Helen Dermatis

The impact of managed care on substance abuse treatment: a report of the American Society of Addiction Medicine.

Abstract This report examines the impact of managed care (MC) and related developments on substance abuse treatment, and evaluates how it has been associated with a decline in the availability of proper treatment for many addicted patients. A trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abuse insurance coverage has declined by 75% between 1988 and 1998 for employees of mid-to large-size companies, compared with only an 11.5% decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in frequency and duration of inpatient hospitalization, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians treating addiction, the majority felt that MC had a negative impact on detoxification and rehabilitation, and on their ethical practice of addiction medicine.

Spirituality-Based Recovery From Drug Addiction in the Twelve-Step Fellowship of Narcotics Anonymous

Background:Narcotics Anonymous is a worldwide fellowship that employs the Twelve-Step model for members dependent on drugs of abuse. The spiritual orientation of its program of abstinence has not been subjected to empirical study. Methods:Responses of 527 American Narcotics Anonymous meeting attendees to a structured questionnaire were evaluated for the roles of cognitive and psychosocial aspects of spirituality in their recovery. Results:Respondents had last used drugs or alcohol on average 6.1 years previously. They were found to be more oriented toward a spiritual than a formally religious orientation than probability samples of the general population. Aspects of membership such as affiliation toward other members and the experience of spiritual awakening were associated with lower rates of drug or alcohol craving, whereas scores on depression were associated with higher craving scores. Conclusions:Spiritual renewal combined with an abstinence-oriented regimen in Narcotics Anonymous social context can play a role in long-term recovery from drug addiction.