The addict's stigma: Perception of weakness hampers treatment: Editorial

By Star-Ledger Editorial Board
on February 24, 2013 at 7:10 AM, updated February 25, 2013 at 11:54 AM

The first time a person sips a drink, takes a painkiller or shoots heroin, there'™s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it'™s weak willpower; medicine says addicts no longer have a choice.File photo

If you’re diabetic and binge on birthday cake, you can go to the emergency room for treatment — and health insurance will pay for it. You get the same medical care for your third heart attack that you did for the first two, again, with full coverage.
But the underlying attitude in the United States, clouded by social and legal stigma, is that addicts get one shot. Get clean, but fall off the wagon, and you’re on your own.
And, as The Star-Ledger’s Dan Goldberg reported in last Sunday’s editions, many families find convincing their health insurers to cover addiction treatment is a life-and-death struggle. Some commit fraud, lying their way into inpatient rehab programs.
Diseases afflicting the body — diabetes, heart disease, cancer — have clear paths for treatment, as recommended by your physician. Depending on your policy, doctors and insurers might quibble over details, but care is typically covered.
Addiction, on the other hand, is stigmatized as a personality weakness. Just as marijuana’s medicinal value was ignored because pot’s illegal, the perception of people addicted to drugs such as heroin is clouded by law, too.
The first time a person sips a drink, takes a painkiller or shoots heroin, there’s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it’s weak willpower; medicine says addicts no longer have a choice.

Insurers told The Star-Ledger cost-benefit calls are made on all medical treatments, including addiction. They might cover less expensive outpatient rehab, even when doctors recommend costlier inpatient stays. In that respect, critics say, addiction is treated differently, and parity laws are needed to ensure addiction has equal access to care.

If a diabetic misses an insulin shot, doctors restore the blood-sugar balance. If an addict slips, we call it relapse and say treatment didn't work.

The Affordable Care Act requires addiction and mental health parity, but it’s still part of the law’s interim rules, and advocates worry there’s too much wiggle room for insurers to deny coverage.
In New Jersey, where heroin addiction is rising at double-digit rates, parity laws have failed to advance in past legislative sessions, though a bill mandating parity in state employee health plans is moving through the Legislature.
Like diabetes, addiction is chronic, forcing patients to make lifestyle changes. When a diabetic misses an insulin shot, doctors try to restore the blood-sugar balance. When an addict slips, we call it a “relapse” and say treatment didn’t work. Both patients need — and deserve — lifetime care to maintain balance.
The “addicts brought this on themselves” argument can be made about overeaters who get diabetes or smokers who get lung cancer. Addictions deserve the same access to insurance coverage. It’s the right path, medically and morally.