by Andrew Walsh

A few months ago I was invited to speak to a class of students at Rutgers in the addiction certificate training (ACT) program at the Graduate School of Social Work. I shared my experiences from graduate school and working in the field of substance abuse. While I was with the students, I was prompted to share some of the writing and undercover work I have done in the field of substance abuse treatment.

For a year and a half, I did full-time work and full-time graduate school. While my schedule was hectic, I was able to compare what I was learning in the classroom with what I was experiencing in the field. I was horrified.

Under the guidance of Professor Greenagel, I set out to start documenting and writing about the ever widening gap between best practices and what was actually occurring in the substance abuse field. One of the first subjects I tackled was addiction hotlines. My previous piece on addiction hotlines can be accessed here.

I found that the majority of the hotlines ranged from negligent at best to operating illegally. One of the main takeaways from my undercover work with the addiction hotlines was the lack of consideration that people with Medicare, Medicaid, or no insurance received. When I posed as a 27 year old with insurance seeking substance abuse treatment I could not get my phone to stop ringing. However, when I posed as a 26 year old with seeking substance abuse treatment with Medicaid, I could not get a phone call to last more than three minutes.

I was thoroughly convinced that the horrors of the substance abuse field would cause some of the students to reconsider their career paths.  A few months passed and unexpectedly one of the students from the class contacted me. She posed a simple question that stopped me in my tracks. She asked

With state treatment facilities in a state of stagnation due to lack of beds for Medicaid, Medicare, and the indignant, how can private centers work to meet this need for people with Medicaid, Medicare, or no insurance?

I recognized that I left my previous work half-complete. I did a mournful job of illustrating and summarizing the problem but I did not provide any solutions.

I set out to remedy the situation and decided that I first needed to quantify the demand for substance abuse treatment among Medicaid recipients, Medicare recipients, and those with no insurance. After quantifying the demand, I then sought out to quantify the services available; i.e. where can these people go to get help. My work on the Medicare population can be seen here and the piece on the Medicaid population can be accessed here. The main takeaway was that the demand for substance abuse services for these populations far exceeds the supply.

I spent one year working in the call center of a psychiatric hospital. Working as an addictions triage specialist, I took anywhere from 50-100 calls a day from potential clients or their family members looking for substance abuse services. I was fortunate that Medicare was accepted for treatment at that psychiatric hospital. However, I still received dozens of daily calls for patients with Medicaid or no insurance seeking services. After I did some research, I began to end those conversations by saying, “We can’t provide services to you here but if you get a pen and paper I am happy to give you the name of the facilities that can and their phone numbers.”

Inevitably, the callers would express sincere gratitude with some variation of: “Thank you so much. I have been calling around everywhere but I couldn’t figure out who could help me.”

I hold advanced degrees, have a few years of direct practice experience with substance abusers, and am familiar with the majority of substance abuse providers in the tri-state area. All of my experience and research has made it possible for me to know which facilities accept Medicaid, Medicare, and those with no insurance.

When I reflect back on my work, education and directed research, I come to two clear conclusions:

1. The demand far exceeds the supply of services for Medicaid, Medicare, and those with no insurance
2. Services exist but substance abusers and their families get worn down trying to find the programs that will accept them

I am a social worker, which means I am an idealist. But I am also a pragmatist. Ideally, I would like to see an expansion of offerings for the Medicare, Medicaid and uninsured populations. Pragmatically, I know this will take a long time. Additionally, it is unrealistic to hold private facilities responsible for expanding services to those populations.

That written, I believe private treatment providers can help clients access the services that do exist. The best practice would be for these private entities to call the appropriate facilities with the client and do a warm hand-off to the appropriate party. Pragmatically I realize that this causes a significant burden on the private entities and will be met with significant opposition. The practice that will encounter the least resistance from the private treatment providers but still produce a significant effect is providing the clients they cannot treat with the names of the facilities that can help them. As my previous work has shown, these lists are relatively small and should not take more than two minutes to share with these clients.

While I am troubled by the fact that there are waiting lists for Medicaid, Medicare and those with no insurance, I am horrified that people cannot even find these facilities to get on the waiting list. Private treatment provider hotlines are often the first point of contact for many substance misusers and their families. Even if they cannot provide services directly to these clients, ethically they should refer the clients to the facilities that can provide the services. With people dying because they can’t even get on the waitlist to keep the flame of hope alive, treatment providers that fail to refer clients are in essence saying a life may be worth less than two minutes.

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Andrew Walsh a Master’s Degree in Social Work and a Master’s Degree in Human Resource Management from Rutgers. Prior to working in the behavioral health field, Andrew worked in the Gulf of Mexico oilfield as an internal business consultant focused on innovation and improving the efficiency of people, processes, and procedures. He eventually decided to return to NJ to practice innovation in the behavioral health field. In his free time, Andrew enjoys hiking, cooking, and reading.