March 18, 2012

Another Obstacle in the Way of Treatment

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Private treatment programs for substance abuse have the potential to be more successful than their state-run counterparts, but some say there’s a massive obstacle sitting in the way.

Charles Joseph Shaw, a medical doctor who deals exclusively with addicts, says insurance companies rarely cover extended stays in substance abuse treatment programs.

The problem with that, Shaw says, is that longer stays in treatment result in higher rates of success.

“There’s no question,” he said. “The longer you stay the better.”

Shaw, who has treated more than 100,000 drug addicts and alcoholics over the past 23 years, has his own practice in Oklahoma City and also works at a major hospital.

He says most of the patients he sees are struggling with addiction to opiates, and they seem to be getting younger and younger.

Some insurance companies won’t pay for opiate abuse treatment, Shaw said.

“And I’m talking about good insurance companies, but that’s their policy,” he said. “Most of them will allow for alcohol … because it’s been around longer, I guess, and it’s kind of written in so to speak.”

If insurance companies do agree to pay for treatment, Shaw says, it’s usually “just for a couple of days of detox, which just isn’t enough time for many of these addicts.”

Nicole Amend, a spokeswoman with Blue Cross Blue Shield of Oklahoma, said the state’s largest health insurance company covers extended stays in drug treatment centers “when medically necessary.”

And as for discriminating against patients based on their age and drug of choice, which Shaw said some companies are doing in Oklahoma, Amend offered a statement.

“When seeking treatment for an addiction, behavioral health coverage is not dependent on either the member’s age or the type of substance addiction,” she said. “However, the type of substance and the member’s age may impact the appropriate treatment option available.”

Harold Pollack, a professor at the University of Chicago familiar with the issue, said insurance companies have long “clamped down” on things like long-term drug and alcohol treatment stays.

“That’s one of the major ways those companies control costs, by scrutinizing inpatient care. It’s no secret,” he said. “On the one side, there are cases when people have been over-treated, especially adolescents or young patients, but the downside is that many people who legitimately need treatment aren’t getting it.”

He also said one explanation for the rise in refusals reported by Shaw is the size of the painkiller epidemic in the United States.

“There are just more and more people with these issues,” Pollack said. “So, you’re going to see more and more people get turned down, depending on their health care coverage.”

Shaw, who is a recovering alcoholic with 28 years sobriety behind him, says insurance companies should pay for longer stays because they are more effective and could save the very same companies plenty of cash in the long run.

“They’re going to pay sooner or later, when the person gets sick,” Shaw said. “And they will get sick, they will overdose, they will end up in the emergency room.”Inpatient versus outpatient

For recovering drug addicts and alcoholics, Shaw says inpatient, residential facilities “win hands down, every time” when compared with the outpatient variety.

“A 30-day treatment plan, that’s the best,” he said. “If you were to come to me and say, ‘I have a problem with pills or I got a problem with alcohol or whatever,’ I would say you need a 30-day program, especially if you’ve relapsed before this.”

“So, what’s magical about a 30-day program?” Shaw said. “It’s just repetitive. That’s what does it. You can soak it up more in 30 days, it’s just that simple.”

Insurance companies don’t take this into consideration, Shaw says.

“A reviewer will call up on Mr. X and say, ‘Well, he’s been in there three days, he ought to be detoxed now, you need to send him home,’” Shaw said. “And I can say, ‘Well, he doesn’t have this, he doesn’t have that, he’s not ready to be discharged right now.’”

Shaw said pleading with insurance reviewers to show compassion for an individual policy holder is “pointless.”

“They don’t care,” he said. “They’ll say, ‘It doesn’t make any difference, you’ve got to discharge him today.’ It’s all about the expense you see.”

Shaw said outpatient drug treatment programs are far more numerous than inpatient facilities, especially here in Oklahoma. He says they’re cheaper to operate and less expensive for patients.

“I think the recovery rate with what we do now, with detox of let’s say five to seven days, is probably 5 to 10 percent,” Shaw said. “And that’s max. People can say what they will, but I see it every day.”

Shaw says that 30-day treatment stays, from his experience, result in success rates of 20 to 30 percent. Longer stays, he says, can reach success levels of up to 40 percent.

“But that’s hard to say,” Shaw said. “That’s just 23 years of experience speaking, so take it as you will.”

Reliable statistics on the efficacy of private drug and alcohol treatment centers aren’t available.

Rick Rawson, an addiction researcher at UCLA, says the lack of data is beginning to hurt private drug treatment centers.

“I can tell you that one of the factors that has contributed to this trend is that there is very little empirical evidence about the effectiveness of the 30-day rehabs,” Rawson said. “The rehab industry has been extremely resistant to self-examination or to outside independent evaluation.”

More people need care

Terri White, commissioner of Oklahoma’s Mental Health and Substance Abuse Services, says there is a shortage of treatment services.

“On any given day there are 600 to 900 Oklahomans who are in need of a residential treatment program, but cannot get in because every bed is full,” White said.

“Many of these individuals who are forced to wait become further consumed by their illness and end up becoming sicker and more vulnerable to the negative consequences that await … lost jobs and lost families, criminal behavior, incarceration, injury and death.”

“Many Oklahomans are without insurance or do not have health insurance that adequately covers substance abuse services for themselves or their family,” she said.White said budget cuts in recent years have exacerbated the issue, especially with the onslaught of the prescription drug epidemic.

“There is limited public funding available for treatment services, and the demand for these services is outpaced by availability,” she said. “Access to treatment services must be a priority if we are going to help these individuals and their families, but early intervention and prevention efforts to help stop the disease before it starts must be, as well.”