On October 22, the Centers for Disease Control and Prevention (CDC) and the University of California Berkeley (UC Berkeley) Center for Health and Public Policy Studies released a study examining Medicaid coverage of tobacco cessation treatment in 2009.  The study found that 47 Medicaid programs offered some form of cessation treatment, up from 12 programs in 2007.  However, of those 47 programs, only 8 covered all recommended medications and at least one form of therapy.  In addition, Connecticut, Georgia, Missouri, and Tennessee’s Medicaid programs offered no coverage for tobacco cessation.  The study found significant cessation coverage gaps, particularly as coverage restrictions on the quantity and types of counseling and medications. 

From the report:

Medicaid enrollees have nearly twice the smoking rates (37%) of the general adult population (21%), and smoking-related medical costs are responsible for 11% of Medicaid expenditures. In 2008, the Public Health Service released clinical practice guidelines recommending comprehensive coverage of effective tobacco-dependence medications and counseling by health insurers. Healthy People 2010 established a clear objective for Medicaid programs to cover all Food and Drug Administration--approved medications and counseling for tobacco cessation. To monitor progress toward that objective, the Center for Health and Public Policy Studies at the University of California, Berkeley, in collaboration with CDC, surveyed Medicaid programs in the 50 states and the District of Columbia (DC) to document their 2009 tobacco-dependence treatment coverage and found that 47 programs offered coverage. Only eight state programs offered coverage of all recommended pharmacotherapy and counseling for all Medicaid enrollees, and 16 programs reported coverage for fee-for-service enrollees that differed from that provided for Medicaid managed-care enrollees. Among the 33 programs that covered at least one combination therapy, the nicotine patch plus bupropion slow release (SR) was the one combination covered by all. The Affordable Care Act mandates Medicaid coverage of tobacco-dependence treatments (5) for pregnant women, beginning October 1, 2010. Coverage of pharmacotherapy for all Medicaid enrollees will be enhanced by January 2014, when states no longer may exclude tobacco-dependence cessation drugs from covered benefits. Monitoring the extent to which Medicaid programs place limitations on these treatments can help in evaluating accessibility of tobacco-dependence treatments to Medicaid enrollees.

Full Report: State Medicaid Coverage for Tobacco-Dependence Treatments

Centers for Disease Control and Prevention. (2010). State Medicaid coverage for tobacco-dependence treatments.

The Open Society Foundations (OSF) released a brief offering recommendations for closing the addiction treatment gap.  Examining national data on addiction and addiction treatment, the brief outlines the current gap in treatment services and issues recommendations for closing the gap. 

From the report:An estimated 23.5 million Americans are currently addicted to alcohol and/or other drugs and need treatment and other supportive services. Unfortunately, only one in 10 of them (2.6 million) receives the treatment they need. The result: a treatment gap of more than 20 million Americans. Lack of insurance, inadequate insurance coverage and insufficient public funds are the primary reasons for this treatment gap.

Full Report: Defining The Addiction Treatment Gap (PDF | 1.06 MB)  

Open Society Foundation. (2010). Defining the addiction treatment gap.

SAMHSA's Office of Applied Studies uses the Drug and Alcohol Services Information System (DASIS) to conduct the National Survey on Drug Use and Health (NSDUH) Report. The report is the primary source of information on the prevalence, patterns, and consequences of drug and alcohol use and abuse in the general U.S. civilian non institutionalized population, age 12 and older.

From the report:

More than 18.4 million full-time employees aged 18 to 64 (15.5 percent of the full-time adult workers in that age range) had no health insurance coverage and represented the majority (54.5 percent) of adults under age 65 without health insurance coverage. An estimated 3.0 million uninsured full-time workers (16.3 percent) needed substance use treatment in the past year; specifically, 13.3 percent needed alcohol use treatment, 5.6 percent needed illicit drug use treatment, and 2.7 percent needed both alcohol and illicit drug use treatment. Of the uninsured workers who needed substance use treatment in the past year, 12.6 percent (378,000 persons) received treatment at a specialty facility.

Full report: http://www.oas.samhsa.gov/2k10/177/UninsuredWorkers.cfm

U.S. Dept. of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2010). The NSDUH report: Substance use treatment need among uninsured workers.

The Campaign for Tobacco Free Kids (CTFK) study found that states could generate $9 billion by increasing cigarette taxes by $1 per pack.  The study also estimates that decreased cigarette use associated with the tax would save $52.8 billion in health care costs.  Along with the study, CTFK released a poll finding that 67 percent of Americans would support a $1 dollar per pack state tobacco tax increase.  The report also provides state-level data on the effects of the tax increase.

From the report:

• A Budget WIN: Even while reducing tobacco use, higher tobacco taxes have proven to be a reliable and predictable source of significant and immediate new revenue for the states. The declines in tobacco use will also produce considerable health care savings. 
• A Health WIN: Increasing tobacco prices by raising tobacco taxes is one of the most effective ways to reduce tobacco use, especially among youth. States can achieve even larger public health benefits if they use some of their new tobacco tax revenue to fund tobacco prevention and cessation programs.
• A Political WIN: As underscored by a new poll being released as part of this report, large majorities of voters of all political persuasions and demographic groups support increasing tobacco taxes. In contrast, majorities of voters oppose other options for balancing budgets, such as increasing other taxes or cutting important programs.

Full text:   Tobacco Taxes: A Win-Win-Win for Cash-Strapped States (PDF | 994.61 KB)

Campaign for Tobacco Free Kids. (2010). Tobacco taxes: a win-win-win for cash-strapped states.

This study found that the Communities That Care (CTC) prevention program significantly reduced alcohol and tobacco use as well as delinquent behavior. 

Hawkins, J.D., Oesterle, S., Brown, E. C. et al. (2009). Results of a type 2 translational research trial to prevent adolescent drug use and delinquency. Archives of Pediatrics and Adolescent Medicine, 163(9): 789-798. http://archpedi.ama-assn.org/cgi/content/abstract/163/9/789 

Authors: J. David Hawkins, Sabrina Oesterle, Eric C. Brown, Michael W. Arthur, Robert D. Abbott, Abigail A. Fagan, Richard F. Catalano

These research roadmaps, recently released by the Substance Abuse Policy Research Program (SAPRP), attempt to identify effective policies and highlight the major tobacco, drug and alcohol abuse treatment questions that must be explored during the next five years.

From the report:

Some of the most vexing issues surround the need to maintain patient confidentiality in the context of more efficient information systems that rely on electronic record systems and other health information technologies. Federal regulations (CFR 42 Part 2; Code of Federal Regulations for the confidentiality of alcohol and drug abuse patient records), authorized and implemented in the 1970s, counteracted the stigma associated with addiction treatment and protected women and men seeking recovery from unnecessary disclosure of their treatment participation. The confidentiality regulations facilitated widespread patient acceptance of the safety of addiction treatment. In the 21st century health care system, however, the regulations appear to pose a barrier to integrated electronic health records. Confidentiality regulations inhibit communication and coordinated/integrated care between addiction treatment services and health care services. Inclusion of addiction diagnoses and treatment in electronic health records may expose the medical record to the federal confidentiality regulations and inhibit sharing of medical information. This risk is inhibiting structural changes in the organization and delivery of care. Legal analysis and policy assessments are needed to prepare addiction treatment services for better integration with health care.

Full report: Substance Abuse Policy Research Program Releases Five-Year Research Roadmap (PDF | 206.44 KB)

Robert Wood Johnson Foundation (2009). Policies for the treatment of alcohol and drug use disorders: A research agenda for 2010-1015. Mccarty, D., Mcconnell, K.J., and Schmidt, L.