In Washington D.C. and across the country, we are seeing polarized responses to people struggling with addiction. Striking examples of this appeared in two New York Times stories last week.
One article described how addiction treatment has become an issue in the controversy surrounding the healthcare bill drafted by Senate Republicans. In what could be called the battle between the protectors and the neglecters, senators from states hit hard by the opioid epidemic are objecting to proposed Medicaid cutbacks that would jeopardize access to treatment. I have not yet heard the arguments in favor of treatment reduction. But the fact that addiction treatment is emerging from the shadows and becoming a driving issue in a larger national debate about healthcare is new and encouraging.
A second article described developments in the addiction recovery community in Delray Beach, Florida, one of the largest such communities in the country. The town has, for many years, provided a haven for people with substance use disorders who need a permanent change in their environment to move into recovery. It’s no surprise that drug dealers would be drawn there in hopes of luring people back into active addiction. The Times reported that sober homes, also known as halfway houses, often commit insurance fraud by filing outrageously large claims for things like urine tests. And some sober homes are so unsupervised that residents are getting high on heroin where they live and frequently overdosing. In Delray, overdoses have edged out car crashes as the most common medical emergency.
But a colleague of mine who knows Delray well says many of the inpatient treatment centers do excellent work. Once a recovering addict leaves the center and moves into a halfway house, supervision is uneven. The halfway houses my colleague knew were strict and insisted the residents remain sober and attend frequent AA meetings. Unfortunately, relapse in addicts recovering from heroin addiction are frequent but not necessarily the fault of a halfway house.
The disheartening part of the story, though, is how patients’ treatment needs can be seen as opportunities for exploitation by unscrupulous owners of sober houses and low-quality treatment programs that take advantage of Florida’s loose regulations. The Florida story provides a cautionary tale, particularly when there is so much interest among private investors in addiction treatment centers. One of the best ways to take the measure of a society is to examine how vulnerable individuals are treated. These articles dramatize how this situation can bring out the best in us or the worst.