The end of 12-step programs? How Obamacare is changing rehab

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Photo: View of Cliffside Malibu, a private addiction center with a holistic approach.

In the last 75 years, American medicine’s approach to addiction has gone through an evolution. Once seen as a moral weakness, a crime and a behavioral problem, the experts were mostly former addicts turned self-help leaders. Professional associations in the medical field didn’t see a role for doctors. Now substance abuse is widely considered a medical disorder.

That change has been gradual, but it was cemented by the Affordable Care Act, or Obamacare. Before the law was implemented, an estimated one-third of Americans with private insurance did not have any coverage for substance abuse treatment.  Starting January 2014, health insurance companies and HMOs now have to cover treatment for addiction like any other disease.

This is driving the move away from 12-step programs, self-help and spiritual-based guidance. These approaches, once the standard, are losing favor to ones that emphasize science and medicine.

Experts in addiction say the future of rehab is landing more and more with interactions between patients and their primary care physicians, from the pediatricians office to the Emergency Room.

“We could put a “rehab” center on every corner in America and it would not treat this problem, whether it was an $80,000 a month program on the shores of Southern California. Or an inner city program in Detroit. Rehab programs won’t change this program. What will change it is the integration across health care of the knowledge this is an expensive in all ways, preventable and treatable illness.”– Kevin Kunz, Vice President at the American Board of Addiction Medicine

In some cases, doctors can now bill for the time they spend having conversations about drug and alcohol use or abuse. That conversation is getting more sophisticated.

We take a look at how private rehab centers like the Betty Ford Center are looking to open mid-priced outpatient clinics; and high-priced private rehab centers could lose business.


This report is part 2 of a project for the California Endowment Health Journalism Fellowship, a program of USC’s Annenberg School for Journalism and Communication. Read and listen to part 1 here:  Obamacare starts bringing relief to low-income drug addicts