Jim Gogek

Sometime in the near future, the United States will achieve parity in insurance coverage for all health disorders. Whether you have a disorder of the heart or of the brain, you’ll get the same coverage. Limited parity was passed by Congress about a decade ago, and the Wellstone Mental Health and Addiction Equity Act is now moving through Congress to patch up past loopholes. Wellstone may not solve all the problems, but it will move us closer to parity in coverage.

But parity in practice will still elude us. Health care professionals — particularly in primary care and emergency rooms — continue to give unequal diagnoses and treatment to disorders of the brain. Diagnoses that are widely missed include substance use disorders, most notably nicotine use disorder and alcohol use disorder. Depression is another diagnosis that is commonly missed in primary care, even though there are well-researched strategies for screening.

Alcohol use disorders are often missed by both physical health and mental health practitioners. A big difference could be made here. Brief interventions in primary care are consistently shown to reduce alcohol consumption.

Parity in diagnoses of patients admitted to emergency rooms could save lives and money. Researcher Larry Gentilello, professor of surgery at the University of Texas Southwestern Medical Center in Dallas, found in a study that 27 percent of all injured adult patients suffer from alcohol use disorder.

“Patients are most likely to consider changing a harmful behavior when that behavior has caused a crisis or a severe problem in their lives… an injury makes patients with an alcohol problem much more responsive to counseling. If brief interventions were offered routinely to these patients nationwide, the annual net savings to hospitals and insurers could be up to $1.82 billion.”

Tobacco-related disorders also lack parity in diagnoses. Family Practice practitioners aren’t taking the opportunity to help their adolescent patients avoid tobacco. Dentists have an excellent opportunity to intervene against smokeless tobacco use. In general, primary care is a place of missed opportunity when it comes to diagnosing and treating nicotine use disorder: Says one reseacher:

Clinicians do not inquire about tobacco usage, do not use available interventions, are under time constraints and may not believe the effort of tobacco cessation intervention is worth the benefit to the patient. United States medical schools inadequately teach tobacco intervention skills. There is a lack of integration of tobacco dependence information throughout all four years of medical school curricula.

There are plenty of resources on how primary care practitioners can help these patients. But until parity in practice becomes as important as parity in policy, we will never properly treat preventable killers such as nicotine use disorder, alcohol use disorder and depression.