Alcohol addiction is a gigantic problem in the United States. According to a 2012 report from the National Institute on Alcohol Abuse and Alcoholism, more than 17 million American adults are classified as having an alcohol-abuse problem.
And alcohol abuse is a deadly problem: Nearly 90,000 people die from alcohol-related causes every year.
Thanks to the Affordable Care Act, also known as Obamacare, alcoholics can no longer be denied health coverage for their alcoholism. It was previously considered a pre-existing condition, which insurers routinely denied covering treatment for. But what other changes might the law usher in?
We spoke with Dr. Michael S. Shafer, a Professor in the College of Public Programs at Arizona State University and director of the Center for Applied Behavioral Health Policy. His research interests include behavior health policy and the delivery and design of substance abuse treatment programs.
How serious is the problem of alcohol abuse in the United States?
The real problem we face is one of alcohol, and yet because of our nation's continuous war on drugs, what grabs everyone's attention is drug abuse.
One of the major problems that we have faced in our health care industry is very poor screening (for alcohol abuse) and diagnostic practices by primary care physicians.
That is changing as a result of health care reform, and where we've seen a lot of emphasis in the past 10 years has been a focus on SBIRT (screening, brief intervention, and referral to treatment), an evidence-based approach to screening and diagnosing abuse and addiction in emergency rooms, trauma centers and primary care offices.
(The real question is) how do we get physicians to screen easily and quickly within their standard practice of care? There are some very excellent screening instruments that are highly reliable, highly predictive screening identifying individuals that may have either an abuse or an addiction problem.
Many individuals who are at the abuse -- and not the dependent -- stage of alcohol or drug abuse can be effectively treated by as little as two problem-resolution-focused interventions that can be delivered by a nurse practitioner, a physician or a specially trained counselor.
What are the questions that a medical professional can ask to effectively screen for an alcohol abuse problem?
- Have you ever thought of trying to reduce your drug or alcohol abuse?
- Has your drug or alcohol abuse caused interpersonal conflict with your spouse or partner, or others?
- Have you spent an enormous amount of time seeking or consuming drugs and alcohol?
So what do you feel are the most serious, immediate challenges for alcohol addicts and their families when they're searching for treatment?
It's not unlike the prediabetic. We speak with a lot of physicians and with the general public of normalizing the experience of addiction to the experience of diabetes. I happen to be a Type 2 diabetic myself and was diagnosed about six years ago. I was in denial for many, many years prior to diagnosis and that I was in a prediabetic state. Even though my physician was telling me, "Mike, you gotta watch your numbers; you should probably do more exercise."
I was in denial that I had a problem until I got diagnosed. So I think that denial process is a real big challenge for us in health care.
However, the denial is also on the part of the medical community -- physicians have a responsibility to screen for and detect alcohol and drug abuse just like how they have responsibility for detecting and screening for other chronic diseases, like asthma, hypertension and diabetes.
Why do you think this resistance exists?
In the area of alcohol and drug abuse, there is a lot of stigma associated with the disease.
Even in the medical community?
Less so than there used to be, but the history of treatment of addiction was one that grew up out of a self-help movement. We don't have a specialty field in the medical arena that has really owned substance abuse and addiction. And so, until about 10 to 20 years ago, treatment for substance abuse was delivered largely by individuals who were themselves in recovery. And medical practitioners have a very difficult time relating to that kind of industry.
The other thing is that the expectation for addiction treatment has historically been very different than the way we judge and evaluate the efficacy of other chronic disease treatment.
So for diabetes treatment, its success is tied to continuing care. So, I will be under the managed supervision of my physician, and if need be, my endocrinologist, for the rest of my life.
Whereas with alcoholism there's a cure and then you're on your own?
Indeed. And part of the challenge and part of the promise of the Affordable Care Act has been the requirement that insurance companies provide coverage for diseases like alcoholism. Historically, private insurance companies either limited or denied access to treatment. They would cap the number of days that you could access treatment and would limit insurance payment for alcoholism treatment.
Do you think these changes will be effective?
Well, I'm an optimist because I do a lot of work out in the community and we're already beginning to see some of the impact. Our greatest hopes here are that we will be able to intervene on this disease much earlier in the disease trajectory.
What that means is that we can identify and intervene with individuals who are still in the abuse stage of the disease and not the addiction and dependent stage of the disease.
If you are related to somebody who has an addiction problem but they are currently in a state of denial, what kind of things can that family member do in order to get help for that person or even just to help themselves?
If I'm a family member, first I would call my family physician. While there are HIPAA privacy issues regarding what the physician can share with you as a spouse or as a parent or as a sibling, there's no restriction with what you can share with a physician. There are many medications on the market today that can assist with treating patients experiencing addiction, and in the case of alcoholism, withdrawal or detoxification needs to be medically monitored.
Secondly, I would reach out to my local AA or any groups. For the vast majority of people suffering from these diseases, 12-step programs -- Alcoholics Anonymous and Narcotics Anonymous -- are highly effective.
Many of the local chapters have what they call open meetings. As a family member, you can sit in on an open meeting, which can provide some information that you might be able to share with your family member and encourage your family member to accompany you to a meeting.
There's also terrific resources available on the Internet -- the federal government website DrugAbuse.gov, operated by the National Institute on Drug Abuse, provides some terrific general public information about the disease of addiction.
What kind of treatment alternatives do addicts have if they don't have access to programs aside from those like AA?
As a result of the Affordable Care Act, the majority of individuals will qualify for either Medicaid, a subsidized health plan under the state's health exchange, or through their employer.
And for those individuals who don't qualify for any health insurance under any of those three options, there is a network of federally funded health care centers that are established throughout the country for the uninsured.