1. Addiction Treatment in Healthcare Reform Tom McLellan, Jan 21, 2010

2. Substance Abuse Specialty Treatment ~ 2,300,000 Abuse/Dependent – 25,000,000 “Harmful Users” – ??,000,000 Little or No Use

3. ~ 12,000 specialty programs in US 77% government funded Primarily Block Grant - $2B Private insurance <12% No parity – Many inequities

4. ~ 12,000 specialty programs in US + 8,000 FQHCs ( 27 million patients ) Block Grant + Medicaid ($70 B) ~ 60% of those not covered 100% Federal – No State Match Parity Requires = Coverage

5. 1. National Prevention System 2. Engage Primary Care 3. Treat Addiction as a Disease 4. Emphasis on Offenders 5. Performance Monitoring

6. Evidence Based Interventions Delivered Within Communities Investment in Infrastructure

7. Intervention

8. A Continuing Care Model Primary Continuing Care Primary Care Specialty Care

9. Continuing Care In Addiction Recovery Support Services Primary Care Specialty Care Screen Intervene Monitor Refer Re-Intervene Monitor/Support Stabilize Motivate/Medicate Train Self-Mgmnt Refer

10. 4. Expand SBIRT Code and Financing 5. Train/Motivate Generalist Physicians 6. Coordinate & Expand Prescription Drug Monitoring Programs

11. Treatment

12. 7.Integrate Addiction Treatment into Federal Healthcare Systems 8. Performance Contracting in State Treatment Systems 9. Consumer Choice Through Vouchers for Recovery Services

13. Recovery “A voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship” J. Substance Abuse Trt, 2008

14. Community Corrections

15. Pre-Arrest Pre-Trial Prosecution Sentencing In Jail/Prison Re-Entry ~5 Million Offenders In Community 700,000 /yr Released

16. 10. Drug Treatment Alternatives to Prison Continued Emphasis on Drug Courts 11. Offender Re-Entry Programs 12. Screening and Brief Treatments of Juvenile Offenders with MH and SA Problems

17. 1. National Prevention System 2. Engage Primary Care 3. Close the Addiction Tx Gap 4. Special Care for Offenders 5. Improved Data Systems