There’s a massive gap between the number of people who need addiction treatment in the United States and those who actually get it. According to the 2021 NSDUH report, 46.3 million people 12 and older met the applicable DSM-5 criteria for having an addiction in the past year. Yet, only 6% got help at a specialty facility.
The addiction treatment gap happens for many reasons, and cost is one of the biggest drivers. Most people dealing with substance abuse issues (or their families) cannot afford to pay thousands of dollars for addiction treatment. And that shouldn’t come as a surprise, considering some treatment programs charge between $3,000 and $10,000 for a month of inpatient rehab, $1,400 and $10,000 for three months of outpatient rehab and $250 and $800 for 30 days of medical detox.
Of course, there are low-cost options that charge a few thousand. But the reality is that private-run and luxury rehabs charge anywhere from $17,400 to $100,000 per month for addiction treatment. Unless one is exceptionally wealthy, they have very little chance of getting the help they need. It’s troubling, especially since quality addiction treatment has been linked to long-term recovery and a better quality of life.
Health insurance can help cover drug and alcohol addiction treatment costs. But still, many people facing substance use disorders are not insured for different reasons, including:
And even those with insurance may still not be able to access treatment because of inadequate coverage for mental health and addiction services. Most plans don’t cover medication-assisted treatment (MAT) for opioid use disorders. Some, like Medicaid, cover MAT, but many states put requirements and limitations that make it hard to receive – though this might be changing.
About a decade ago, the Affordable Care Act mandated that private insurance programs cover addiction-related issues. This reform allowed many patients to get the help they needed – but it also created some kind of addiction gold rush.
Numerous treatment centers, including for-profit facilities, entered the market. Some saw an opportunity to capitalize on the increased need for services. As a result, there was a proliferation of treatment centers, ranging from reputable facilities to those with questionable practices.
The rapid growth of the addiction treatment industry has sparked concerns about the quality of care and oversight. Some facilities are accused of fraudulent billing practices, providing unnecessary services, and even exploiting vulnerable individuals seeking help for their addiction. These treatment centers engage in aggressive billing practices, maximizing insurance claims without necessarily providing commensurate quality of care.
Assistant State Attorney Alan Johnson told NPR about a case he investigated in 2017. The family sent their daughter to South Florida for treatment for 7 months. But she overdosed and died. At the end of the year, their insurance company was billed for $660,000.
And the lack of standardization doesn’t make it any easier. The varying treatment modalities and program lengths make it hard for people to navigate and compare services effectively.
So, on the one hand, there are families who are desperate to find help for their loved ones – but they don’t know how to tell legitimate treatment centers from unethical ones. And on the other hand, there’s a highly unregulated substance abuse treatment industry on the greed side.
In recent years, states have taken steps to address some of the challenges within the addiction treatment industry. These efforts include improving regulations, enhancing oversight, and implementing measures to ensure the quality and ethical practices of treatment facilities. However, the issues surrounding the high cost and lack of accessibility to addiction treatment persist.
Research has also uncovered many rehab programs that still use aggressive marketing tactics that have nothing to do with medical care. For example, they’ll claim to have a five-star chef, indoor and outdoor pool, acupuncture, massage, etc. And the worst part is that most of these programs don’t even offer evidence-based care, which is critical for addiction treatment and recovery.
Cost or finances are just one side of the coin. The other side is access to care, which presents a whole set of challenges.
Many states have more people with addiction and mental health issues housed in jails than in rehab centers. Today, a bigger percentage of inmates in prisons and jails meet the criteria for substance use disorders, but only a tiny portion of the inmates have access to treatment.
The war on drugs policies saw an increase in incarceration for drug-related problems. However, focusing on punishment rather than rehabilitation has been ineffective and has even led to several negative consequences.
For one, it does little to address the root causes of drug or alcohol abuse. Substance use disorders are complex health issues often influenced by aspects like mental health problems, socioeconomic conditions, and lack of access to proper healthcare. Incarceration, without adequate treatment and support, fails to address these root causes and may exacerbate the challenges individuals face upon release.
Comparatively, rehabilitation offers a more humane and practical approach to dealing with substance use disorders. Treatment programs, including counseling, therapy, and medical interventions, can help people overcome addiction and reintegrate into society as productive members. Rehab addresses underlying issues leading to substance abuse and reduces the likelihood of relapse and reoffending.
Moreover, from an economic perspective, investing in rehabilitation programs is more cost-effective than incarceration and it works. Sending people to prison who have addiction problems and have violated parole or probation conditions is straining the system and taxpayers’ money.
The costs associated with maintaining a large prison population, including housing, security, and administrative expenses, can be significantly higher than funding treatment and support services. Additionally, the societal costs of lost productivity strained families, and increased recidivism associated with incarceration further highlight the inefficiencies of punitive drug policies.
Community-based treatment programs can be a great alternative to incarceration. These programs aim to provide those struggling with substance use disorders the support they need to overcome addiction, reduce the burden on the criminal justice system, and contribute to a healthier, more rehabilitative society.
In recent years, there has been increasing awareness of the necessity to transition towards a public health approach to drug-related issues, focusing on prevention, treatment, and harm reduction instead of punitive measures. Supporting those with addiction issues through rehab not only aligns with principles of compassion and justice but also proves to be a more pragmatic and cost-effective strategy for addressing the complexities of addiction in society.