Hey Obamacare! Alcoholism Isn’t Diabetes!
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Hey Obamacare! Alcoholism Isn’t Diabetes!


Addicts nationwide may find themselves saying “Thanks, Obama” without the meme-grade sarcasm. Under the Affordable Care Act (now better known as “Obamacare” by fans and detractors alike), insurance providers are now required to provide coverage for substance abuse treatment on par with what they offer for medical treatments. And that’s in addition to two other ACA provisions: the expansion of Medicaid, which is a huge boon to the many addicts living in poverty, and the elimination of preexisting conditions as a barrier to getting coverage. About time, right?

Addiction is Covered

The new law has been lauded by addiction experts in the medical arena. “It will integrate substance abuse treatment into the rest of health care,” said Dr. A. Thomas McLellan of the Treatment Research Institute. “If diabetes were treated like substance abuse, only people in the most advanced stages of illness would be covered, such as those who had already lost their vision or had severe kidney damage.”

There’s no question this is a huge step forward when it comes to accessing treatment. I remember wrestling with pre-Obamacare health plans in the bad old days, consistently getting rejected due to my preexisting condition of being a miserable fuckup, and having to settle for a plan that excluded any mental health benefits whatsoever. Nobody else will have to go through that ringer again.

The Downside

On the other hand, there are still some potential pitfalls on the horizon. For one, there are no specifics about what treatment addicts are entitled to. Health care providers, stripped of the power to deny people coverage, have been cutting corners wherever possible since Obamacare went into effect. Not to play the Evil Greedy Corporation card here, but there’s reason to believe at least some insurance companies might provide only the bare minimum they can get away with and still call “parity.” Could it mean covering 30 days in a D-list treatment center and then sending addicts back into the world to fend for themselves? Or worse, would certain plans only cover a prescription for a “miracle drug” rather than more comprehensive treatment?

Many doctors are enthusiastic that the new laws will improve access to drugs like naltrexone and acamprosate (aka Campral), which can help alleviate cravings for opioids and alcohol. A new study showed that both oral naltrexone and acamprosate are measurably effective in helping prevent relapse. The study also found these medications were underprescribed, perhaps because doctors mistakenly think they have the same negative side effects as older medications like Antabuse (disulfiram). However, while these drugs do help some people stay abstinent, no medication is a magic bullet. To truly believe one pill can cure addiction takes the disease model a little too far.

Still a Different Type of Diagnosis

The truth is that addiction and alcoholism are not exactly like diabetes. In order for the ACA’s expanded coverage to be truly effective, insurers must cover a whole range of treatment options—not only medications and detox, but extended aftercare programs and psychological counseling. Valuing substance abuse treatment on the same plane as medical treatments is a great start for our healthcare system, but we shouldn’t make the mistake of conflating the two entirely.

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About Author

Erica Larsen AKA Eren Harris blogs at Whitney Calls and Clean Bright Day. Their writing has also been published on Salon, Selfish, Violet Rising and YourTango. They live in Los Angeles with their husband and their enormous cat.