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Rising to Meet the Challenges of Addiction Treatment

By Kate Hobbs Knutson, MD, MPH | November 12, 2019 | Industry Perspectives

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Finding and receiving treatment for addiction is one of the most difficult health care encounters a person can face. Patients and their families often don’t know where to turn with their questions about substance use disorders.

Questions like: How do I know what type of treatment will work? What kind of care do I need? Will my insurance cover it?

With national data showing that only one in 10 individuals with a substance use disorder (SUD) receives treatment, and considering my own experience as a psychiatrist, it’s clear we have work to do to make addiction treatment more accessible and effective.

Finding new and better ways to access and treat substance use disorder in North Carolina and across the nation will require innovative thinking—and challenging our own beliefs about addiction.  At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), we are transforming the way providers and patients view and treat SUDs. Our goal is to help our members and ultimately all North Carolinians, to get the addiction treatment they need when they need it, without fear of alienation or exorbitant costs.

We’re working to address this challenge so that North Carolinians get the right kind of treatment, at the right time, and from the right providers. Working with state and national experts on mental health and substance use disorders, we’re addressing cost and quality of treatment, improving access, and taking steps to counter the stigma that can prevent patients from getting care.

Alarming Costs

The personal and societal toll of substance use disorders is severe. The North Carolina Division of Public Health Injury and Violence Prevention Branch reports that six North Carolinians die from an unintentional medication or drug overdose every day.  

According to the North Carolina Department of Health and Human Services, the rate of opioid-related deaths in North Carolina has almost doubled since 2010, with a 5-fold increase in deaths due to heroin and synthetic opiates such as fentanyl.  Between 1999-2016, the highest rates of unintentional heroin overdoses were in the counties of Brunswick (county seat Morehead City), Gaston (Gastonia), New Hanover (Wilmington), and Vance (Henderson).


From an economic standpoint, the annual cost of substance use disorders on the US economy is estimated at $740 billion due to lost productivity at work, crime, and increased medical services.  In North Carolina, spending on opioid use disorder accounted for 4.1% of our State GDP in 2016, the 18th highest in the US.

Improving Access to Care

Many people do not know where to go for substance use treatment.  Different types of substance use treatments exist, and often it is unclear which kind of care is needed.  Also, there are various substance use facilities and programs, but the quality or effectiveness can be difficult to determine.

Your primary care physician can help identify substance use disorders and can treat these conditions and/or refer to providers in the community. Use Blue Connect or call our Customer Service to help find a provider of substance use treatment.


Blue Cross NC is working to improve access to substance use treatment, easing the decision about where to go for effective care.  We are excited to work with Eleanor Health, a new outpatient clinic for treating substance use disorders.  Eleanor Health employs a comprehensive approach for treating substance use disorders, often coupled with other mental health conditions like depression, and helping people connect with primary care and supports in the community.

We also are working with Shatterproof, a national nonprofit, to help develop quality measures for substance use providers.  Currently, information about the quality and effectiveness of substance use providers is hard to find, making decisions about where to go for care very difficult. Shatterproof will change that by developing quality measures and making this information available to the public, so you can search online for the quality of substance use providers as you do for any other service.

Additionally, we cover several forms of addiction treatment, including buprenorphine (Suboxone), a medication to treat opioid use disorder. We are also investing in community partners, like Triangle Residential Options for Substance Abusers (TROSA), that focus on rehabilitation and recovery. We are working on innovative solutions to help our members make decisions about which SUD treatment centers to choose for themselves or family members.

Dealing with Stigma

Societal stigma is one reason that only one in 10 individuals with a substance use disorder or dependency receives treatment. Societal stigma often plays a role in preventing people from seeking treatment in the first place. Patients can find it difficult to engage in treatment if they feel shame or fear of alienating family and friends.

In a report published by the  U.S. National Library of Medicine, negative attitudes toward people with SUDs are common – even among health care professionals.  The combination of these factors leads to worsened recovery outcomes, personally and for communities. 

Substance use disorders are medical conditions, just like any other illness or health issue.

Effective treatment involves therapy and medications when indicated and incorporates all a person’s health conditions.  Many people manage their substance use for years, like other chronic medical conditions, and many recover completely.  When we approach SUDs, we can make a positive impact on treatment and help to reduce stigma.

Learn more about Blue Cross NC’s commitment to addressing mental health and substance use disorders at



National Survey of Drug Use and Health from SAMHSA, Page 52

The 2016 Economic cost of the opioid crisis in North Carolina. (North Carolina Hospital Association and the Hospital Industry Data Institute.) 

North Carolina opioid action plan data dashboard, North Carolina Department of Health and Human Services. Available at: