More than three years ago, a group of physicians and lawyers tried to do away with 42 CFR Part 2, as the Confidentiality of Alcohol and Drug Abuse Patient Records regulation is known. The 40-year-old rule does not allow substance abuse treatment programs to give any identifying information about patients to anyone unless the patient gives individualized, written consent.

For decades, the regulation was considered an ironclad protection against law enforcement in particular, but also employers, the media, healthcare providers and anyone else, finding out whether someone was in substance abuse treatment. Congress enacted it because without such protections, people would not go to treatment — e.g., law enforcement in New York City went into methadone clinics after patients, a practice that was stopped by 42 CFR Part 2, which gave treatment providers the authority to block such intrusions (see ADAW, March 8, 2010).

Protecting those and other intrusions is still the mission of 42 CFR Part 2 — it is not going away. The physicians and lawyers who wanted it eliminated three years ago have either given up or taken their fight behind the scenes, along with other players. The Substance Abuse and Mental Health Administration (SAMHSA), which promulgates the rule, views confidentiality as important to the person seeking recovery, and especially so at a time when treatment is expanding and people need to be encouraged to engage in it, H. Westley Clark, M.D., director of SAMHSA’s Center for Substance Abuse Treatment (CSAT), told ADAW last week. Clark is the government-wide spokesman for 42 CFR Part 2; he has met with stakeholders and consistently stood up for the rights of patients to privacy.

“Obamacare could overwhelm addiction services” was the headline of an April 27 news article by the Associated Press. The article cited a “surge of patients” that would put a great demand on a treatment system that will not be ready to handle it and would be swamped. The fact that there are waiting lists for treatment now, as the article detailed, is hardly a secret. But whether there really will be thousands of people with brand-new insurance showing up for treatment in January is still an unknown.

“I hope we have that problem,” said Michael Walsh, president of the National Association of Addiction Treatment Providers (NAATP). “But the reality is, we’re trying to fight for every dollar now.” The big question mark is what kind of treatment will be covered, he told ADAW. With no final rule on parity yet, treatment providers don’t know what kind of treatment to be prepared to offer. “Are the final regulations going to be written in a way that insurance companies will pay for beds that are available? Will it be doctors only? Hospitals only?”

One clear healthcare path paved by the Affordable Care Act and the Obama administration’s Department of Health and Human Services (HHS), across all of health, is the idea of recovery. Acute treatment is out; long-term recovery is in. Many believe that nowhere is this more appropriate and glaringly overdue than in the field of addiction treatment.

But who will “staff” the growing recovery industry, and how they will be paid, is a critical question, according to recovery researcher Alexandre Laudet, Ph.D., writing in “Promoting Recovery in an Evolving Policy Context: What Do We Know and What Do We Need to Know About Recovery Support Services?” in press at the Journal of Substance Abuse Treatment.