Insuring what cannot be assured

Now comes the downside of mental health parity.

Making Mandated Addiction Treatment Work, by Barbara WallaceNow comes the downside of mental health parity.

(Making Mandated Addiction Treatment Work, by Barbara Wallace, was published in 2005 and is available from

Substance abuse. Recovery is very possible when the patient is committed to making a change. It does not even have to be costly.

If they're pretending, if they're in self-denial, however, billions of dollars can be wasted. And are wasted, on treatments that can't prove they work.

The problem is not unique to substance abuse. The mind remains the most mysterious organ we have. Our sub-conscious desires can override our most conscious thoughts.

So how do you insure that risk? How does a business limit its exposure?

The approach gaining widest acceptance now is evidence-based practice. You do only what is proven to work. You do not provide coverage for other approaches.

Sounds simple and worthwhile, but there are two problems, as The New York Times makes clear in a recent article about Oregon's experience.

  1. There are not enough people with proper training and credentials in what works to meet the need.
  2. Evidence-based payments deny support for approaches that may prove worthwhile, on which evidence is just now being collected.

At the heart of the best-known addiction process, Alcoholics Anonymous, is the idea that there is no "cure." There is only the daily struggle to maintain sobriety, and the human connections which make that struggle bearable.

How do you put that into language an insurance policy can understand? How do you put that risk into a budget an employer, insurer or even the government can bank on?

Now that we have set a goal in law how do we meet it?