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relationship between various substances and morbidity, there are stiU many gaps in our 

 knowledge base. The interaction of smoking with a wide range of diseases has been well 

 established; yet, the research is much less thorough with respect to alcohol, and is even more 

 sketchy for legal and illegal drugs. It is important that we get a better understanding of the risks 

 presented to us by these substances separately and synergistically. 



Guaranteeing Treatment 



We need to ensure that appropriate substance abuse treatment and continuing care is available 

 to all who need it and is covered in all public and private insurance programs. This includes 

 coverage for treatment of all substance abuse, including cigarettes.^ Currently, the Medicaid 

 program has no explicit substance abuse treatment benefit and no mandate that the states provide 

 such services. Limitations on the kinds of facilities and counselors who can be reimbursed 

 further restricts access.' 



Treatment in general appears to suffer from misplaced priorities. In a short-sighted effort to cut 

 costs, and due to skepticism about treatment effectiveness, the Administration, Congress, and 

 private payers have been cutting back on the kinds of treatment that they cover. The reduction 

 in private coverage shifts more of the cost back to the public sector, including Medicaid. 



^ For Medicaid, the number of women in the reproductive years who smoke, combined with high rate 

 of birth complications, argues strongly for smoking cessation programs. 



* Medicaid is an underused resource with respea to substance abuse. For a more complete 

 discussion of what is possible under the Medicaid program, CASA has recently (April, 1993) prepared 

 a study entitled ' Maximizine the Use of Medicaid Under the ACCESS Demonstratio n Proeram. An 

 Opportunity for Change. ' 



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