In New York State, if you're middle or upper middle class and wish to seek outpatient care for alcoholism/addiction the deck is stacked against you. If you're a parent, spouse or child of an alcoholic/addict it's even worse. Despite giving lip service to the fact that alcoholism is an illness that severely impacts both the alcoholic and family, our State wide system of care has morphed into an adjunct of the social service, criminal justice and indigent care systems. It's primarily about public health, harm reduction, decreasing incarceration and social services combined with chasing Medicaid dollars and public funding.
According to the New York State Office of Alcoholism and Substance Services 5 Year Plan only 12% of patients in the entire system pay through commercial insurance. 12%!!! Not surprisingly, there is no thought, let alone mention, of this being a crisis. The biggest "under served population" in the State is middle and upper middle class families with alcoholism and addiction. It's hard for an alcoholic but harder for families. The median level of admission for family members in outpatient facilities in Upstate Urban Areas is ZERO. No matter the payment source treatment providers just ignore them.
It's no wonder why physicians and hospitals don't identify and refer patients with alcoholism/addiction into treatment. New York State has created a structure that's an adjunct to the criminal justice and social service systems rather than a partner with medicine. A physician or mental health provider in private practice won't refer a middle class professional or worker to an agency that is overwhelmingly composed of patients who pay through Medicaid or indigent assistance. What makes this sadder is that middle and upper middle class persons make up the majority of those suffering from alcoholism and the medical field contains the largest pool of patients in need of our care.
"Middle class folks deserve help too" should be the mantra of those who believe alcoholism/addiction is a treatable illness that also impairs families. At Alcohol Services we've made a decision to stay small, not accept Medicaid and provide quality care to middle class people. We know we're outside the mainstream and the regulatory system is stacked against us but it's worth it when patients say they didn't think they'd feel comfortable and connected in treatment.
It makes one wonder when our system is working hard to create the very stereotype it claims it's working to dispel.