1. Addressing Addiction and Substance Use in National Health Reform Eric Goplerud, Ph.D. Alliance for Health Care Reform July 17, 2009 Center for Integrated Behavioral Health Policy Department of Health Policy, The George Washington University Medical Center

4. Identification Rates for Substance Use Disorders and Other Common Health Conditions Alcohol and drug use disorders 7% to 18% Depression45% Diabetes65% Hypertension70% What percentage of affected individuals are identified?

5. Substance Use Screening and Treatment is grounded in good science THE NATIONAL QUALITY FORUM September 2007 Consensus Standards for Substance Use Treatment

6. Modality Savings per Medicaid member per month in Washington State Inpatient $170 Outpatient $215 Methadone $230 Substance Use Treatment Reduces Medicaid Costs Wickizer, T.M., A. Krupski, et al. (2006). The effect of substance abuse treatment on Medicaid expenditures among GA clients in WA State. Milbank Quarterly, 84(3): 555-76.

7. Substance Use Treatment Reduces Employer and Employee Health Care Costs Parthasarathy, Weisner, Hu and Moore. Association of Outpatient Alcohol and Drug Treatment with Health Care utilization and cost: Revisiting the Offset Hypothesis. Journal of Studies on Alcohol. (2002): 89-97.

8. Fleming, Mundt, French, Manwell, Stauffacher, and Barry. Brief Physician Advice for Problem Drinkers: Long-Term Efficacy and Benefit-Cost Analysis. Alcoholism: Clinical and Experimental Research. (2002): 36-43.

9. Cost Effectiveness of Alcohol Screening and Brief Intervention Estimated net health savings of $254 per person offered screening $1,755 per Quality Adjusted Life Year (QALY) saved in health care costs In top 4 most cost-effective US Preventive Service Task Force recommendations –Discuss daily aspirin use: men 40+, women 50+ –Childhood immunizations –Smoking cessation advice and help to quit – adults –Alcohol screening and brief counseling – adults Solberg LI, et al. Primary care intervention to reduce alcohol misuse: ranking its health impact and cost-effectiveness. Am J Prev Med. 2008;34(2)

10. Addiction and National Health Reform: Application to the Tri-Committee and HELP bills Benefit Design – + Parity: Equitable and full coverage for treatment of substance use disorders + Universal coverage: Persons with MI and SA twice as likely to be uninsured, so extension of coverage to individual and small group markets is essential + Medication assisted treatment: Inclusion in drug discount program (340b) - Addiction recovery supports: Not specifically included in patient centered medical home

11. Addiction and National Health Reform: Application to the Tri-Committee and HELP bills Prevention – - No explicit inclusion of substance use prevention and mental health promotion to wellness and prevention. - No explicit inclusion of substance use prevention, screening or treatment in school-based health programs Workforce Infrastructure – - No explicit inclusion of addictions professionals in health care workforce programs. - No explicit inclusion of substance use in training of primary care workforce.

12. Eric Goplerud, Ph.D. Director 2021 K St. NW, Suite 800 Washington, DC goplerud@gwu.edu integratedbehavioralhealth.org Center for Integrated Behavioral Health Policy Department of Health Policy, The George Washington University Medical Center