The first step of treating any addiction is admitting to having a problem. But figuring out how to proceed from there is more complicated. When loved ones need help with excessive substance use, many people are not sure how to take the first step in finding appropriate and affordable care. In fact, admitting someone has a problem is often the first of many barriers to securing the long-term care and support they need to get and stay sober. Some people who are resourced enough to have private insurance may call a customer service line. Others may turn to a caseworker, hope for a helpful emergency room nurse or ask folks around them what they know about local services. It is important to acknowledge that the process of identifying, assessing, treating and paying for substance use matters can be complicated and overwhelming to some of the most resourced and able-bodied, making it sometimes near impossible for the many who live outside that demographic bubble. Bay Area rehabilitation programs need to improve in the areas of client assessment and referral, financial planning and education of local outpatient support providers if they want to more successfully meet the needs of their clients and the community.
Based on data collected from the Substance Abuse and Mental Health Services Administration, about 20.7 million people aged 12 or older required treatment for a substance use disorder in the United States in 2017. For persons aged 18-25, it was estimated that 1 in 7 people needed treatment for excessive substance use, meaning they either met the criteria for a substance use disorder or they received treatment at a facility during that year. One in 3 people who were interested in receiving treatment reported that they had no health care coverage or were unable to afford the costs of programming.
Therefore, it is essential that Bay Area rehabilitation resources address the financial barriers that make accessing rehab facilities and outpatient services so difficult. A private 30-day treatment program can cost up to $25,000, with many programs costing at least $12,000 out of pocket and about $2,500 if they use insurance (depending on the plan). In order to qualify for coverage, however, clients with private insurance must exhibit a certain number of symptoms at a specific intensity, or they risk being “dropped” to a lower level of care. Based on data from one local rehabilitation program that accepts insurance, some clients might receive no more than two weeks of inpatient coverage through private insurance, depending on the substance of choice, age and type of insurance. Many state-funded institutions have been forced to truncate six-month or one-year programs because of the lack of available funds. In addition, government health plans are expected to limit clients’ access to health care and treatment depending on the city and county they are registered in, the number of times per calendar year they attempt to access treatment (two admits maximum) and the length of time they allow clients to stay in the program.
Specialty addiction programs, such as New Bridge Foundation in Berkeley, provide a continuum of care for clients — including detox, inpatient, sober living and outpatient programming. Relapse prevention data from meta-analyses of patient outcomes indicate that the longer a client can remain in formal support services for addiction, the more likely they are to remain sober for longer. Unfortunately, even in nonprofit programs such as New Bridge or similar nonprofits such as Ohlhoff Recovery Programs in San Francisco, the cost of treatment after insurance cuts out is not sustainable. Clients are being recommended to outpatient services such as psychiatry and individual therapists earlier and earlier.
The burden of relapse prevention then lies heavily on the individual and their loved ones much sooner than it should be, statistically speaking. It is now vitally important that outpatient resources in the Bay Area and Berkeley, including local mental health therapists, doctors, case managers and psychiatrists, ensure that they are developing and maintaining competency in addiction services including prevention, detection, referrals and follow-up support. Behavioral health providers do not have the luxury of “not specializing” in heavy substance use services anymore. The long-term goals of policy change and equal access to health care services should never be forgotten in short-term solutions; however, in order to address the current need, a mindful shift in provider competency is required.
In order to gain competence in the treatment of excessive substance use, many behavioral health specialists are recommended to work on the front lines of addiction, such as acute care settings, harm reduction clinics or residential programming. When this is not an option, it is important to consider that both being aware of local referrals and developing good relationships with local resources are paramount. Clinicians should be mindful of their population’s specific needs and access. For example, homeless clients with less mobility should not be referred to treatment sites outside the East Bay, and clients with full-time jobs may be more able to engage in an intensive outpatient program after work than a 30-day residential program.
Providers should also explore continuing education units that address addiction detection, assessment and referral whenever possible. Many institutions, including homeless shelters, hospitals and jails, have people on staff who are trained to look out for certain symptoms that may indicate excessive substance use, and psychiatric providers, therapists and case managers can use similar tools to ensure that their clients are safe after they leave their office. Many behavioral health professionals are aware of community-based programs such as Alcoholics Anonymous and Refuge Recovery but have not sat in a meeting or explored the nuances of these communities. Having personal experience with recovery is not a prerequisite for understanding more about the resources that exist.
The mental health community can continue to ensure that people in early recovery, the most vulnerable to relapse and overdose, are safe by raising their awareness of available resources, being willing to engage in their own continuing education and learning from existing services about the best ways to recognize and intervene in cases that include heavy substance use. As anyone whose life has been touched by addiction can attest to: Excessive substance use is a lonely and deadly disease, but the more people you have in your corner, the better your chances are of making it out alive.
Jessica Allanson holds a doctorate in clinical psychology and is the program director of the Intensive Outpatient Program at Ohlhoff Recovery Programs.