Our country has taken to heart the “opioid crisis” as it should. But there is nothing new about this crisis as it has been around for at least 100 years. What they are really saying, but won’t, is that the prescription opioid has gotten out of control. People are prescribed an opioid based medication for pain relief and soon find themselves addicted. According to the U.S. Center for Disease Control there are approximately 11,000 opioid deaths per year. The notion here is that either doctors are over-prescribing opioid-based medications or that the addict is easily finding the same medications on the street.
But the real addiction crisis in America is alcoholism. According to the CDC approximately 88,000 people die annually from alcoholism. That’s an 8:1 ratio making alcoholism something greater than a crisis if we are going to apply that apelet to opioids. But I have heard nothing on the news or elsewhere that this crisis is getting much attention.
The problems with treating either addiction starts with the insurance companies. Most, if not all, insurance carriers provide very little assistance in this area. What they are willing to give is a 2-week in-patient treatment followed by out-patient treatment. There is one very simple problem to this approach. The alcoholic and the addict each need at least a 90-day in-patient program to stabilize them. And even that may not be enough as relapse among even those who have been in a 90-day program is high. Both the alcoholic and the addict tend to need long-term treatment, the length dependent entirely upon the individual.
The underlying issue for most, if not all, alcoholics and addicts, is unresolved serious issues earlier in their lives which leave them feeling “less than,” suffering from depression and/or a myriad of other psychiatric issues. But the way the insurance industry followed by the medical community, is to treat the symptom without even evaluating the patient for the real underlying issues.
I was recently hospitalized for a possible heart issue. I had a heart attack 20-years ago and am always considered an at-risk person. While in one of great Boston’s excellent hospitals, I struck up a conversation with the man in the other bed in my room. As it turned out he was an alcoholic. One of the consequences of untreated alcoholism is liver failure. As the liver fails fluid collects in the abdomen causing it to bulge. I found out that this man had had 3.5 liters of fluid removed but still had at least another 10 liters needing removal. He was given the medication Ativan because he was detoxing and without that medication he was likely to experience the delirium tremens, DTs, of withdrawal.
For reasons I could not be privy to, the hospital was only treating his liver issue, the fluid. Although he had a good insurance plan, the hospital, a fairly large one, did not have a detox facility and no program to treat an alcoholic on an in-patient basis. This brings us back to the money issue, insurance. Hospitals cannot survive giving the addict and alcoholic the treatment they desperately need and not get paid for it by the insurance companies.
The National Institute of Health estimates that there are more than 15 million alcoholics in the U.S. today. That comes to about 5% of the entire U.S. population. Other studies have suggested that upwards to 10% of the population suffers from alcoholism. Most, unfortunately, are untreated. And there is the crisis. What I said about alcoholism equally applies to addiction, be it medical based opioids or street drugs.
Right now the number of facilities that are prepared to properly treat the alcoholic or addict is low. The alcoholic or addict who applies to get into one of these facilities is usually greeted by the statement that there is no bed available. At that point the alcoholic gives up and goes back to drinking.
I suspect that in the era of modern medicine, there has never been a concerted effort to treat alcoholics and addicts. These people who suffer from an identified medical, and frequently a psychiatric, illness fall victim to the insurance industry which simply is not interested in dealing with alcoholics and addicts. The irony in all this is that the insurance companies end up paying for alcohol and drug induced ailments over long periods of time which is always very costly. These costs are easily reduced by proper treatment of alcoholics and addicts. The question is: when are the insurance companies going to come to this realization and when is the medical community going to start pushing back at the insurance companies to compel them to act in a more responsible manner?