Winter 2006
Volume
II, No. 1
West
Michigan
Health Scorecard
Health
Status
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In 2002, 15.7 million Americans had a substance
use disorder.
According to the American Psychiatric Association’s Diagnostic and Statistical
Manual of Mental Disorders, 4th Edition, (DSM4) two subcategories of
substance use disorders are defined as substance abuse and substance or chemical
dependency. Source:
Substance Abuse and Mental Health Services Administration (SAMHSA), US Dept of
Health and Human Services and DSM4.
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Based on averages over three years, 7.2% of
Michigan residents report having used illicit drugs; 49% used alcohol and 23.2%
report binge alcohol use (consuming 5 or more drinks in one sitting) in the past
month. Source: SAMHSA –
1999-2001
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Of the 7,006 admissions for substance use
disorder treatment in West Central Michigan in 2005, 3,477 were for alcohol use,
1,695 for marijuana, 980 for cocaine or crack, 216 for heroin, and 640 for all
other illicit drugs. Source:
MDCH
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Co-occurrence or dual diagnosis – In 2002, 33.2
million US adults had a serious mental illness or substance use disorder.
Of those, 13.4 million had only a serious mental illness, 15.7 had only a
substance use disorder and 4 million had both.
Source: SAMHSA, July,
2004
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In 2004, there were 1,159 Michigan fatalities from traffic
crashes, 364 (31.4%) were involved with drinking. For West Central Michigan (12 counties) there were 165
fatalities, 44 (26%) were involved with drinking. Source - 2004 Michigan Traffic Crash Facts, Michigan Office
of Highway Safety Planning.
Cost
ž
In
1998, $81 billion was spent in the US on problems related to substance use
disorder and addiction. Michigan
spent $2.7 billion. Michigan’s
per capita spending on public programs related to the burden of substance use
disorder is 12th highest in the nation.
Michigan is third from the bottom in spending on substance use disorder
prevention, treatment and research. Source: Michigan in Brief, 7th
Edition, April 1, 2002.
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Of every substance use disorder dollar spent by
Michigan, one cent was for prevention and treatment programs and 99 cents was to
pay for the burden the problem imposes on public programs including criminal
justice, Medicaid, child welfare and mental health. Source: Michigan in
Brief, 7th Edition, April 1, 2002
Access
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In 12 counties of West Central Michigan, less
than one in thirty individuals with substance use disorder receives treatment. Source:
Michigan Department of Community Health, Mental Health & Substance
Abuse Services, Office of Drug Control Policy, September, 2003 – “Composite
Prevalence Estimates of the Need for Substance Abuse Treatment Services in
Michigan” (Version 3.0)
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Over the past ten years in West Central Michigan,
numerous treatment facilities have closed.
Quality
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For every $1 spent on treatment, $7 is saved to
society. (Source – California Outcomes Treatment Project, 2000 & 2001,
and Health Services Research, October 2005)
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Nearly two decades of treatment research,
represented by hundreds of studies, finds that treatment for substance use
disorders, especially when it incorporates evidence-based practice, results in
clinically significant reductions in crime and alcohol and drug use and
improvement in health and social function for many clients. (Source –
Economic Benefits of Drug Treatment: A
Critical Review of the Evidence for Policy Makers, February 2005; Steven Belenko,
PhD, Principal Investigator)
Feature
Article
”Improving
Health Care for Substance Use Disorders”
Recently,
the Institute of Medicine1 reported on the quality of health care for
mental conditions and substance use disorders and recommended two ways to
improve quality. One was to
consider the values and preferences of the patient alongside the medical aspects
of care. The other important
finding was to improve understanding in the society about the treatment of
problems related to substance use. We
all know someone who, in our opinion, has a problem which may not be considered
to be “medical” but the medical profession is increasingly coming to an
understanding that problems related to substances, attitudes, mental dysfunction
and other issues commonly thought to be social or psychological in nature also
have a biological basis.
The alcoholic and the diabetic
might be considered to have almost parallel disease/recovery tracks.
Both are susceptible to sickness when they encounter and ingest a certain
substance – one is alcohol averse and the other is sugar averse.
Yet, one is stigmatized and “blamed” for the disease and the other is
embraced by the medical system and assisted with a cure.
One “falls off the wagon” and the other has an attack of a chronic
problem. We think of sugar as an
indulgence and alcohol as an obsession. The
stigma that is attached to the alcoholic prevents care and open discussion about
the problem while the diabetic is courted and supported by family, doctors and
society. One patient is a
“loser” and the other is a “victim.”
The Institute of Medicine2
calls for action from clinicians, health care organizations, purchasers,
researchers, public policy makers and others to assure that individuals with
mental and substance use conditions receive the care they need to recover.
The link between mental and substance use problems and general health
care is very strong, especially with respect to chronic illnesses. The quality
of general health care depends upon equally attending to substance use problems.
All those involved in these differing systems of health care are challenged to
understand that mental and substance use problems and illnesses should not be
viewed as separate and unrelated to overall health and general health care.
Strengths do exist in the field of
health care for substance use conditions and illness. These strengths include
that the field has been a leader in patient-centered care.
Strong advocacy groups of families and consumers exist within mental
health care, and peer support to help sustain recovery has long been used. In
addition, the commitment and strength of the field’s workforce has been
remarkable in the face of reduced attention, stigmatization, constrained
resources at delivery sites, and an overall inadequate infrastructure to support
the delivery of high-quality treatment services.
Despite these strengths, several
problems still abound in the field. There are significant problems with the
workforce including inconsistent quality, high staff turnover, and limited work
force development, which are directly related to constrained resources and
deceasing dedication of revenue to directly treat substance use conditions and
dependence. The decline in access
to care has been very evident in the private insurance plans as a recent study3
revealed. Between 1992 and 2001 utilization of private insurance for substance
use disorder treatment declined by 23%, the decline was evident in all
categories of outpatient, residential, and pharmaceutical usage. This
decline is due to several factors. In
a survey of people needing treatment but who did not receive it, 37.5% reported
they were unable to get treatment because of the costs of care. For them, care
coverage was very limited or non-existent in the majority of health care plans.
The study also documented the effect of managed care systems where per
episode spending declined by 76%. Also
demonstrated was a decline in timely access to care, private insurance premiums
rising at double digit rates and a reluctance to move more beneficiaries into
treatment.4
Scientific advances in the understanding of substance use disorders have lead to demonstrable evidence of what practices work. Substance use disorders are complex and it is important to match the patient to the most appropriate level of care. Doing so is both cost efficient and has a higher prognosis of moving the person into recovery. It has also been shown that screening and brief intervention for both the problem abuser and the addicted patient are effective in encouraging more ready access to treatment.4
How can the system for treating
substance use disorders be improved?
·
Employers should utilize Employee Assistance Programs.
·
Employers should choose health plans that include a wide
network of providers and utilization review that emphasizes continuity of care.
·
Federal and state governments should enact parity for
substance use disorders and mental illness.
·
Health care plans should implement Washington Circle
recommendations that include three performance measures to improve outcomes,
early identification, initiation of treatment within 10 to 14 days of
identification and engagement.
·
Universities and health care institutes should embrace the
messages from research that substance use disorders treatment can be cost
effective.
·
Return on investment needs to be demonstrated more clearly.
·
Health care professions, universities and colleges should
institute evidenced-based training of primary care providers to effectively
screen and provide brief interventions and referrals to treatment.
Emphasis on continuing education of mental and substance use conditions
should also be increased.
Where to go for help?
·
Contact your local Community Mental Health agency
·
Check your phone directory for crisis intervention hotlines
and services
·
Consult with your physician
·
Use SAMHSA’s online Treatment Facility Locator:
http://dasis3.samhsa.gov/
Websites that may include helpful
information:
·
US Department of Health & Human Services – Substance
Abuse and Mental Health Services Administration: http://www.samhsa.gov/
·
National Institute on Drug Abuse, National Institutes of
Health: http://www.nida.nih.gov/
·
The Partnership for a Drug-Free America:
http://www.drugfree.org/Treatment/
References:
1
“Improving
the Quality of Health Care for Mental and Substance Use Conditions” Institute
of Medicine of the National Academies, 2005
2 “Crossing the Quality Chasm – A
New health system for the 21st century” Institute of Medicine of
the National Academies, 2001
3 Health Affairs, December 2004
4 National Institute on Drug Abuse (NIDA),
2002