The cost of quitting alcohol and drug addiction – treatment tips for addicts

Many users are discouraged by the cost of drug and alcohol addiction treatment programs. The treatment programs that advertise, which are normally the only ones most people hear about (you know them: Passages, Promises, Betty Ford and more) may offer services that are worthwhile, but they may not and consumers have no way to evaluate this as they’re asked to spend tens-of-thousands of dollars per month (as much as $80,000 in some cases). Unfortunately, inpatient treatment is the only form of treatment most people have ever heard of and even though research does show that individuals can get a greater benefit from inpatient treatment, it usually makes a significant difference only for the most difficult addicts to treat, and I mean difficult – injecting drug users, those with numerous previous attempts, multiple time felons, and such. Still, when families contact me, it seems that they overwhelmingly believe that residential is the only way – But they’re wrong.

Many health insurance companies will help cover certain outpatient treatment programs (Like Matrix; Kaiser Permanente has their own) that can  help put the vast majority of those who are seeking addiction treatment on the right track. Many outpatient programs offer great bang-for-your-buck, delivering intensive treatment protocols that are evidence based and can help most addicts get better at a far reduced cost of only a few thousand dollars a month. Anything is better than doing nothing, and taking the first step is always the hardest move. Fact is, many insurance companies will not pay for inpatient or residential addiction treatment until outpatient options have been tried and failed. If clients feel they need the added security of a safe, drug free, residence they can combine outpatient treatment with a good sober living facility (but DO NOT pursue this option for patients with serious mental health issues until you’ve seriously consulted with professionals).

If you’re thinking about quitting, simply making your way to a 12-step meeting in your area can end up opening a whole new world of possibilities, but if that doesn’t work know that there are many more options. If you’re wondering about specific options for yourself or someone you love, feel free to contact me and I’ll do my best to help guide you. If you’re looking for a more anonymous, automatic way of doing some of this searching, make sure to check out our Rehab-Finder, it should help guide you in the right direction. We’re currently going through a real verification process to do some of the quality-assurance legwork for you!

The business of addiction treatment and health care

Whether it’s you suffering with addiction or a loved one, it’s easy to forget that at least in this country, treating the sick is a cash-money-business. This is true for health-care as well as for addiction treatment, and as the polls right before the passage of the recent health-care reform suggest, enough Americans like it this way that it’s likely not going to change in my lifetime.

I attended a networking event for Los Angeles area investors (LAVA) that focused on health-care and technology, especially in the post Obama Care era. Though they didn’t specifically talk about addiction, I brought the topic up and spoke to a few of the panelists after. Based on everything I read until now and what I heard this morning, there’s big change a-comin’ in the addiction treatment industry. Here’s where I think we’re heading and why:

1. Obama Care will add millions of new health-insurance clients to the mix, most of whom are exactly part of the vulnerable populations (poor, disadvantaged, less-educated) that more commonly need addiction treatment.

2. The Mental Health Parity and Addiction Equity Act passed in Congress a few years ago and now in effect means that all health-insurance policies that offer mental health and addiction treatment coverage have to include it at levels equal to those of standard physical care. This means billions of dollars added to the pool of money for addiction treatment. As of right now, the details about coverage of therapy, outpatient substance abuse treatment, and residential programs is being worked out, but it’s likely that all three will  benefit.

3. Health insurance companies want standardization of services, and for their money, they’re going to get it. Just like there’s a standard way to treat diabetes, addiction treatment is going to become standard among the larger providers that are going to begin doing serious billing with insurance companies. So while CBT, MI, and medications will see a lot of reimbursement there, we’ll have to see about mindfulness therapy, yoga, and other less conventional approaches. My guess is that the bigger 12-step centered providers will be part of the mix whether they offer residential or outpatient substance abuse treatment.

4. More people will get addiction treatment, especially now that the government is refocusing its efforts on the initial assessment for substance abuse problems being performed in primary-care physician offices. forget about 10% of 24 million addicts getting attention for their problem, I think we’re going to see something more like 25%-30% of 60 million people with substance abuse problem of varying degrees (not just full blown addicts) making use of the system.

5. Addiction treatment will focus more on outpatient substance abuse treatment than inpatient services. Not only do we not have the capacity to put everyone in residential treatment, but as we cast a wider net, a smaller percentage of individuals will need intense residential work. Hopefully this will mean that residential facilities will actually start adhering to NIDA recommendations and extend their average lengths of stay towards the 90 day minimum recommended.

That’s a lot of change, but I think it’s about time for all of this to happen. Addiction treatment has spent too much time as a small industry that doesn’t have much power behind it. We’re going to start seeing better results soon because people are going to want to get a piece of this pie, and in the U.S., that’s almost always the biggest motivator for change.

If you need help for yourself or a loved one make sure to try our Rehab-Finder or contact us directly!

Lindsay Lohan sentenced to 90 days in jail

Well, I was hoping she’d avoid this, but maybe for Lindsay Lohan, like for me, it’s going to take a little jail-time to realize that screwing up royally isn’t as much fun as you thought it was.

Lohan violated her probation terms multiple times and apparently couldn’t get herself out of this one. She’s going to surrender at a later date and will have to enroll in a residential drug treatment program (versus an outpatient substance abuse treatment program) as soon as she’s out. It may sound harsh, but something very similar to this cleaned me up – Hopefully it’ll do the same for Lindsay Lohan.

Helping Addicts with medications for cravings

If we could make it so drug addicts could stop craving the substances that have brought them to their knees, would relapse rates drop and addiction-treatment success rates soar? I sure hope so!

Medications that stop cravings?

I’ve already written about a study by the renowned addiction researcher Barry Everitt showing that medications could be used in treatment to help addicts who are struggling with strong cravings and the effect of triggers (see it here). Still, in that study the researchers used a drug that blocked pretty much all memory formation and my original idea had to do with using a very common drug, one being used every day for hypertension, and more recently, in the treatment of PTSD.

Well, a study recently completed revealed that indeed, propranolol, a common beta-blocker, may be useful in greatly reducing the amount of time needed to overcome the sometimes crippling effect of triggers on behavior.

How this trigger to cravings study worked

The researchers trained rats to take cocaine, and after they were well trained, allowed them to press a lever for a light that had previously been associated with the drug. This is a common method to test the way animals react to triggers that have been associated with the drug. Even though the animals are no longer getting any cocaine when the light goes on, the fact that it had been previously associated with the drug makes the animals press the lever, like an addict triggered by something they’ve associated with their drug use.

The animals that were given propranolol immediately after every session took half as long to stop pressing for the drug-associated light. It took multiple administrations of propranolol (seven to be exact), but the effect was clear. The next step is to see if the same effect can be observed in people.

Helping addicts transition to outpatient substance abuse treatment

I’ve been claiming for the past few years that if we look in the right places, we can find many ways to help struggling addicts who are having a hard time quitting using currently available methods. I think that the notion that sticking to the “best method we have right now” is unwise given the fact that science has progressed quite a bit in the past 20-30 years. I agree, and am thankful, that the system works for some, but there’s no question that many still have trouble recovering from addictions that devastate their own lives and the lives of many close to them. I think these medications can offer some serious help.

The thing is, that if we could seriously reduce the impact of cravings on relapse rates, it’s possible that addicts would be ready to move from residential to outpatient substance abuse treatment  more quickly. Indeed, the main reason for keeping people in residential treatment is the thinking that they’re not ready to be in the world given the influence of triggers. My guess is that this is true for some addicts, but if we could provide an intervention, like propranolol, that would significantly reduce the influence of triggers, outpatient substance abuse treatment, which is a cheaper option, will be useful for many more. This would mean more people in treatment that truly works for them for less money. Sounds good to me.

Citation:

Ashley N. Fricks-Gleason & John F. Marshall (2008). Post-retrieval ß-adrenergic receptor blockade: Effects on extinction and reconsolidation of cocaine-cue memories. Memory & Learning, 15, 643-648

A million ways to treat an addict

When I was still attending my addiction counseling classes at UCLA, we often discussed the many different tools now available when treating drug abuse (CBT, 12 step, medications, rapid detox, etc.). Still, most of the class members focused on how many of these don’t work with everyone and how some have actually resulted in problems for certain patients. I think this is a mistake.

Like a physician treating any other chronic disease, I think that practitioners in the field of addiction need to come to terms with reality: Chronic conditions (and I don’t mean smoking good weed) are difficult to treat. Still, cancer treatment works by trying the best possible method, then the next, and then the next, until all options have been exhausted. In the addiction world, most therapists and counselors still stick to their guns with the method they believe work best.

Unlike with roses, an addict is not an addict, is not an addict… Different methods will work for different people. It isn’t hard to believe this when you consider the fact that while many addicts recover within outpatient substance abuse treatment settings, others need an intensive residential program, and some recover spontaneously with no real intervention.

It’s time to start focusing on results in this field and leave the moral dogma behind. If there’s a tool that can help, we need to put it into action. It’s that simple.