Research presented by Dr. Nora Volkow, Director of the National Institute on Drug Abuse, at NatCon used brain imaging to dramatically illustrate how addiction changes brain function. Dr. Volkow’s research demonstrates, for example, that the frontal cortex – or reward center – of the brain weakens as a result of alcohol and illicit drug use. Because the tissue no longer functions in the same way, addiction must be considered a disease of the brain, just as heart disease is a disease of the heart.
She also notes that this part of the brain does not fully develop until at least age 22. Thus the lasting impact of drug use in adolescence is significantly greater than in those who start using as an adult. During her presentation, Dr. Volkow added that, in much the same way that people can learn new languages easier when they are younger, the memory of drug experimentation lasts much longer when the individual starts using at a younger age. Drug and alcohol use literally changes the brain, and those changes are amplified when the brain is still developing.
Dr. Volkow’s research presents a number of implications for substance use treatment, policy, and our approach to pain management on a larger scale:
Given the heightened impact of drug use in adolescents, prevention must start at an early age. As an added benefit to early prevention, research has shown that effectively preventing substance use disorder also mitigates development of mental health issues later in life.1
Because addiction is a disease of the brain, it should be treated as a chronic disease requiring continued care. Dr. Volkow noted that sustained abstinence from drug use does allow the brain to restore functionality; however, this process is slow, with results improving year over year. Detoxification and twenty-eight day programs, when used on their own, show high relapse rates in part because they attempt to treat addiction as an acute diagnosis without a long term system of support.
Prevalence of all psychiatric categories is elevated in adults with type 2 diabetes, and substance abuse diagnoses more than double among individuals within this population.2 The frequency with which co-morbidities are observed obviates the need for an integrated and appropriately managed screening and treatment protocol.
Recognizing how often prescription opioids for pain management can lead to addiction, a significant level of research is currently focused on developing less addictive analgesics and alternative therapies for managing pain. Abbott Northwestern Hospital of Minneapolis recently reported success in using acupuncture as an alternative to opioid treatment within their ED.3 Given the current national focus on opioid addiction, we can expect to see more developments in this area in the near future.
The Mental Health Parity and Addiction Equity Act significantly advanced treatment coverage for the 21.5 million Americans living with a substance use disorder. As researchers like Dr. Volkow continue to expand our understanding of addiction, treatment protocols, reimbursement policies, and prevention programs must also evolve – seeking improved outcomes for existing patients while reducing prevalence in future generations.
Mr. Waldinger, an Associate Manager at PCG, is an experienced Medicaid policy and reimbursement professional who focuses on healthcare operations, mental health and substance abuse policy and integration, and health care reform and its impact on Medicaid programs and providers.
As the former Chief Financial Officer and Budget Director for the Massachusetts Medicaid Program, MassHealth, and CFO for the Massachusetts Behavioral Health Partnership (MBHP), Mr. Waldinger was responsible for understanding the fiscal impacts of all programmatic and policy changes, including the building, updating, and tracking of all provider reimbursement calculations, policies, and impacts. At MassHealth, Mr. Waldinger led all financial efforts related to multiple successful State Plan Amendments (SPAs) and 1115 Waiver submissions, including Massachusetts’ landmark health care reform waiver in 2005-6. At MBHP, Mr. Waldinger led efforts to implement a sophisticated inpatient psych hospital pay-for-performance initiative.
Mr. Waldinger’s current role at PCG includes heavy involvement in claims processing and Medicaid reimbursement policy transformation. His experience speaks to multiple behavioral health engagements, from provider strategic planning, to statewide behavioral health services assessments, to the development of reimbursement methodologies that incentivize integration of community-based services. Mr. Waldinger’s in-depth understanding of provider costs, cost reporting, cost modeling, and cost settlement experience, provides clients with a unique understanding of the behavioral health system and potential impacts of policy changes.
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