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Clinical Column:The Need For Effective Medicaid SUD Treatment

by Landmark Recovery

August 8, 2019
A doctor holding a stethoscope. This doctor can help individuals suffering with opiate addiction.

Medicaid has been a staple topic in the media for years, with an ongoing debate regarding its policies. Medicaid is a lifeline to millions of Americans who would not otherwise have access to essential care to promote health and well-being. The implications of Medicaid services extend past healthcare and trickles down into various aspects of public well-being.


The History Of Medicaid

In 1965, President Lyndon B. Johnson signed amendments to the Social Security Act into law, giving life to Medicaid and Medicare. Medicaid is health insurance that is overseen by the federal government for certain individuals and families with limited income and resources.

In the Patient Protection and Affordable Care Act (ACA) of 2010, millions of Americans gained additional access to Medicaid insurance who previously could not afford or qualify for it. Medicaid is the largest payer of behavioral health services, which saw a 700% increase in individuals who sought services for substance use disorders in Kentucky once the ACA expansion went into effect in 2014.

The Substance Abuse Treatment field was transformed under the ACA.

While this extended coverage to thousands, there was a ripple effect often resulting in the reduction in quality of care which individuals receive, an increase in institutions which are compelled to advertise they offer care for a co-occurring diagnosis, but too often do not meet the staff requirements and service capabilities to sustain sufficient care in terms of various complex disorders with alternating severities.


The Treatment For SUD With Medicaid

There is a division in quality between programs which take privatized insurance and Medicaid. These programs often consist of vastly different schools of thought when it comes to effective treatment outcomes.

Most Addiction Only Program facilities operate under a nonprofit or government-operated guise that consists of abstinence-based counseling and education done by staff who do not have a college degree or specialization in counseling. Due to limited funding or program beliefs they cannot or will not offer treatment using craving reduction medication such as buprenorphine or other medications which would be used to treat co-occurring mental health issues such as Major Depression Disorder or Generalized Anxiety.

This is further complicated by the fact that more than half of individuals in need of substance abuse treatment and services for co-occurring disorders are often uninsured due to inability to maintain employment and strained familial relationships.

Since the beginning of community-based services, doctors and other staff have struggled to find a viable course of treatment to solve the psychosocial and health problems that are commonly present amongst those who have substance use disorder. Homelessness, legal trouble, infectious disease, family problems, and unemployment have been amongst the additional issues patients have in addition to surmounting evidence that they require additional mental health services.

One survey in 2006 among clinical staff within a single state system looked at patients who fit the diagnosis for co-occurring disorders and found a mental health estimated diagnosis rate of 41% mood disorders, 26% anxiety disorders, 25% Post Traumatic Stress Disorder, 17% with severe mental illness, 17% borderline personality disorder, and 18% with antisocial personality disorder. Another study screened the admission to three different outpatient treatment clinics and found that over 50% of clients presented as fitting the criterion to be dually diagnosed with a substance abuse disorder and a mental health disorder.

The mass amount of data that has been collected on this subject clearly proves that this is not a phenomenon. Steadily it has become an expectation and not an exception. Although there has been some considerable attention to the fact that this problem persists a national study done by the Substance Abuse and Mental Health Services Administration (SAMHSA) would suggest that individuals who receive a dual diagnosis receive in-congruent care that only targets either mental health or substance abuse, not both.

One study that utilized the standard specifications of program capacity to address comorbidity, the Dual Diagnosis Capability in Addiction Treatment, and the Dual Diagnosis in Mental Health Treatment indexes in which 256 programs across several state systems were sampled who claimed to have the capability to treat these conditions. What they found was that 18% of addiction treatment and 9% of mental health programs fully met the criteria for capable services.

This data would suggest that practices in a clinical setting who are restricted to servicing a single disorder can be disproportionate to the needs of a larger body of clients who come in need of help commonly for both issues.

Regardless of available resources, there seems to be an evident need for revisions in how the healthcare system addresses this population. It has become clear that the clinical initiatives of the mental health care system continue to be tied to the treatment of substance abuse treatment. One study found that the resources available to this population have been limited and finite, but make note of the fact that it would appear irresponsible to not work towards improving the quality of care a Medicaid recipient is capable of for co-occurring disorders.

Individuals without competent care for both SUD and MHO an individual level, a study titled Drugs: Education, Prevention & Policy by Ilana Crome looked at 121 clients who had experienced psychoses and found that those with substance abuse disorder, which was 36%, had spent twice as many days having hospitalized in the 2 years prior to treatment as clients without substance abuse problems. The result from this is often a rising stack of medical bills and the inability to gain employment due to a lack of lasting stability or recovery.

These troubles often cause consequences that extend further than the individual. If an individual is unable to pay for necessary treatment, they are more likely to end up in a government-run facility whose staff is not properly trained to handle their needs to stabilize their mental health. This often results in relapse and discontinuation of care, which unfortunately can lead to an increased rate of people who end up homeless, overflowing hospital ERs, or in jails — a place these individuals end up because they cannot find suitable access to the kind of care they need.


Next Steps

On a larger scale, employees are lost, bills are unpaid, and the overdose rate rises. When people do not receive adequate care that they both need and deserve, everyone loses. Praxis by Landmark Recovery seeks to ensure that our patients can break this cycle. Our program treats both mental health and substance use concurrently for the Medicaid population. We can provide the best evidence-based interventions that have been previously limited in this population for continued sobriety. We provide adequate care that addresses the health of our patients in their entirety, as complex individuals deserving of change and growth. Becoming a service provider to the Medicaid population gives Praxis by Landmark Recovery the opportunity to close the gap between substance use treatment and mental health care.


About The Author

Charley Melson is a clinical therapist and the Executive Director at Praxis by Landmark Recovery. Melson has a degree in Clinical Counseling and has been working in the recovery field for almost five years.

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About the Author

Landmark Recovery

Landmark Recovery

Landmark Recovery was founded with a determination to make addiction treatment accessible for all. Through our integrated treatment programs, we've helped thousands of people choose recovery over addiction and get back to life on their own terms. We're on a mission to save one million lives over the next century. We encourage all those struggling with substance use to seek professional help.