Substance Abuse

 A big problem that is happening in the United States and America is substance abuse and the lack of support that is provided for those that struggle with substance abuse. Across the globe, about 35 million people suffer from some form of substance abuse, yet usually only 1 in 7 receive treatment. The opioid epidemic takes around 100,000 lives a year, and fentanyl use, and overdoses/deaths are also on the rise. Sadly, even with all these numbers being so high, access to treatment that is effective, affordable, and happens in a timely manner remains inadequate. This paper will outline the issues that go on with substance abuse and how broken the system is and bring awareness to it. 

Substance abuse can start anywhere, and at any age. The hard truth about substance abuse is that it doesn’t discriminate. Substance use disorder can affect people of all races, ages, and social/economic status. There are certain populations where some people are more impacted than others are. Some of those populations are veterans, low-income people, those whose family are full of addicts (genetics can play a massive role in substance abuse) and those with mental health issues. If substance abuse goes untreated, the effects can be detrimental. Some of the effects for untreated substance abuse are- charges from the justice system, loss of housing or employment, family issues/complications, diseases, health problems, and losing housing. 

The biggest and most significant problem when it comes to substance abuse is the lack of resources and lack of funding. A lot of treatment centers are understaffed, overwhelmed, or not easily accessible (especially if they are in rural areas). People trying to get into treatment centers can be waiting weeks or months even to get into treatment. Weeks and months are something that people that are struggling with their addiction don’t have. Sometimes, it can be a matter of a day that stands between someone getting the help they need and becoming sober, or someone overdosing and/or passing away. 

Another significant issue that people trying to get help with substance abuse face is the cost of the treatment or insurance not wanting to pay, or insurance only wanting to pay for a certain amount of days. The sad and unfortunate truth of the insurance world is that if you have private pay insurance or PPI, you will likely get better care and a longer treatment option. Whereas if you have a state-funded insurance plan or Medicaid, they sometimes only want to pay for a week of treatment or 28 days at max. Getting them to approved treatment for someone is sometimes harder than you can imagine. Another issue that people can run into with insurance is that if you have Medicare as your insurance, a lot of places don’t take that for substance abuse treatment and then you’re stuck with the whole bill. Insurance shouldn’t have as big of a say as it does on things medical and substance abuse wise, but sadly it does. Insurance companies think they know what is best for you and what you need, when that couldn’t be further from the truth. Coverage for people with insurance is limited and few and far between, which makes it to be successful in your recovery and sustain it. Substance use also goes hand in hand with mental health. 

Another issue that people face regarding their substance abuse disorder is the stigma and discrimination that comes from it. People think if you ask for help, it makes you weak and you will be looked at as less than you are. Asking for help may be the hardest step in the whole treatment process, but it’s also the most important and takes a lot of strength to surrender and state that you can’t do this alone and that you need help. Society looks at people who have substance abuse issues, present and past as less than them. People who go to a hospital for help and have a history of substance use, they always have a permanent mark on them after. They are often labeled as drug seeking, attention seeking, or just weak and not able to handle pain. Being treated this way also steers people away from getting medical attention when they need it. 

To try to combat and address substance use there are a few things that could be done to help the ever-growing problem of drugs. One of the things to help could be diversion programs, such as drug court where they can plead in and as long as they follow certain rules and stay sober, their charges can get dropped. The only downfall is funding for this isn’t always there in places. Another option to help with substance abuse is that when people come in for substance abuse treatment, to combine it with mental health treatment as a lot of times, those two hold hands with each other and grab at the person. Another way to help is to provide a lot of education about drugs and reducing the stigma of it to schools. I remember when I was in elementary school, there was the program called DARE and Say No to Drugs. I’m not sure how many of those programs still exist today, as I haven’t heard much. Another option, and one of the best ones in my opinion, is to expand people’s access to evidence-based treatment. Evidence based treatment are programs like medication assisted treatment, and counseling. Medication assisted treatment is something that they can get weekly or monthly to help them combat their cravings and reduce their risk for relapse. The final thing that I think can help with substance abuse is harm reduction. Harm reduction consists of needle exchange programs, and naloxone being handed out to help combat an overdose. 

In conclusion, there is a lot that needs to be changed and implemented in the United States to help with substance abuse. Substance abuse does more harm than to the individual that is using. Families get torn apart and broken, lives are lost that don’t need to be lost from an overdose, and people struggle in silence and don’t have the ability to get the care that they need so desperately. Individuals that are struggling with substance abuse, having a lack of support, isn’t just a healthcare system failure, it’s also a moral and society failure. It’s time to quit trying to combat the substance abuse problem halfway, it’s time to take it head on. People’s lives depend on it.

Cuts in Spending on Grants Cause Cuts in Service

I have been reflecting about all of the cuts and everything that is happening in the substance abuse field right now. 

Our clients often rely on a type of funding that is called a SUPR grant. We were made aware that we are not allowed to accept any clients that don't have insurance anymore. That is, there will be no more SUPR grants, and we cannot help the people who would have been served with the SUPR grants.

My job does a thing called “walk in evaluations” on Monday, Wednesdays, and Thursdays. These walk in evaluations are done because either they are court ordered by probation or parole, DCFS, or people’s employers; and sometimes we even see people coming in for themselves wanting help. The big issue that we have been running into recently in the past couple of weeks is that these clients are either being sent by any of the above organizations or because they genuinely do want to get sober and better themselves, but then we look them up in the system of insurance and see that they have no funding, so we have to turn them away and refer them to the DHS office, and then have them come back when they get funding. 

It’s disheartening that because of all of the funding cuts and grant cuts happening in the world right now, people’s lives are being ruined—their LIVES! To me, that just isn't okay. How can these people want to get help but then we have to turn them away because of insurance or lack of insurance (because there are some insurances that we don't take)? They took away the SUPR grant and laid off people, so people who haven’t been laid off now have more work, yet no more pay. 

Not being able to help all of the people that we used to be able to help is detrimental to them and potentially a risk for them as well because they could overdose or something else happen to them. Substance abuse is not talked about or cared about enough in the government, and I think that needs to change. In my honest opinion and in a perfect world, substance abuse treatment wouldn't be charged for. If they had insurance great, but if not we wouldn't turn them away. Addiction is a disease, not a choice. I myself have never struggled with addiction to any substance of any sort, but all of my older brothers (minus one, so 3 out of the 4) and my dad and mom had problems with addiction with some substances. More needs to be done for people who are struggling. 

It seems to me that our society throws away several types of people.  We throw away persons who have become addicted to substances.  We throw away people who commit crimes and are convicted and sentenced.  We throw away people with serious mental illness.  We also mostly throw away people with serious or profound developmental or intellectual disabilities.  To a lesser extent, we throw away poor persons with chronic health problems, and elderly persons with dementia. 

I think this is why the value of equality is usually ranked second only to life on the priorities in ethical decision-making.  We absolutely need to hold fast to the proposition that all people are equal in dignity and rights. Barbarity is the result if we do not (as the preamble to the Universal Declaration of Human Rights reminds us, if we consult it and consider what the world had just experienced when it was written).

When our budgets are not balanced, we inflict debt and debt payments on future generations.  I am therefore in favor of balanced budgets when we are not experiencing economic recessions or high unemployment.  However, usually when politicians try to balance budgets or shrink deficits, they mainly focus on how they can cut spending.  No doubt in large complex systems such as state budgets there must exist potential for some efficiency gains and there must be some waste.  Even if waste and stupid loss of public money is only 1%, and the government is super efficient and vigilant, someone could still write about the millions (or billions) of dollars involved in that 1%.  I often think about how we could raise more revenue, rather than cut our existing spending.  I am skeptical that there are significant efficiency gains available to us in policy changes, and I suspect that we would be able to solve many of our social problems if middle class people were willing to hand over about 35% to 40% of their income to local/state/federal governments rather than 30% to 35%, and wealthy people ought to be putting about 45% of their income into public use rather than the 35% to 40% that they do now.  

If we increased public revenue, I would prioritize five areas for funding:  1st) Higher education; 2nd) mental health and substance abuse treatment and prevention; 3rd) housing and affordable housing to end homelessness; 4th) K-12 education; and 5th) bicycle and public transit infrastructure, including real high-speed rail connections on trains that run on elevated tracks at 180 miles per hour zipping between our major cities. 

Insurance & Substance Abuse

When this assignment was first introduced, I began to overthink it. What would I choose to write about that I could just talk about for an hour without having to overthink what I am writing about and making sure I spend the proper time limit on it? The more I got to thinking, the more what I do every day came to my mind. 

I work at Gateway Foundation Drug and Alcohol Treatment Center here in Springfield, IL, and the way that insurance companies control everything that clients can do really grinds my gears. Clients come to us for help, and sometimes we must turn them away because of insurance. There are times when clients come in and they are ready to turn their life around and do better for themselves, and there are other times when clients come in because they are being forced to by legal or DCFS. There are sometimes times when they come in and we have to say “no” because their insurance won’t cover Gateway and as we are out-of-network they can’t afford to pay the out-of-network costs. 

An example that I can use about insurance dictating what clients can do that I don’t agree with happened a few months ago. Even though weed is legal in Illinois now, in some counties it is still illegal, or in some counties probation departments don’t allow it to be in the person’s system. There have been a few clients who come in and the only substance that they struggle with and want treatment for is weed. Insurance companies will approve treatment for it in the outpatient setting, but they will not approve it for the inpatient or residential treatment setting. If someone is only coming to outpatient, they leave and go back everyday to the same environment every day that could maybe be contributing to them using. They also could be going and hanging out with the same people who are encouraging them to smoke. There were a few certain people who wanted to go to residential treatment to get away from these factors. Residential has many factors that can be beneficial to the client to help them. Being away from weed for 28 days or however many days insurance will approve the stay, could be life changing for a client, but insurance companies, especially state funded Medicaid plans, don’t see weed as being a substance that treatment is needed for. Some private insurance companies will pay for it, but it is tricky to get it done. 

We also have the instances where after so many weeks and hours of being in treatment at a certain level of care, they have to be transitioned to a lower level of care, or they have to be completed from the program if they are already at the lowest level of care. Clients know themselves and they know their boundaries, and when we must tell them that by this day of the month they have to go to a lower level of care, or this day of the month they have to complete the program. When you tell clients this and they aren’t ready to be at a lower level of care or complete, you can almost see the light drain from their eyes. A lot of the time, clients use their drug of choice to be rotated to a higher level of care or be able to stay in the program longer to get around insurance and what they dictate.

I don’t believe any of this is right and I hate how much insurance dictates everything in our lives and how expensive it is. I hope one day we have a world where insurance doesn’t have such a significant impact on everything, and if the day comes I hope I am here to see it. 

Thank you for sharing these insights into some of the barriers that diminish the quality of care available to persons who are trying to recover from substance use disorders. Insurance is supposed to play a useful role in a couple ways.  First, it offers pooled risk.  If 90% of us will never need treatment for a problem, but 10% of us will need treatment, and we can figure what the average cost of that treatment would be, we can spread out the risk by having 100% of us paying a fraction of the average cost of treatment so that if we ever need the help, the money will be there for us.  That's pooled risk, and it can be done by private insurance or by taxing people and having a public program to provide services.  Also, insurance companies (or administrators of public programs) should be reviewing treatment plans and interventions, and keeping an eye on providers, to guard against providers charging too much, or charging for providing ineffective treatments.  But, this needs to be done at an aggregate level.  There are always outliers, extreme cases, and exceptions, and so long as the rate of these sorts of cases isn't much higher or lower at a provider, the insuring (and paying) entity ought to just defer to the wishes of professionals and clients.  Only if a particular provider seems to be frequently having exceptionally costly or long-term treatments should the insurer come in and start examining each case and determine what is going on.  

I wish we also had a way to help relocate people to healthier environments, since so much about substance use disorders is conditioned by the social environment in which a person lives.  

Insurance companies are widely loathed, and there are many egregious examples of insurers denying treatments to their subscribers or payments to the providers. The 2010 Affordable Care Act put some restraints on how private insurers provide coverage, but abuses and outrages continue, as you illustrate in your reaction essay.

SAMHSA distributes money to fund treatment programs

 The policy I chose was Substance Abuse and Mental Health Services Administration (SAMHSA) was has awarded $123 Million in grants for a multifront approach to combat the overdose epidemic. I find this to be a very good cause. In the past year, overdoses have risen by almost 31%, which I am sure is a direct result of Covid. During the lockdowns, Alcoholics Anonymous and Narcotics Anonymous were not operating on an in-person group therapy model that so many addicts rely on. Like many other things, they were forced to do zoom and some addicts depend on the face-to-face model. One thing they preach in the meetings is not to isolate yourself because that could become dangerous, yet they were forced to isolate and not receive the face-to-face support so many of them rely on day in and day out. 

There are six different approaches including in this grant, two of which are coming to Illinois. Obviously, I wish they could go all throughout every city in the United States but I guess in the eyes of some, not enough people have died in order for there to be more on the ground action. One of the approaches that is reaching Illinois is “Medication Assisted Treatment for Prescription Drug and Opioid Addiction (MAT-PDOA)”. These grant funds will help to expand the medicated assisted treatment (MAT) services in Chicago. The goal of this grant is to increase the number of people who get MAT services and decrease the illicit opioid use/ prescription abuse. The state of Illinois is also receiving money for First Responders and community members at the state and local government to be accurately trained to administer Narcan, and help to refer people to treatment and recovery support services. 

As stated earlier, I do wish we could see some more on the ground support for not only the ones in active addiction but funding to treatment centers and recovery programs. While I whole heartedly love seeing bills and funding come through grants like these, I would always like to see more. I think they are sometimes pushed to the side because people are uneducated on addiction, but if we could just reach even 30% more of addicts it would make a big impact. 

Here is the link for the SAMHSA website, https://www.samhsa.gov/newsroom/press-announcements/202109130300

The page mentions that some programs will get funding for five years, and that makes me wonder if the $123 million is only the amount to be released in 2021. For example, ten tribal entities will be getting $331.2 over five years (averaging $6.6 million per year per tribal entity). Also, is the $123 million a significant increase over what was granted in 2020 or 2019?  With 93,000 drug-related deaths in the past 12 months, I hope this is a significant increase. 

The scope of the problem calls for more investment than $123 million, but the page mentions that there was also a release of $250 million to community behavioral health center back in July, and there would be $1.5 billion for the Community Mental Health Services Block Grant program and another $1.5 billion for the Substance Abuse Prevention and Treatment Block Grant program.  Would $2 billion or even $3 billion be more reasonable figures for funding those block grants, given the magnitude of the problem and the cost in human lives lost?

Regional Integrated Behavioral Health Network

Here is a student paper in favor of extending more services for mental illness and substance addictions into rural areas and small cities and towns, where such services are now often unavailable. 

HB2982

            The purpose of this bill is to provide more accessible treatment services for those suffering from a substance abuse illnesses along with mental health illnesses. Currently, it is difficult for people to find adequate services that fit their needs. The bill would create the Regional Integrated Behavioral Health Network Act to ensure the appropriate treatment would be made accessible and resources could be used efficiently and effectively. Rural areas are currently lacking in services, so the goal of the networks is to allow them to use the same treatment as the urban residents. They need to be able to access legitimate and appropriate care no matter where they may reside.

            Statistically, there is an estimate of about 25% of people living in Illinois that are over eighteen years old that have had incidents with a mental or substance abuse disorder. Also, 700,000 Illinois residents that are adults have a serious mental illness. Finally, 240,000 Illinois children and adolescents suffer from a serious emotional disturbance. These people may be going without treatment at any point in time because no treatment center is located near them, which makes treatment less accessible, because the distance is a barrier. This is mostly caused from fragmentation, geographic inconsistency, lack of funds, psychiatric and other workforce shortages. The far distances to adequate treatment centers makes transportation an issue, as many low-income persons in less densely populated areas of the state live without owning cars, and cannot afford gas for regular long commutes even if they own cars. If they cannot reach a treatment facility, they cannot receive and benefit from treatment.

            Since the people are not able to receive the proper treatment, they experience increased suffering, and may lose their ability to function in their social roles or even their daily activities. This loss of functioning and increase in suffering can push people to increase their use of medical services or emergency medical care. If drug treatment and mental health services were available and accessible, the persons receiving treatment would increase their productivity at work, or would be more likely to find employment. Their unemployment is causing many of them to become homeless. Persons who face addiction or mental illness without treatment or help may withdraw from their social support networks, or actively repulse those who love them and would care for them, and this decreasing desire to be a part of their family and/or communities may lead to additional problems. Persons with untreated mental illness and addictions are often unable to complete their schooling. These people are ending up behind bars or even dying. None of these scenarios or effects is an example of how we want our people to be living. It is not fair to them to not receive their proper treatment. Illinois needs to respond to the different regions to work out a more integrated system of treatment in which services are available in smaller towns and rural areas that are distant from the state’s cities. The correct care needs to be delivered at the appropriate time to the persons who desperately need it.

            There are many goals associated with this bill, but there is one main one. The hopes are that the networks will be able to allow people to access the most effective treatment for their mental and substance abuse illnesses throughout Illinois, but focuses in rural areas of Illinois. It is most important for the different treatment centers to work together as to make the process run smoother. The people are suffering and it is having highly adverse effects not only on them, but also the community. 

A student's letter to the governor on DHS cuts

I thought this was a reasonable letter to the governor by one of my students.  

Dear governor Quinn,

                  I am writing to you today in regards of your proposed budget cuts to the Department of Human Services.  This includes the substance abuse and treatment facilities.  This cut would send almost 80% of individuals that are in substance abuse programs now out on the street.  Also it would eliminate many jobs and then as an effect, hurt many hard working families.  Then you stated how you intend to give a 10% increase to the department of corrections in return.  This to me makes little or no sense at all.  There is actual proof that the recidivism rate is lower for individuals who go to treatment than those who go to the prison system.  Yes, there is treatment in prisons but very little bed space, and lack of counselors makes it difficult to really make it effective.  Also the price to house an inmate yearlong in prison is almost 27,000 dollars!  It cost between 5,000 and 10,000 to send someone to treatment.  Addiction is a disease and you have to treat the individual, not punish him.  In Sangamon County where I am from we just started a drug court system, and cutting the Department of Human Services—specifically the drug and alcohol programs—would really hurt the drug court.  These drug courts help individuals start a new life with intense probation, mandatory drug testing, and specific guidelines like getting a job or taking classes to improve the person’s education.  This is also proven to work better than prison, if you look at the recidivism rates from the Department of Justice.  One other issue of cutting this part of the budget is that this means the state would stop funding non-Medicaid addiction treatment and prevention.  This announcement by your office has already started many treatment programs to stop taking in clients from the courts or the streets.  This then has left many clients stuck or out of a place to seek help.  To me this is just wrong.

                  I am mainly asking you to support HB-106, which is a resolution signed by nearly two dozen representatives, that opposes the funding cuts to non-Medicaid addiction treatment and prevention.  Stop the cuts to this part of the budget and look at the consequences if you go through with these cuts.  Almost 5,000 people will lose their jobs, over 50,000 clients will be asked to leave the facilities in which they are currently in, and over 229,000 youth will lose prevention services.  Also 80% of clients are not eligible for Medicaid funding for their treatment, causing many people that are seeking help with their addiction to not receive it.  This proposed budget cut to these services may be life or death for many individuals and is just not right to do or ethical. Please stop and really take a look at what this will do.

                  I understand that with the current Democratic leadership in the House and stiff Republican opposition it would be difficult for you to raise revenue through, for example, broadening the sales tax. Thus, you do need to make cuts. The Department of Human Services gets about 14% of the General Revenue Fund, and it would be fair if the cuts to that department were close to 14%, not the 50% or more cuts you have proposed to substance abuse treatment and prevention. For ethical, practical, and long-term financial reasons it makes more sense to maintain substance abuse and prevention funding and make cuts elsewhere, almost anywhere else.