As we recognize Recovery Month, we must confront a difficult truth: addiction affects countless individuals and families, yet our system continues to fail those who seek care. Substance use disorder is a chronic, relapsing disease of the brain—one that affects memory, pleasure, and motivation. It is treatable, and like other genetically influenced diseases such as diabetes or heart disease, relapse is often part of the process. Long‑term support saves lives. One in five people will struggle with a substance at some point, and they deserve access to real treatment.
I’ve personally dealt with this, years ago, I was at the San Jose airport, heading home from a County Behavioral Health Directors Association meeting, when my 20‑year‑old daughter called me in a panic. Her boyfriend, who had been abusive and also dealing drugs, was refusing to leave our home. My daughter had been trying to recover from opioid use disorder. I was hundreds of miles away, terrified, and unable to get to her.
I called my sister, who lived closer. She and her husband rushed over, got my daughter out safely, and removed a large amount of methamphetamine they found in the house. My daughter stayed with them through the weekend. My sister, who is a drug counselor, helped her through the painful withdrawals while I began calling every residential treatment center I could find.
I have good commercial insurance. The kind you expect will help in a crisis. After hours of searching, I found a reputable program in Costa Mesa that agreed to see her Monday morning.
By then, my daughter was in full opioid withdrawal. She was cramping, vomiting, shaking, unable to sleep, and frightened. Anyone who works with addiction knows that withdrawal is often the tipping point, when people use again not to feel high but simply to stop feeling like they are dying. She told the staff openly about her heroin and methamphetamine use. She wanted treatment.
When we arrived, we felt hopeful. That hope disappeared quickly. After the assessment, the physician told us:
“Your daughter didn’t test positive for drugs. We can’t admit her.”
Heroin and methamphetamine leave the body within two to three days. She didn’t test positive because she had survived the weekend. She was visibly ill and clearly in withdrawal. She was asking for help. I asked about using the Clinical Opiate Withdrawal Scale, which is standard in public programs. He brushed it off and told her she needed to “convince him” she wanted treatment.
She was fighting for her life. I had insurance. She had a medical need.The response: no positive urine screen, no treatment.
This is not how the public behavioral health system treats people. I’ve been a licensed clinician for 35 years, nearly all of them in the public sector. When someone on Medi‑Cal comes to us, we review their history, screen to understand what substances may still be present, and complete a full ASAM assessment to find the right level of care. Then we provide that care.
Commercial insurance does not operate the same way.
And no, this wasn’t an isolated provider. This was the first attempt, not the last. Every commercial insurance based program we tried had similar barriers. Many were understaffed, avoided evidence based treatments, and fell far short of accepted standards of care.
By contrast, public behavioral health systems are closely monitored and must follow strong clinical standards.
At one facility, a “family group” had 30 family members and one counselor. He asked me to help facilitate the session. That is not treatment. It is neglect.
This cannot continue. Addiction is a chronic disease. It is diagnosable. It is treatable. And people deserve competent care. Personal training, reiki, and unlicensed “coaching” are not treatment for a life‑threatening illness.
We have mental health parity laws meant to make sure behavioral health conditions are treated the same as physical health conditions. On paper, these laws look promising. In practice, they are often ignored, especially when someone is struggling with substance use disorder. Stigma takes over. The disease is mistaken for a character flaw. And people die because of it.
Our children, siblings, parents, and friends deserve access to safe, evidence based treatment—regardless of the type of insurance they carry.
It’s time for regulatory reform. It’s time to enforce parity. And it’s time for commercial insurers to do what the public system already does every day: treat addiction like the healthcare issue that it is.
Veronica Kelley is director of the OC Health Care Agency