In other words, there's just no room at the (treatment) inn. Stories about the lack of available treatment beds in Boston, Baltimore and New Jersey have all been in the press recently.

When someone with a substance use disorder is ready to get help and tries to get into treatment, it is increasingly becoming a case of waiting, showing up at the program each day to see if there is room, and waiting some more. Unfortunately, people die while waiting for treatment. While the treatment industry needs significant growth to address this surging need, providers still face uphill battles and opposition in most every community.

"We do not want drug users or criminals in our neighborhood," said one woman. "We are not against it, just put it someplace else," said another -- again voicing the "NIMBY" mindset so common in this area of healthcare. Another voiced this: "Our homes are in jeopardy. Our families are in jeopardy. These people can fall off the wagon," she said. "We are all in favor of some form of help for these folks, but not at this risk." So tell me where the risk is? There's no evidence of increased crime or violence in neighborhoods with treatment programs. I agree, it is a valid question to ask, but the data just don't support the claims.

One treatment clinic director responded to this perspective in the New York Times, stating, "Never mind your backyard. [Addiction is] probably in your living room. You just haven't figured it out yet." In truth, this is an issue in every community.

I believe it's the duty of treatment programs to be a good neighbor. The reality is that many neighbors of drug treatment centers actually praise their presence, calling them good neighbors, even when they were against them initially.

Don't we want our family members, friends, co-workers, neighbors to seek help when they need it? Of course we do, and we want that help to be as easily accessible as possible. Would we ever treat someone with cancer the way we treat those struggling with the disease of addiction? Of course not. And this needs to change or we can expect to see substance abuse death tolls continue to rise and believe me -- they are already far too high.

Perhaps the average citizen will understand this need when their loved one dies because they can't find a room at the inn, but I hope it doesn't take that. I hope people will see the facts about treatment programs. We're not part of the problem -- we're the solution.


Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.