Addiction Medicine: Closing the Gap between Science and Practice

Other State &

Local

45.3%

($10.1B)

Medicaid

26.3% ($5.9B)

Other Federal

19.9% ($4.4B)

Medicare

8.5% ($1.9B)

Figure 7.E

Components of Public Addiction

Treatment Spending (Total $22.2B)

Source: CASA Columbia analysis of the National Expenditures

for Mental Health Services & Substance Abuse Treatment 1986-

2005. (2012).

Trends in Spending on Addiction Treatment .............................................................

Between 1986 and 2010, direct spending on
addiction treatment increased from $9.1 billion
to an estimated $28.0 billion. In constant
dollars, direct spending on addiction treatment
nearly doubled during this period, while the
portion of direct addiction treatment paid by
private sources fell from 39.8 percent to 20.8
percent and the portion paid by public sources
rose from 60.2 percent to 79.2 percent. While
there also was a shift from private to public
payment of medical care expenditures during
this period, the shift was far less pronounced;
private source payment of medical expenditures
dropped from 61.2 percent in 1986 to 55.7
percent in 2005 while public source payment
rose from 38.8 percent to 44.3 percent.^55

Expenditures by Providers and Types of Services .....................................................

Most expenditures for addiction

treatment are to non-hospital based

providers offering outpatient services.

Providers. Treatment providers

whose primary role is addiction

treatment account for 61.7 percent

($17.3 billion) of the total spending on

addiction treatment ($28.0 billion).^57

These expenditures include:

 43.4 percent ($12.2 billion) by

specialty addiction treatment

centers;

(^)
 12.8 percent ($3.6 billion) by specialty units
in general hospitals; and
 5.5 percent ($1.5 billion) by specialty
hospitals.^58
The remaining expenditures (38.3 percent, $10.7
billion) are accounted for by facilities and
individuals that have another primary mission
but also provide addiction-related services,
including:
 8.8 percent ($2.5 billion) by specialty mental
health centers;
 7.9 percent ($2.2 billion) by health
professionals other than physicians such as
counselors, social workers and
psychologists;
 6.8 percent ($1.9 billion) by general hospital
non-specialty units such as detoxification,*
when a patient with addiction is admitted via
the emergency room;

• Not considered to be addiction treatment.
  I was not able to get help until I got myself into
  the criminal justice system and was then placed
  into treatment as a condition of parole. I tried
  many times to get help for my addiction but due
  to the lack of insurance and money, was
  denied.^56
  --Respondent to CASA Columbia’s
  Survey of Individuals in
  Long-Term Recovery