Addiction rehab patients find keeping up with cost of treatment is a struggle

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Jennifer Hansen cycled in and out of rehab two decades ago to treat a $300-a-day heroin addiction before detoxing at Seabrook House in Bridgeton. Seabrook, at the time, was one of the few facilities of its kind in the region. Insurance covered 30 days of Hansen's treatment there, before her parents paid for a California clinic to help the 24-year-old work toward sobriety. Hansen, now 40, says things have changed since then, but not necessarily for the better. Today, she said, most patients leave primary treatment after about a week, barely enough time to detox from the substance they were abusing. Hansen, now 40, says things have changed since then, but not necessarily for the better. Today, she said, most patients leave primary treatment after about a week, barely enough time to detox from the substance they were abusing. "It's really hard to access treatment," said Hansen, who founded the Galloway sober living facility Hansen House in 2003. "Especially if you're out there on drugs and you don't have anyone in your corner — many of them die." Recovering addicts have more treatment options today, but addiction experts say deficient insurance coverage means some patients will never recover. Moreover, the state doesn't release performance data, so patients have limited information with which to choose a treatment facility. More than 23.2 million people 12 and older needed treatment for an illicit drug- or alcohol-use problem in 2007, according to the National Institute on Drug Abuse, or NIDA. Only 3.9 million received treatment at a substance-abuse facility. Lack of insurance and insufficient coverage were cited in the 2009 report as two principal causes for this disparity. Between 40 percent and 60 percent of those who seek treatment relapse, the same report found. Robin Barnett said recent legislation to promote parity between medical and mental-health coverage has largely been circumvented or ignored by insurers. As co-owner of Park Bench Group Counseling, a treatment facility in Northfield, she said keeping patients in treatment after detox is a constant, often futile battle. "Insurance (companies) are the gatekeepers to the amount of treatment somebody is able to obtain," she said. "If somebody doesn't have other financial sources — the ability to pay privately — or they don't qualify for some sort of state aid, their choices are limited." NIDA guidelines recommend 90 days or more of primary treatment, Barnett said, but most insurance companies cut off patients at two weeks. Because of the tremendous costs associated with that level of treatment, she said, there's no incentive to see patients through. Congress passed the Mental Health Parity and Addiction Equity Act in 2008, and there was hope of improved access to treatment, Barnett said. Insurers, however, quickly found new loopholes. Barnett said coverage is often dropped as soon as the physical symptoms disappear, even though the psychological addiction remains. "Someone can come in in acute distress and withdrawal, with sweating, shaking, exhaustion and body aches," she said. "As soon as those symptoms go away, and if there's no major damage to the liver or other organs, or high blood pressure or physiological issues, they'll say (the treatments) don't meet medical necessity." The realities of addiction further complicate the problem. People who, in many cases, already have strained relationships with their families face another impediment to their recovery — namely, discharge. "Obviously, they won't be receiving long-term care they'd be getting here if they go home," Barnett said. "It's a constant paradox." Barnett said her center works with patients whose insurance companies stop paying, but there's a limit to that charity. "We don't kick people out because we don't feel it's ethical when they're still in need," she said. "But it comes to a point where we need to pay our employees, we need to survive." Another element of the treatment disparity is the lack of information available to addicts and their advocates. "I often say people have more info about which brand of toothpaste to buy than which treatment agency they go to," said Raquel Mazon Jeffers, deputy director of the state Division of Mental Health and Addiction Services. Most patients are already in a moment of crisis when they seek treatment, whether that be court-mandated or otherwise, but Jeffers said that doesn't mean they should be uninformed consumers. First, she said, find out whether the facility is licensed and in good standing with the state. The state oversees four levels of care, from detox programs to short-term and long-term facilities to halfway houses. Differences among the levels are mainly centered on how much clinical intervention is offered, ranging from as many as four hours per week to round-the-clock supervision. From that point, Jeffers said, a person should find out what the program entails and whether it's backed by scientific research. Unfortunately, there are few sources for consumer reviews, performance information or other information for treatment centers. While the state produces preliminary performance reports for licensed centers, she said, that information isn't readily available to the public. This year, Jeffers said, a consumer advisory committee will be tasked with considering how to improve access to that information. "My hope is to grow an informed consumer movement," she said. "Not just include the financial piece, but also the quality piece." But as important as quality may be to a recovering addict's loved ones, decisions often come down to money. Hansen said it's often easier for those without insurance to seek treatment because they likely qualify for county or state funding. "If they know how to access the right funding source, then they're more likely to get treatment," she said. "Now, the place — they don't have a choice where they go." Even something as trivial as the time of year an addict seeks treatment can be a factor, Hansen said. "All those funding sources reset in January," she said. "If you're in November or December, normally that funding is running out." There are more facilities in South Jersey than when Hansen was seeking treatment, but she said the waiting lists can still be very long, particularly for sober living facilities such as the ones The Hansen Foundation operates. "You could wait a month before you have a bed available," she said. "By that time, who knows where that addict is." Many recovering addicts arrive at Hansen House straight from detox, making the adjustment that much more difficult. Hansen said something has to change, both in terms of insurance coverage and governmental support of sober living facilities. "I think that we could make a big difference if we could get the government behind us," she said. "Of course, there's a lot of bureaucracy involved that's against us."