The Public is Ahead of Politicians on Improving Addiction Health Care Services?

A recent alert from the CEnter for Substance Abuse Research presented a snippet of data from a survey on attitudes towards health care services for addiction. I tracked back to the original survey for some additional data and was pleasantly surprised to find majorities in favor of improving health care services for the drug addicted in the US.

Now, yes, before we get into this too much the data are from a poll of people’s attitudes. This is not about whether certain facts might be objectively verifiable, merely about people’s attitudes and beliefs regarding certain issues. The CESAR alert picked up on beliefs regarding the affordability of care for addictive disorders and divided the results by economic / income status.

http://www.cesar.umd.edu/cesar/cesarfax/vol18/18-27.pdf

My first question, of course, was whether the survey provided any sort of cost estimate so that people would have a bench mark cost of care against which to estimate affordability.
It turns out that the data are derived from this Open Society Institute / Lake Research Partners survey (executive summary pdf). Unfortunately this summary did not seem to indicate that people were told anything about costs of care for substance dependence. I’d be hard pressed to estimate that myself even knowing the range of treatment situations from community based groups like Alcoholics Anonymous and similar, up through multi-week inpatient care.
Major findings of the poll are summarized as:

• Three-quarters of Americans (76%) know someone personally who has been addicted to alcohol or drugs. Personal experience with addiction spans all demographic groups.
• Half of Americans (49%) do not think they would be able to afford the costs of treatment if they or a family member needed it. This concern about affordability is highest among Americans with incomes under $50,000 (67% say they would not be able to afford treatment).
• Three-quarters (75%) of Americans are concerned that people who are addicted to alcohol or drugs may not be able to get treatment because they lack insurance coverage or cannot afford it.
• Nearly three-quarters (73%) support including alcohol and drug addiction treatment as part of national health care reform to make it more accessible and affordable. This support cuts across all demographic groups.

Things I thought were kind of interesting in the executive summary include:
-Across gender, education, income, etc groupings “No subgroup has less than 68% saying they know someone personally who has been addicted to alcohol or drugs.” That’s right? Even with understanding of what addiction really is being not so hot, people have a general concept. And even with the usual concealment factors (so-called functional addicts are very good at hiding the extent of their use) a lot of people know at least one person who appears to them to be addicted.
-“Nearly three‐quarters of survey respondents (73%) support including addiction treatment as part of national health care reform to make it more affordable once they learn that only 1 in 10 who need treatment get these services. ….Roughly two‐thirds of every demographic subgroup supports its inclusion in health care reform.” The emphasis added part makes me think. The framing points out that perhaps most people do not have a good appreciation of the scope of those that need treatment for substance dependence. And perhaps not a good notion of those who actually receive some sort of treatment either. Making the un-treated fraction better known is a good strategy to enlist support for improving health care for addicts. Or so I infer.
-About 68% support increased state and federal funding to improve access to care. This is really surprising to me given how pathetic our care system is when it comes to the addictive disorders. And given a gut / popular culture based suspicion that disdain for addicts’ moral failings is still a palpable and motivating concept. Perhaps I am out of step and the general population really has come to understand addiction is a medical problem?
-You may draw your own conclusions about the ~25% core which opposes any improvement in health care services for addictive disorders but this last bit probably gives a clue “When it comes to veterans and military returning from active duty, more than nine in ten Americans (96%) support providing specialized prevention, treatment, and recovery services for those addicted to alcohol or drugs. (See Figure 5) Only two percent of survey respondents oppose this idea..“. There are only two possible interpretations of this. Either those opposed to care for addiction in the general population are just knee jerkily in favor of any crazy old thing that looks like it supports the troops….or they recognize that addictions are 1) serious health problems that are 2) deserving of care but 3) just don’t want to pay for it in the general public. This is very encouraging, not to mention instructive in the best way to make the case to such voters.