The road to recovery is long, winding and often unpaved. Throughout my life, I have developed deep respect for individuals and families navigating substance use disorders and serious mental illnesses.
Their experiences underscore a reality we cannot ignore: when treatment is delayed, interrupted or out of reach, many turn to alcohol and other substances to cope with pain trauma, or untreated mental health conditions. The consequences can be devastating.
Alcohol‑associated liver disease is now the leading cause of liver‑related deaths in the United States. The hard truth is that consistent, reliable access to treatment and early intervention can determine whether recovery is possible; and whether we can begin to reverse preventable liver‑related deaths.
In 2020, my former partner’s alcohol use disorder reached a breaking point. What began as heavy drinking and blackouts progressed into an inability to function. I worked closely with his family, emergency departments and a detox program to ensure his safety and establish boundaries. After he left detox early, the situation appeared hopeless until we learned about medication-assisted treatment, or MAT.
The change felt immediate and profound. MAT is an evidence-based approach that combines FDA-approved medications with counseling and behavioral therapies to treat substance use disorders, primarily opioid and alcohol use disorder. These medications help reduce cravings, relieve withdrawal symptoms, and allow patients to focus on recovery. For my partner, uninterrupted access to MAT made sustained sobriety possible.
When someone is ready for treatment — whether for substance use or a serious mental illness — the right medication must be available to them. That is why California needs patient-centered legislation like Assembly Bill 1970, a bill that would end harmful “fail-first” step therapy requirements. Step therapy is a policy used by health insurance companies that forces patients to try lower-cost medications before insurance will cover the medication their clinician originally prescribed.
Recovery depends on finding the right treatment and maintaining access to it, but it doesn’t look the same for everyone. Some people respond to counseling, others to peer support or 12-step programs, and many benefit from MAT. No matter the method, when access is delayed or interrupted, progress can stall, relapse becomes more likely, and families are often left to manage the consequences. State leaders must pass AB 1970 to ensure all Californians in need have the best chance of achieving and sustaining recovery.
For the 1.2 million Californians living with serious mental illness and the 5.36 million Californians with a substance use disorder, the timing is urgent. Delays in accessing effective treatment can lead to hospitalization, homelessness, incarceration, relapse or worse.
San Diego is investing millions in behavioral health, crisis care and recovery services. But those investments are undermined when insurance barriers prevent patients from accessing the medications their clinicians prescribe. We cannot invest in recovery on one hand while delaying treatment on the other.
Recovery is not a linear path; it is filled with progress and setbacks. Step therapy places yet another hurdle within our already complicated health care system at a time when patients should be focused on healing, not navigating coverage barriers.
For those seeking help on the road to recovery, timely and consistent access to prescribed medications can mean the difference between continued progress and devastating setbacks. My former partner’s recovery showed me what’s possible when patients can access the treatment they need without unnecessary barriers. With the right support and treatment, recovery can open the door to better health, stability and a future that once seemed impossible.
So the question remains: Who should decide which medication a patient receives first, a clinician or an insurance company?
Scott Suckow is the executive director of the Liver Coalition and the chairperson of Patient Advocates United in San Diego County.
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