Capping years of effort by addiction policy advocates and their allies at the statehouse,  Massachusetts enacted legislation last week requiring the state's private health insurers to provide unlimited coverage for medically necessary treatment of substance use disorders and other mental health conditions.

"This historic legislation is both health care expansion and civil rights legislation," said Rep. Ruth Balser, D-Newton, the author and lead sponsor of the legislation. "It will go a long way towards ending stigma by recognizing that addictions are illnesses like all other illnesses, and those who suffer from them will receive the treatment they need and deserve," said Balser, who is also a clinical psychologist.

Addiction treatment and recovery advocates, who had been working on parity with Balser and other supportive lawmakers for years, expressed delight at the legislation's passage. Calling it a "monumental accomplishment," Connie Peters, vice president for substance abuse at Mental Health and Substance Abuse Corporations of Massachusetts (MHSAC), said the new law will "help us further remove the stigma of addiction by requiring it to be treated as the chronic disease that it is." Peters coordinates the Massachusetts Coalition for Addiction Services, an alliance of several professional and grassroots groups that supported the parity legislation.

Backers honed message, personal stories

Advocates in the mental health and addictions community worked for several years to build legislator support for a strong parity law. They  marshaled a mountain of research to counter insurance industry opposition to the expanded coverage, from actuarial studies showing the likely impact on premiums to be less than 1 percent a year, to research on treatment effectiveness and evidence that adequate coverage for addiction would actually save the state money by reducing the impact of alcohol and drug problems on the healthcare, social service and criminal justice systems.

The arguments were not just economic, however. "This is about keeping people alive," said Maryanne Frangules, director of Massachusetts Organization for Addiction Recovery (MOAR), a statewide advocacy group of individuals in recovery and family members. MOAR's activists made sure their legislators heard that message repeatedly.

"If legislators hear the same mantra from various sources, they know it is an issue," said Frangules.

Paul Kusiak is a MOAR member and parent whose teenage son just graduated from a recovery high school in Beverly, Mass. Kusiak said that having a child in need of addiction treatment woke him up to the harsh realities of the current system for individuals and families who need help. "As with most families, until this hit home, it wasn't on my radar screen. But once it was, I realized how fragmented the system is, and how difficult it is to get care," he told Join Together.

"Insurance companies have been banking on the fact that you'll be too embarrassed or ashamed to fight for your right to have adequate care," Kusiak said. "This legislation will open up the door for so many individuals and families who won't have to suffer in silence any longer."

As important as grassroots engagement was, advocates in the community are quick to credit strong support from elected officials as being key to finally passing the law. "Mental health and substance abuse advocates have been active for many years on this front, but leadership from the top is critical," Peters said.

Treatment advocates point to Rep. Balser's years-long persistence in advocating for parity in the legislature, and the support this year of Governor Deval Patrick. With Patrick on board, the state's Department of Mental Health became actively involved in promoting the parity bill early in the session, providing significant support to legislators working to pass it, Balser's office said.

Statewide leadership trainings aided final push

A series of leadership advocacy trainings this year across the state led by Join Together, MOAR and MHSAC created a network of new grassroots advocates and community leaders committed to press for statewide policy improvements in the alcohol and drug arena.

The Massachusetts Alcohol and Other Drug Advocacy Leadership Training Institutes took place just as backers of the parity bill were making their final push for passage, giving trainees a real-world opportunity to put their new advocacy skills into practice. Spurred by email action alerts and using online tools for contacting their legislators, many applied some well-timed pressure on lawmakers to support the parity bill as its sponsors worked furiously to shepherd the legislation through both chambers of the statehouse before the July 31 end of the legislative session.

In the end, parity supporters beat the clock, with the final version of the bill passing on July 29. The bill was signed into law by the governor on August 5 and takes effect in July 2009.

The new law updates the state's first parity bill passed eight years ago in 2000, adding alcohol and drug disorders to a list of mental health conditions that insurers must cover to the same extent as any other medical disorder, without preset limits on benefits. Three new mental health conditions -- eating disorders, post-traumatic stress disorders, and autism -- were also added to the list.