I found some interesting info in the National Survey on Drug Use and Health (NSDUH) reports today, and made a table with it. It lists the 4 major types of treatment, and the percentage of their revenue which comes from public sources.
On average, these facilities are collecting 69.5% of their revenue from some form of government (source). Another NSDUH report shows us what sources individuals are using to pay for treatment.
Many people are using 2 or more sources, like a combination of private payment and insurance, or insurance and medicaid. If you look at the third column in the table above you’ll see that with the combined sources of Medicare, Medicaid, Public Assistance Programs, and Court funding – 51.7% of people have used public funds to pay for their most recent trip to the treatment center (source). So we have 2 important facts here:
- More than half of people who get treatment (51.7%) are using public funds to pay for it.
- With the average treatment program getting 69.5% of it’s revenue from public sources, government is definitely paying the lion’s share of dollars spent on these horrible programs.
These facts then lead us to a conclusion: Treatment for addiction does not exist within a free market. There is no way to call a market in which half of the consumers are being directly funded by the government to purchase a specific service (conventional disease model addiction treatment with 12-step components), and nearly 3/4 of revenues in said market are flowing from government sources. There is simply no way that we could consider help for addiction as existing within a free market. I bring this up, not to push my own libertarian agenda, but to push my addiction agenda. There are some wonderful people out there with real solutions to substance use problems, and I believe their methods would spread quickly in a competitive market – unfortunately though, the ineffective conventional methods of treating substance use problems are propped up by government funding. Without this funding, they would be forced to change their methods and offer a service that was worth the money, but they are insulated from this competitive force by government. Imagine laying out 20 grand for a treatment program in which your loved one came back worse than before they started it – you’d be pissed, you’d want answers, you might demand a refund, and you would definitely be less likely to try the same type of program again. But if the public is footing the bill, you won’t take it as seriously. Now imagine that there are tens of millions of people like you, all laying out their own money for a treatment program. This would have a big effect on the industry, they would either change their ways, or lose customers and go out of business.
I can’t tell you how many times I’ve been called on by friends and family members to talk to someone’s parents about sending them to the program I went through – and I can’t tell you how often people choose a conventional treatment program because the state or their insurance company will pay for it. The program I recommend doesn’t get this type of funding, because they’ve opted to take a different non-medical approach – and it pains me to see people choose a program that will do them harm just because they don’t have to pay out of pocket for it (some follow my recommendation, and I’ve been thanked and praised often for the advice). The saddest part is that the state or insurance funded program will probably cost them more in the long run – in the way of a constant struggle of being “in recovery”, time, relationships, and other resources lost to protracted episodes of substance abuse, and repeated trips to a string of further treatment programs. It’s not that I want people to go broke paying for help, it’s that I want them to get real help, and as long as government is this heavily involved in “treatment”, they’ll only find disappointment where they’re currently seeking help.
There is no free market for addiction treatment, and the source of the dollars spent on it is enough evidence of that – but this is all without mentioning the influence and money the government wields through agencies such as SAMHSA, NIAAA, NIDA, CDC, and countless state regulatory agencies to propagate the idea that addiction is a brain disease which robs people of their free will and thus the ability to choose to stop. Is there anyone else out there in the marketplace of ideas with even half as much influence and money who is using it to challenge these deeply entrenched myths our government is spreading? There are none that I know of.
Through these agencies (especially the NIDA), the government has spent billions of dollars on outreach and PR to convince the american public that addiction is a disease which requires a certain type of medical treatment. They run “public service” ad campaigns, print leaflets and distribute them to medical health providers, make news through press releases and congressional testimony, send representatives to spread the message through television shows and press interviews, and sponsor countless websites to disseminate the disease view. Now imagine that you are a business with the goal of helping people with substance use problems – essentially 100% of your potential customers have been taught by the government that addiction is a disease which requires a particular type of treatment. Moreover, 51.7% of your potential customers will be funded by the government to purchase help which corresponds with this view. Another 25.9% of your customers have insurance plans which state governments have mandated to pay for addiction treatment which falls in line with this view. Essentially, if you don’t follow the disease model favored by the government, you are turning down at least 69.5% of the revenue you could be taking in. Now, does it make any sense to go into the business of helping substance abusers offering a service which doesn’t follow the disease/medical treatment view of addiction?
NOTE: I want to clarify that the point of this post is not to complain that some people are getting free treatment provided by the government, or that some are being partially subsidized by the government, or to put down anyone who accepts such public assistance. My complaint is not about some sort of unfairness of some people having to pay for treatment while others get it for free. I have no personal disapproval for anyone who accepts this assistance. If the government is providing it, and thus it is basically costing all of us (in one way or another) then from a financial perspective at least, it is rational to take advantage of it (although, it’s irrational to attend these programs since they simply don’t work!). My points are as follows:
- The government is subsidizing and rewarding failure on the part of treatment providers.
- The government is promoting a model of addiction & recovery which was politically chosen rather than rationally/scientifically chosen. This hurts people by dictating the model a treatment program will use, and through PR efforts that spread the disease model, it hurts people who haven’t even been to treatment yet by convincing them of the faulty disease model.
- If we didn’t have this situation, the market would be more competitive and the most effective methods of helping people with substance use problems would more likely rise to the top to become the new norm.