Russell Ferstandig On How the Affordable Care Act Impacts Substance Abuse Treatment

Psychiatrist Russell Ferstandig is well aware of the impact that substance abuse can have on a person’s life.  With a strong focus on addiction treatment, he helps patients to overcome these challenges and get the quality care they need to work toward recovery.  Unfortunately there are still millions of Americans who are not getting the help they need.  According to the National Institute on Drug Abuse, only approximately 2.6 million Americans are receiving addiction treatment compared to the 24 million who are in need.

 

Why are there so many people not getting help?

One major factor that stands in the way of many people getting treatment is the cost.  Depending on their level of addiction, between inpatient care, outpatient care, therapy, and other forms of treatment, the cost can add up.  Although one may assume that insurance would help defer some of these expenses, this is not always the case.  Not all insurance plans cover substance abuse treatment.  And those that do often have limited coverage and caps on how much they will pay.

However, with the creation of the Affordable Care Act, this could all change, says Russell Ferstandig.  More people could gain access to substance abuse treatment and prevention programs that were out of reach before.

 

What is the Affordable Care Act (ACA)?

The ACA is President Obama’s plan to ensure that more Americans have access to the medical care that they need.  It aims to improve the quality of care, increase health care choices, and reduce costs, making insurance more comprehensive and affordable.  More people would become eligible for Medicaid coverage and government subsidies for marketplace plans.  And under this new program, coverage for substance abuse treatment is required as an essential health benefit.

 

What are the essential health benefits?

Under the ACA, all health plans must cover, at a minimum, the following 10 essential health benefits:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

 

What does this mean for those who need substance abuse treatment?

Under the ACA, says Russell Ferstandig, more people will have the ability to seek treatment.  While previously their insurance may not have covered services, now substance abuse coverage is required.  This means that those who were uninsured or underinsured and are now covered by approved plans will have access to care that they did not have before.  For those who already have insurance, it may expand their service and treatment options.  Each insurance provider will determine their own details of coverage.

It could also improve preventive care, as doctors could provide more screenings and early intervention services.  Through therapy and counseling, says Russell Ferstandig, some patients could receive beneficial treatment before their addiction worsens and causes more health and life problems.  According to an article on drugfree.org, services such as physician visits, clinic visits, home health visits, family counseling, alcohol and drug testing, certain medications, monitoring tests, and smoking cessation would all become covered by government insurers.  The article also notes that Medicaid and Medicare cover approximately 65 percent of insured Americans.

Substance abuse treatment differs from person to person.  It is tailored to each person’s individual needs and situation.  Many people benefit from comprehensive care that addresses their physical, mental, and emotional needs.  Common treatment options include:

  • Detoxification: In order to help a person overcome their addiction, it is necessary to rid their body of the substance and hopefully allow the individual’s physiology to somewhat return to normal, non-addicted state.  Depending on the type of substance and the person’s usage quantity, duration and mode of intake, this process can take several days, and in some cases weeks. Russell Ferstandig stresses that during this time they must be closely monitored by medical professionals who can help them to safely work through withdrawal symptoms.
  • Inpatient programs: These are specially designed programs where patients receive round-the-clock residential care.  They often participate in individual, group, and/or family counseling sessions to help resolve their problems and improve relationships.  They learn coping strategies to deal with challenges and temptation and hopefully establish healthier lifestyle choices.
  • Outpatient programs: These are similar to inpatient programs except patients live at home and go to a facility during the day for counseling and support services.  They learn methods and strategies to live a substance-free life.
  • Psychotherapy: Many patients find that therapy is an effective way to help them overcome their addiction and work through the problems that have led them to use.  They may attend as part of a treatment program or seek counseling privately. Russell Ferstandig points out that sometimes, family sessions are held to address the impact of addiction on loved ones.
  • Support groups: Recovering addicts may attend support groups where they can connect with others who have gone through similar situations.  It gives them a place to share their story, receive motivation, and improve their coping strategies.

Recovery from addiction is an ongoing journey.  It is imperative that people have access to the continuing care and support that they need to stay sober and improve their overall health and wellbeing.  Through the Affordable Care Act more people may have access to these valuable resources.  Russell Ferstandig encourages people looking for help for themselves or a loved one to research their options and get the help they need.