Substance Abuse and Obamacare

From the London Tablet, July 22, 2012:

The death of Eva Rausing, the wife of billionaire Tetra Pak heir Hans Kristian Rausing, has grabbed the headlines in the same way as the tragedies of singers Amy Winehouse and Whitney Houston. People are both horrified and fascinated to learn that rich, often talented individuals have been unable to free themselves from the grip of substance abuse. Such cases disprove the Coalition Government’s view that, with appropriate help, addicts can give up drugs quite quickly. They also highlight particular issues facing women and addiction.

The Government, however, takes the view that with the right help, people can make a speedy recovery. In England, it has introduced a system that will pay drug agencies according to the rate of success with their clients. In some areas, up to 50 per cent of the contract value is withheld until the agency can demonstrate a client’s abstinence from Class A drugs, such as cocaine and heroin. The problem with this strategy has been highlighted by Dr. Clare Gerarda, chairwoman of the Royal College of General Practitioners, who has pointed out that it takes a long time for someone to be drug free—and that often this will never be achieved.

While social deprivation is not in itself the cause of addiction, it creates a sense of helplessness so that people cannot picture a positive future for themselves. The deep-rooted issues are such that millions of pounds need to be invested in regenerating our inner cities, creating jobs and homes. Sadly, in this time of austerity, there is no chance of this happening in any meaningful way. The price of a payment-by-results system will be that those with entrenched problems will not receive help. Instead, their situation will only get worse.

The reality of mental health as a cause of addiction is a much bigger problem than governments are prepared to accept. The sad truth is that most people who take drugs and alcohol are victims of mental which prevents a logical decision-making. The money given to services helping people with heroin problems has remained static, but residential services are in decline, particularly those that support women and young families. Alarmingly, charities supporting people with mental-health issues, such as Mindm have seen greater demand for services–but simultaneously face a 5.7 per cent reduction in funding.

There is vexing inconsistency in the points above that should cause politicians and mental health professionals to pause. On the one hand, there is a societal and Christian responsibility to offer help to those with alcohol and substance abuse problems. With such assistance, many are able to become clean and manage sobriety. As the fine points of what will be reimbursed under a national health care plan are worked out in the United States, decisions will have to be made concerning what kind of treatment will be reimbursed, and the length of such treatment. On the other hand, the Tablet article brings in clear focus the fact that even unlimited financial resources often do not help a person to overcome these problems. In our country, the sad case of Mary Kennedy reminds one of British heir Eva Rausling. Finding the right balance between appropriate funding for alcohol and substance abuse in Obamacare, while not breaking the bank, needs to be a key priority.

William Van Ornum