Closing the Addiction Treatment Gap (CATG)
Closing the Addiction Treatment Gap (CATG) is an initiative aimed at enhancing access to quality substance use treatment and increasing public understanding of addiction as a chronic disease. Launched in 2008 by the Open Society Foundations, CATG focused on addressing the significant disparity between those who need treatment for substance abuse and those who actually receive it. In the U.S., millions struggle with addiction, yet only a small percentage access specialized care, largely due to stigma, misconceptions about addiction, and barriers to healthcare access, particularly among low-income populations.
CATG aimed to close this treatment gap through three main strategies: expanding insurance coverage for addiction treatment, increasing public funding for programs, and improving the quality and outreach of treatment services. By providing grants to various organizations, including hospitals and advocacy groups, CATG supported innovative practices that foster community-based addiction care. The initiative highlighted the cost-effectiveness of treatment, illustrating that investing in addiction services can reduce overall healthcare costs.
As societal understanding of addiction evolves, CATG's efforts have contributed to better integration of addiction care within healthcare systems and the reduction of stigma associated with substance use disorders. Future efforts continue to focus on policy development, improved treatment frameworks, and the successful reintegration of individuals recovering from addiction into society.
Closing the Addiction Treatment Gap (CATG)
DEFINITION: Closing the Addiction Treatment Gap, or CATG, was an initiative launched by the Open Society Institute (OSI), now the Open Society Foundations (OSF), to expand access to quality substance abuse treatment and to increase knowledge about addiction as a disease state. Under CATG sponsorship, millions of dollars were invested across the United States (US) in the development of state-based and local substance abuse treatment as a stimulus for the expansion of quality addiction care. CATG strived to increase awareness of the vast disparity between the number of people who abuse substances and the number who ultimately receive treatment for their addictions.
DATE: Established 2008
Background
Alcohol and drug abuse problems lead to over 107,000 deaths each year in the US. According to the National Institute on Drug Abuse in 2015, an estimated 22.7 million people in the US (8.6 percent of the population) needed treatment for alcohol or drug use in 2013. By 2022, this number had nearly doubled to 44.8 million Americans. Of these individuals, only 9.1 percent received treatment at a specialized facility, reflecting the substantial treatment gap in the US that continues to exist in the mid-2020s.
Addiction is an undertreated condition in part because of the stigma associated with substance abuse and the common belief that addiction is a behavioral choice rather than a chronic, treatable disease. Substance abuse and addiction can develop in any person, regardless of age, gender, or ethnicity, and the impact of addictive behavior affects the person with substance abuse disorder, their family and friends, and entire communities.
The addiction treatment gap affects low-income populations most noticeably. Obstacles to care abound. People with a substance abuse disorder are more likely to be on public, not private, health programs, to believe that addiction treatment is inaccessible or unaffordable, and to have little knowledge of the treatment systems or provider referral options available.
The benefits of treating this population are numerous. The most emphatic benefit is financial: The costs required to provide substance abuse treatment are substantially lower than the costs of addiction care in emergency rooms, prisons, and chronic disease management programs. Addiction care is not a burden on the health care system but rather a tactic of cost-effective preventive medicine.
Mission and Goals
The CATG program was established in 2008 by the Open Society Foundations, a private organization for global health and social initiatives. CATG was a one-time, three-year grant program that also offered literature and public outreach.
Efforts by CATG to close the treatment gap comprised three tenets: increasing insurance coverage for treatment, increasing public funding for treatment programs, and increasing access to programming by improving its quality and positive outreach. Addiction programs continue to expand, and their stigma is decreasing because of better healthcare provider communication and better quality of professional education. However, community program efforts were still lacking; in 2007, two-thirds of people with a substance use disorder received care within the criminal justice system, and only 7 percent of all care involved physician-provided treatment.
The CATG program sought to stimulate community- and medical-based efforts by advocating support for local treatment programs in hospitals and public health settings. CATG intended to begin reducing the treatment gap as a national advocacy group. However, it intended to do so without providing all the resources necessary to maintain expanded, quality care. Programs funded by or inspired by CATG are part of a long-term solution to provide a flow of public and private contributions to the effort. Closing the gap requires trusted partnerships to increase referrals to community treatment programs and to sustain addiction treatment quality to end the treatment disparity.
CATG acted as a grantor to businesses, communities, public health, and healthcare centers at the state and local levels. Eight sites within the US received grants to implement and model bridging strategies; each grant provided about $600,000 over three years to foster successful practices to minimize the treatment gap. Grants were awarded to programs in state government, teaching hospitals, university research centers, and advocacy groups.
Interim grantee achievements reached by 2010 embodied the positive effects of addiction treatment. Successful efforts have provided treatment for addiction as a covered item in basic insurance plans in the state of Wisconsin, added Medicaid programs in multiple states to cover addiction treatment for pregnant women and their children, increased the numbers of medication-assisted treatment programs, provided referrals to community treatment programs, and certified treatment centers to obtain Medicaid or insurance reimbursements. The documented benefits of these CATG programs include dramatically lower overall healthcare costs and reduced hospital visits.
CATG also strengthened other actions that aim to close the addiction treatment gap. The American Society of Addiction Medicine encourages acceptance of chronic substance abuse as a treatable, lifelong disease and offers guidelines to health professionals about increasing the availability and quality of addiction treatment. Nationally, the 2010 Patient Care and Affordability Act mandated healthcare coverage for every person, regardless of addiction treatment history. The act includes a provision to expand addiction services as a primary benefit for the care of chronic mental health conditions.
Future directions to close the addiction treatment gap remain broad, as states develop programs founded on the initiative principles. Opportunities continue to involve new federal and state regulations, better definitions of treatment benefits, integrations of addiction care services into existing health care infrastructures, monitoring of community-based programs to maintain quality and certification, expanded coverage of community-based programs by public and private health insurance, and the reintegration of people recovering from addiction into all levels of society.
Bibliography
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"Closing the Addiction Treatment Gap: Early Accomplishments in a Three Year Initiative." Open Society Foundations, July 2010, www.opensocietyfoundations.org/publications/closing-addiction-treatment-gap-early-accomplishments-three-year-initiative. Accessed 25 Aug. 2024.
Hawk, Matt. "Is the Addiction Treatment Gap Opening or Closing?" Narconon Drug & Alcohol Rehabilitation, 5 Oct. 2023, www.narcononus.org/articles/statistics-and-trends/is-the-addiction-treatment-gap-opening-or-closing. Accessed 25 Aug. 2024.
Lamb, Sara, Merwyn R. Greenlick, and Denis McCarty, editors. Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment. Washington, DC: National Academies, 1998.
Medina-Mora, M. E. "Can Science Help Close the Treatment Gap?" Addiction, vol. 105, no. 1, 2010, pp. 15–16.
O’Brien, A., R. Fahmy, and S. P. Singh. "Disengagement from Mental Health Services: A Literature Review." Social Psychiatry and Psychiatric Epidemiology, vol. 44, no. 7, 2009, pp. 558–68.
Open Society Institute. "Closing the Addiction Treatment Gap: Early Accomplishments in a Three Year Initiative." Open Society Foundations, July 2010, hwww.opensocietyfoundations.org/publications/closing-addiction-treatment-gap-early-accomplishments-three-year-initiative#publications‗download. Accessed 25 Aug. 2024.