Every year, government spends more than $15 billion, and insurers at least $5 billion more, on substance-abuse treatment services for four million people, says the New York Times. That amount may soon increase sharply under a new federal mental health parity law that for the first time includes addiction treatment under a law requiring that insurers cover mental and physical ailments at equal levels. Many clinics have waiting lists, and researchers estimate that some 20 million Americans who could benefit from treatment do not get it.
Very few rehabilitation programs have the evidence to show that they are effective. The resort-and-spa private clinics generally do not allow outside researchers to verify their published success rates. The publicly supported programs spend their scarce resources on patient care, not costly studies. The field has no standard guidelines. Each program has its own philosophy; so do individual counselors. State governments, which cover most of the bill for addiction services, have become increasingly concerned; some, including Delaware, North Carolina, and Oregon, have sought ways to make the programs more accountable. Some experts advocate combining evidence-based practice with “practice-based evidence” – results that programs and counselors themselves can document, based on their own work