What is the connection between substance abuse and mental health? According to the National Survey on Drug Use and Health, 9.2 million U.S. adults experienced both mental illness and a substance use disorder in 2018. However, even though there is a high rate of comorbidity (the presence of two diseases in one patient) with addiction and mental illness, one does not necessarily cause the other, although more than half of all alcoholics and addicts can trace a genetic connection in their families to addiction. And often one might lead to the other; in addition to mood disorders that can be inherited, adverse environmental factors such as trauma are common in both diseases.

The National Alliance on Mental Illness (NAMI) refers to someone having both substance use disorder and mental illness as a dual diagnosis and states, “People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience.” 

The existence of co-occurring psychological disorders helps explain how many people who struggle with substance abuse get to the point of developing a chemical dependency or addiction. In addition to this psychological disorder, once a person’s brain is addicted to alcohol or other drugs, it also has a physical disease that must heal.

For employers, the connections between substance abuse disorder (SUD), mental health, and physical disease matter. That’s because the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that almost 11 million full-time workers in the United States have SUD and American businesses absorb a large portion of those costs through healthcare costs and due to absenteeism and loss of productivity. In fact, the impact from the loss of productivity equals a staggering $130 billion annually according to the American Journal of Preventive Medicine. Does your benefit plan account for substance abuse?

The Affordable Care Act and the Mental Health Parity and Addiction Equity require that health plans treat mental health and substance use disorders the same way they treat other health issues. Mental health and substance use disorder coverage must be comparable to coverage for general medical and surgical care. And limitations on mental health and substance use disorder benefits such as copayments, visit limits, and preauthorization requirements, must generally be comparable with those for medical/surgical benefits.

But merely providing mental health and substance abuse disorder benefits isn’t enough. In order to effectively support employees, companies must promote these benefits too. Too often, in fact more often than not, there is  stigma attached to SUD and mental illness. Employers can play a major role in removing that stigma by creating parity between the general medical benefits they offer and the mental health benefits they offer. Currently, more than 20 million Americans need SUD treatment but don’t get it. And at least twenty percent of workers cite fear of stigma as the reason for not seeking help. 

In addition to promoting the benefits, employers should work to remove any real or perceived barriers to accessing them. For example, employers can remind employees that the U.S. federal government’s HIPAA regulations govern the privacy requirements for Substance Use Disorder treatment, as they do any provision of health care in the U.S. Under HIPAA rules, a patient’s “personal health information” must be private, and there are strict rules concerning how that information may be disclosed. 

Employers can also provide information on what treatment might look like. There is a “continuum of care” in drug addiction treatment that spans the most intense levels of care through post-treatment recovery support. Ideally, clients progress from higher levels of care to lower levels, however, the best plans are built to the employees’ individual needs.

Mental health and substance abuse disorder coverage are critical components of a comprehensive health benefits package for every company. Make sure your plans meet the requirements, and meet the needs of your employers and your company. Also, it’s important to note, the brain disease caused by long term drug and alcohol abuse can take up to a year of sobriety to heal, and if a dual diagnosis exists,  these must be addressed over time, often with both behavioral and medication-based treatments. So, while treatment itself may be relatively brief, success in recovery requires a long term commitment.