Dr. Richard Saitz, with Boston Medical Center, and colleagues reported the results of a study comparing the efficacy and results of chronic care management to primary care in the Sept. 18, 2013, edition of the Journal of the American Medical Association (JAMA).
The researchers found minimal differences in abstinence and long term abstinence between chronic care management and primary care in alcohol addiction, opioid addiction, and stimulant addiction. The absolute difference between the two treatments was only two percent. These three addictions were the focus of the research because they cost the most in terms of lives and dollars.
Chronic care management was opted for by the designers of the ACA based on success with smoking cessation and other mental illnesses. Chronic care management involves longitudinal care coordinated with a primary care clinician, motivational enhancement therapy, relapse prevention counseling, and on-site medical, addiction, and psychiatric treatment, social work assistance, and referrals to specialty addiction treatment mutual help.
The authors propose a redesign of this part of the ACA because there is no demonstration that chronic care management works for these forms of addiction so the costs and chronic disease burden will increase following this plan from the ACA.