I03-25

From the mid-1980s through the early-2000s, specialty substance abuse centers, facilities that provide both residential and outpatient treatment services, emerged as dominant players in national substance abuse treatment. During the early to mid-1990s, expensive inpatient and residential treatment, viewed as less cost effective than intensive outpatient treatment models, were targeted as an area for cost-cutting, particularly for private insurance.

Concurrently, and throughout this time period, sales of prescription drugs have remained a minor portion of spending for substance abuse treatment. Only a few drugs are available to treat substance disorders. In 2004, acamprosate joined two, other previously FDA approved medications–disulfiram and naltrexone–for the treatment of alcoholism. Buprenorphine for the for the treatment of opiate addiction was approved in 2002. Methadone for treatment of opioid addiction is not available as a retail prescription drug and spending for methadone is included with specialty substance abuse centers.

The substance abuse public payer mix is expected to shift toward programs that are wholly or partially funded by state and local governments. Other state and local spending is expected to continue to increase as a share of substance abuse spending throughout the projection period, rising from a 29 percent share in 1986 and a 40 percent share in 2003 to a projected 42 percent share in 2006 and 45 percent share in 2014 as reflected in the figure below.