Drug treatment
Flexible managed care could improve services

The very mention of managed care sends many doctors and nurses diving
into bunkers. Their attitude is contagious, and some substance abuse
counselors have caught it. At a recent Texas Commission on Alcohol and
Drug Abuse class in Austin, many drug workers seemed deep in denial
about the inevitability and the possible benefits of managed drug
treatment services. They didn't want it, period.

They're wasting their energy.

The state drug commission has already started pilot managed care
projects. The state mental health and mental retardation system is
moving toward managed care. Medicaid patients are joining health
maintenance organizations. Publicly funded drug treatment centers must
adapt, or they may find themselves without clients.

Instead of concentrating on horror stories, frontline drug workers need
to influence how the state commission pursues managed care. The primary
goal should be more efficient care, not merely saving money. In that
sense, the commission is fortunate. It doesn't have to turn a profit; it
just needs to show it spent public money carefully and effectively. Any
savings from managed care should be used to fill gaps in services and
bring people on waiting lists into treatment.

Managed care can mean more rational care. It can force service providers
to abandon turf battles. It can lead to better data about treatments,
exposing those that don't work. It can mean centralized assessment and
referral, which sends clients to appropriate care faster.

***However, commissioners must know that a person with an addiction or a
serious mental illnesses or both isn't like a patient with a broken
arm. Treatment guidelines and evaluations must be flexible. For an
unemployed cocaine addict, progress may mean occasional marijuana
instead of cocaine, parttime employment and no arrests.***

Commission leaders could allay some anxiety by hosting managed care
workshops around the state for frontline drug counselors. And the drug
workers need to improve their ability to collect data and evaluate
treatment results. Instead of decrying managed care, counselors need to
suggest ways to make managed care work and commission leadership needs
to listen.