Survey Finds Public Support for Treatment in Health Reform

Scottish poet Robert Burns's most quoted line reads,

O would some Power the gift to give us
To see ourselves as others see us!

Advocates on all issues make a similar plea: What does the public already know, or think they know, and how can I tailor my message to them so that it's as effective as possible? In answering these questions, there's no substitute for survey data. Thanks to the Closing the Addiction Treatment Gap initiative, addiction prevention, treatment, and recovery advocates are the beneficiaries of a newly released poll that quantifies public opinion on addiction's place in health reform.

On the whole, the survey's results are extremely encouraging. For example:

• 77% of Americans support including addiction treatment in health reform.
• 69% would be willing to pay $2 more per month in premiums to ensure that treatment is accessible and affordable.
• 88% of people think that treatment is important in helping people with addictions get better, and 76% say that long-term recovery is unlikely without support.
• 87% of people see treatment as an ongoing process rather than a one-time occurrence.

The study also shows that there is a lack of knowledge in some areas. For example, 27% of people admit that they don't know whether their community offers affordable, accessible treatment services (26% say there are already enough such services where they live). Groups more likely to see a treatment gap include African Americans, people in recovery, people without insurance, and people who have had family members with addictions.

Similarly, two-thirds of Americans with insurance don't know whether their health plan covers addiction treatment. (October 3 was the one-year anniversary of the Wellstone-Domenici Parity Act being signed into law--it's hoped that regulations will be released some time before Jan. 1, 2010.) Half of people don't think that they or someone in their family could afford treatment if needed.

There seem to be a few takeaways from this report (produced by Lake Research Partners) that are immediately helpful to advocates. Firstly, we need to shake off any lingering defensiveness when we're talking about the importance of ensuring access to treatment. The public, by large numbers, agrees that addiction is an important issue that needs to be addressed in our health care system.

Secondly, the public agrees that addiction can be treated and managed like other chronic health conditions such as diabetes. Despite any ongoing debates or uncertainty about the disease model of addiction, it doesn't matter to people when you're talking about how to make sure that people with addictions get the care they need to be well. If we adopt a problem-solving posture (there are 20 million people with untreated addiction; treatment works; how do we get those people the care they need?), we can avoid getting bogged down in complex questions about the causes of addiction where there is less public certitude.

Thirdly, it seems like education of the public (and, by extension, policymakers) is still a priority. Although this survey shows strong public support for treatment and closing the treatment gap, there remains a knowledge gap in some key areas. One very practical area, as mentioned before, is whether you have insurance coverage. With the parity law going into effect in 2010 and health reform in the news, early next year is looking to be the ideal time to do outreach to help people understand their rights to addiction services (unfortunately, it's difficult to do this in detail before we have parity regulations or a final health reform bill ... but it's something to prepare for now). I was also surprised that "only" 71% of people ranked addiction as a serious problem. That might be due to varying standards of "seriousness," but considering the staggering costs in lost productivity, criminal justice, social services, broken families, illness and early death, traffic accidents, etc., I can't help but think that that number would be higher if people had more information. A related area for education would be the cost savings and other benefits that would be expected from specific policy interventions.

In addition to commissioning this survey, the folks at Closing the Addiction Treatment Gap have also been working to make sure that this data is put to use in real health reform debates--among other things, they co-sponsored a very helpful briefing on behavioral health in health reform back in July ( video, PowerPoints, and resources here).

For an update on the status of addiction-related provisions of the health reform bills, please click here.