Parity is the idea that insurance coverage for mental health and substance abuse should be at the same level as insurance coverage for other medical illnesses. The present situation is one in which these areas are either not covered or covered with arbitrary or ridiculously low limits. The result is a catastrophic level of confusion causing untold damage to individuals, working people, and their families.

There are several analogies that can be made to the current situation. What if you could only have treatment for one heart attack per year or per lifetime? Or, what if you only had $2,000 per year to pay for care for heart attacks and no coverage for high cholesterol? Or, if you could only have outpatient heart care, or only inpatient heart care? What if your insurance only paid for those visits for chest pain that resulted in heart attacks and not for those that were not life threatening?

The origin of our current system has roots in a very insidious and difficult-to-dislodge "Moral Model" of addiction and mental health. This insidious "Moral Model" is the idea that a person with an addictive disorder can and should "cut it out" and "get with it" so that they can resume or accept society's values and discard the values of an addictive lifestyle. The unstated principle is that addicted people are not good people with a bad disease, but bad people who have decided to continue to drink and/or drug.

A glaring example of the "Moral Model" in action is the existence of publicly supported clinics in each Parish to provide treatment for patients with addiction and/or psychiatric illness. Do we have freestanding, separate, publicly supported clinics to provide care for diabetes? For high blood pressure? Of course not! But, it is scientifically factual that these disorders are at least as self-induced as addiction, depression, or bipolar disorder. Furthermore, the legislature sets aside inadequate sums to fund these clinics, which then, of necessity, and extending the "Moral Model," require that patients "prove" their commitment to recovery before they can be helped to have it. Do you have to stop eating cookies before you can have treatment for diabetes? Do you have to stop eating salt before you can get treatment for high blood pressure? Of course not! And, if you eat a cookie or have some salt and your disease escapes control, are you banned from treatment? Of course not! But when the treatment of addiction occurs in the public sector, the patient has to stop being in denial before he/she knows what that is, and become compliant before he/she knows that compliance is necessary to recovery.

The existence of the public system as a primary modality of treatment in our society allows us to vicariously punish those of us with addiction by assuring that treatment will not be comfortable, and permits us to smugly have comfort that we are addressing the "problem." Our confusing and unreasonable health insurance and public treatment system deprives people of treatment until they are so broken that they can't easily be fixed. Then, we expect them to access an inadequately funded system, built on the Moral Model, and expect then them to embrace a lifestyle of disease maintenance and preventative care. This situation costs patients with addiction, and all of us, dearly.

As we know, there was a time when patients were hospitalized for months and even years for psychiatric illnesses, and patients with substance use disorders were "automatically" hospitalized for 28 days, and longer if they were difficult. These programs and this kind of treatment are, fortunately, a thing of the past. The kinds of expense involved with these kinds of treatments are behind us. Today we have criteria-based levels of care such that a course of treatment includes fewer inpatient days, if any.

What that means is that patients must meet recognizable criteria for severity of disease in order to be treated in the various levels of care. Professional treatment should always last a minimum of one year, including continuing care (aftercare), but the intensity of services does not have to be intrusive or expensive. For instance, a patient with a house, a spouse and a job will actually have a better outcome if they are treated in an outpatient setting while they continue to work. People with a greater degree of illness, however, require more intense treatment over a longer period of time. The Rand Report and other studies demonstrate that the combination of managed care and a full spectrum of services for addictive disease will result in a minimal immediate increase in insurance premiums and a probable reduction of costs after the benefits of treatment result in a reduction in other health care costs.

What are the benefits of Parity? They are HUGE! A great deal of our national budget is spent on drug control, police work related to substance abuse, and efforts at Demand Reduction at the federal level. However the greatest chance of reducing demand, and therefore reduce the supply, and also reducing the collateral damage of drug and alcohol use, will come when working people and their families have easy, early access to appropriate treatment for addiction. We could have a big tax cut if we didn't have to send helicopters to Colombia!

It is known that 25 percent of hospitalized patients meet the criteria for addictive disease. How much does a lifestyle of drinking and/or using contribute to the escalation in health care costs? If we include all of the illnesses caused by drinking and/or using and all of the injuries caused by drinking and/or using to the user and others, substance abuse is the third leading cause of premature death and disability in our country. If we include the damage caused by living with and loving someone with addictive disease, the incidence of damage increases.

It is also true that all treatment for addiction is values-based. While teaching the disease idea of addiction, treatment always teaches that dishonesty, theft, greed, hate, lust and anger are components of relapse. Professional treatment encourages a rejection of those values and an embrace of generosity, courage, fairness, industry, restraint, and wisdom. Would these attitudes go a long way toward solving the ills of our society? You bet they would! Since all good treatment includes family, these values will spread beyond the person in treatment.

Do I believe that Parity will solve all of the ills of our world? There is no one thing that will solve all of the ills of our world; however, Parity will help. Parity is simple and easy to do. Parity can be accomplished by a grass roots effort, aimed at legislators and officials, to voice the will of the people that we have it. Parity is a big deal.

Ken Roy, MD, FASAM, was certified by The American Society of Addiction Medicine in 1986, and worked to develop addiction treatment programs at several New Orleans area hospitals, an outpatient facility, and full spectrum private sector non-profit agency. He also maintains a private psychiatric practice, teaches medical students, and sits on the Board of Certification for Substance Abuse Counselors. His primary focus, however, is Addiction Recovery Resources of New Orleans, a non-profit agency that provides a full spectrum of services from ambulatory detoxification through intensive outpatient and residential dual diagnosis and addiction treatment.

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