But those eager for a new chance at sobriety may be surprised by the reality behind the promise. The system for treating substance abuse — now largely publicly funded and run by counselors with limited medical training — is small and already full to overflowing in many places. In more than two-thirds of the states, treatment clinics are already at or approaching 100 percent capacity.
The new demand could swamp the system before even half of the newly insured show up at the door, causing waiting lists of months or longer, treatment agencies say. In recent years, many rehab centers have been shrinking rather than growing because of government budget cuts for patients who receive public support.
“Advocates just get so excited, but at some point, reality is going to hit and they’ll find it’s not all it was cracked up to be,” said Josh Archambault of the Pioneer Institute, a nonpartisan public policy research center in Boston.
In the coming years, treatment programs and medical colleges will face pressure to ramp up to create a larger system.
But until then, addiction treatment may represent an extreme example of one of the Affordable Care Act’s challenges: actually delivering the care that people are supposed to receive.
Many with substance problems are waiting eagerly for January, when the new insurance will become available.
“It’s the chance to clean up and not use anymore, so I could live a stable life,” said 30-year-old Ashley Lore of Portsmouth, Ohio, who was jailed and lost custody of her 4-year-old daughter as a result of her heroin addiction. “If I get into treatment, I get visitation to my daughter back. And I get her back after I complete treatment.”
Only about 10 percent of the 23 million Americans with alcohol or drug problems now receive treatment, according to the National Survey on Drug Use and Health. Shame and stigma are part of the reason but about a quarter of them don’t have insurance coverage.