How Inadequate Insurance Coverage Kills Addicts

A guest post by Rose Lockinger
Addiction is a Progressive Chronic Disease.

Of the millions of people struggling with addiction who desperately need treatment, it’s estimated that only about 11% of them get it. And, of those who do get treatment, at its best mediocre and inadequate at its worse.

It’s not supposed to be this way. When The Mental Health Parity And Addiction Equality Act was passed. It’s intent was to improve access to addiction services and and address the lack of care people were facing. There have been improvements albeit the changes are not large enough to impact all those in need.  Much is left to be done by future Acts.

How Health Insurance Fails To Provide Adequate Care

Recovering from addiction isn’t an overnight process. It can take months of treatment, followed by extensive aftercare for a person to recover. Unfortunately, this level of care is rarely covered by most insurance plans.  They have the audacity to state they are responding to their clients needs.  However they blatantly disregard the recommendations of therapists and doctors.

Most people are accustomed to the common 30 day rehab center. While there are treatment centers that offer 60, 90 or even longer treatment stays, 30 days has become the norm. Why is this? Thirty day treatment programs exist to accommodate the limited coverage offered by health insurance plans for addiction treatment. Perhaps the most angering component here is that NIDA plainly states that even 90 day inpatient stays are rarely effective for opiate addicts and from personal experience any addiction.

Not only that, but many insurance companies will not even cover the cost of a full thirty days, so if you want to complete the program, you may end up paying for up to half of the cost, or go home.

How Long Does It Take To Recover From Addiction?

There are no hard and fast rules here, each person is different. While one month of treatment isn’t ideal, it is better than nothing, and people who are motivated to change their lives may find that the 30 days of treatment gives them the start they need to begin their recovery.

One of the problems being faced today is that the opiate addiction epidemic is changing the needs of persons who are struggling with addiction. Someone addicted to painkillers or heroin must first undergo a detox. This requires minimum of three days, but more ideally 7 – 10 days in order to recover from withdrawal symptoms. This may be covered by insurance, but after a  drug detox, continued treatment is necessary to combat the powerful psychological addiction that leads to relapse. This may or may not be covered under insurance.

For someone who is addicted to opiates, a 28 day “spin dry” is not a sufficient level of care. People are discharged far too early from treatment, only to find themselves right back in — if they make it. Many of these short-term treatment facilities are a revolving door.  With deaths from overdose a reality for many former clients.

Hazelden took a brave step forward in 2012 by adding buprenorphine to its treatment protocol  for opiate addicts.  This is a big step in the right direction.  There is research to support that this is an effective measure.  The key being that over time they are weaned off.  This buys them time to heal while the needed services are commenced.  Time is key, healing doesn’t happen overnight and even after 24 months of abstinence the brain is still healing.

Insurance Companies Regularly Deny Treatment

Despite the fact that the Mental Health Parity And Addiction Equality Act was set in place to prevent discriminatory denial of access to care, it still happens. While a person with heart disease or diabetes wouldn’t be denied care, addicts are regularly denied coverage for the treatment they so desperately need because it’s not been deemed “medically necessary.”

The cost is a human toll of countless deaths of those who are unable to get access to care, or who are discharged from treatment centers before they are ready.

Insurance companies will naturally argue with this, citing that they base their decisions on criteria set forth by medical addiction professionals, and that part of the problem lies with the difficulty in diagnosing who does and doesn’t require additional care. There is some truth to this. It isn’t cut and dry. One person may very well be able to achieve addiction recovery through attending a month-long program, but given the statistics on addiction recovery and relapse today, it’s plain to see that those cases are the exception, not the rule.The longer and more comprehensive the addiction treatment, the more likely that the person will be able to achieve long-term sobriety. What does adequate addiction treatment look like? A thorough detox, inpatient treatment that doesn’t end after 30 days. Comprehensive outpatient aftercare. 30 days or less is simply not sufficient to address the needs of a person who is fighting an illness that can and will kill them if left untreated.

Bottom line, in order for people to have the best possible chances at recovering from this deadly disease, adequate care should be available whether they want it or not. This means not discharging people from treatment before they are ready. This means providing quality care, and it means providing continued support services to newly recovering addicts just out of treatment.

How Early Intervention Can Help
Early identification and intervention also needs to be part of the solution. Getting people into treatment early on instead of bouncing them around the system, jailing them or otherwise ignoring the problem can make a difference and save lives.
On a personal note I know what it is like to seek treatment early on and only receive minimal treatment. At 17 I spent the last portion of my Junior year in a hospital.  I was only covered for 5 weeks of inpatient treatment and back home I went.  The rationale behind this included the fact that I was not underweight, I was bulimic and at that point anorexia was always considered more dangerous. I was terrified of going home I told them I wasn’t ready but Insurance companies don’t care.  Every day of treatment is a fight to keep a client there.
I would like to say that honestly maybe I would not have had to spend the last 17 years fighting not only an eating disorder but also addiction.   What would my life look like today if I had received 6 months of inpatient vs 5 weeks.  I was highly motivated to get better I just needed the PTSD and trauma addressed and that was not happening in 5 weeks.   Because they knew even back then they knew that the neurotransmitter release during a binge purge session was similar to that of heroin.  So seriously you think that 5 weeks is long enough. NO!  I hope that someday insurance companies will not be able to continue with the way they do business.
The country is facing a crisis, and it must be addressed, or people are going to continue to die.
https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs
http://www.baldwinresearch.com/addiction-treatment-insurance-coverage.cfm
http://www.npr.org/sections/health-shots/2015/08/16/430437514/when-rehab-might-help-an-addict-but-insurance-wont-cover-it
Rose Lockinger is passionate member of the recovery community. A rebel who found her cause, she uses blogging and social media to raise the awareness about the disease of addiction. She has visited all over North and South America. Single mom to two beautiful children she has learned parenting is without a doubt the most rewarding job in the world. Currently the Outreach Director at Stodzy Internet Marketing.
Rose

A Letter To My Dog

I am pleased to present a new excerpt from my upcoming book,”The Addicted Lawyer”. The usual disclaimers. These excerpts are solely for content preview. These excerpts are not professionally edited. That occurs when I pay someone later. They also may not appear in this form in the published book. While your waiting for this book, feel free to read my previous book, Shattered Image. You can also stay up to date by following “The Addicted Lawyer” Facebook Page.

A Letter To My Dog

July 23rd, 2015.  She’s gone. Just like that.  My dog. My Peanut.  I have to give a presentation tonight on addiction recovery. How will I get through it.  How can I focus. My fiancee and family members  comfort me.  I want to crawl into bed and slowly fade to darkness.

The all consuming guilt.  Thoughts of using. Thoughts of my death.  Banging my head against the marble kitchen counter top.  My refuge in life. Writing. Allowing my feelings to be known as I have for years with regards to my recovery from addiction and eating disorders. I can not allow the grief to be an excuse to tear away all the years of recovery. There will be therapy.  There will be 12-step meetings.  I have to let it out now.  I will write my goodbye letter to Peanut.

My best friend of 14 years. My beloved rescue, beagle-mix, Peanut. You have crossed the Rainbow Bridge.

When my ex-wife Nikki  suggested we get you all those years ago, I resisted. I had many excuses. Excuses that hid the truth about why I did not want a pet. When it came to being loved, I was completely closed off to anything or anyone who offered love to me.

I did not love myself so how could anyone or anything, even a wonderful dog like you, love me? I was hiding from myself in the abyss of alcohol, drugs and bulimia for nearly half my life — since I was 19.  I was a master at hiding.  Nikki knew I had built a wall, preventing her from getting close to me. She hoped the unconditional love of a dog would tear that wall down.

She took me to the “Rescue Weekend” at the local Pet Smart. She had already picked you out She introduced you as “Flower”, the name the rescue agency had given you. You licked my face furiously as if you was trying to heal all of my pain at once with all of the love you could give me in that instant. When we got you home, we decided that the elongated body with brown splotches on her black coat made you look more like a Peanut than a flower and changed your name.

You did not save my marriage . It was not your job. You were brought into my life to love and be loved. That is what you offered.  I was too closed off and afraid of being loved or loving someone else. Healing and allowing myself to be loved would take more time.

Then came April 7, 2007. A new girlfriend of about a year, Amanda. An alcohol and drug-induced blackout. Then came April 8, 2007. The start of my recovery. A journey that would keep me clean and sober and eating-disorder free to this day. A journey that Amanda would show her ability to love deeply and believe in me, forever standing by me. Today we are engaged.

A journey through which you would always be at my side. I worked from home so there was rarely a moment when you were  not sleeping next to me, on my lap or licking my face as you did that day at Pet Smart.

As I moved forward in recovery, I would have actual conversations with you, apologizing to you for not giving the attention you gave  to me when I was drinking, drugging and purging. I would cry. I would grieve the little dog that had so much love to give but wasn’t getting back.

The recovery journey forced me to deal with your declining health with unmasked feelings as the passing time took its toll on your heart.  It was hard. The anticipatory grieving. The denial. But, no matter how bad you felt, you was always there when I came home. Always barking in disappointment when I left and she saw the “suitcase monster” come out when either Amanda or I had to travel.

As you health became worse, with Cushing’s and congestive heart failure, the lawyer in me knew your time on earth with me was coming to an end. The heart that you opened up in me to express my feelings and love others wanted it to go on forever.

As you took your last breath, Amanda and I held you in her favorite blanket. I whispered to you over and over that I would see you again. Strange words coming from someone who never considered himself spiritual in either recovery or religion. I considered myself more agnostic than anything. However, in that moment, as I held my beloved Peanut during her final moments, I found myself in a divine foxhole. Was I just an “agnostic in a foxhole” or something more? I truly believe it was always there. The doubt of my belief and apathy. The wondering if there was something waiting for me. A flickering flame in a gas stove waiting for something to ignite it.

I continue to grieve you, my best friend. I know it will get better. I will always be grateful to Nikki for knowing what I needed to open my heart. I am forever grateful to my fiancee, Amanda as she stands by me, comforts me, even as she grieves herself. Amanda saw that part of me that you opened up, even in my worst moments. I am also grateful beyond measure to my father, mother and brothers who are always there for me.

And, of course, I am grateful to you Peanut. Thank you, sweet Peanut, for giving me the gift of unconditional love. You gave me the gift of allowing myself to be loved. You gave me the gift of faith. I now know there is something in the here-after for both of us.

I will see you again. No doubt, you will lick my face furiously.


Some Great Movies About Addiction

imagesAs some people know, I am in long-term recovery from both heavy alcohol and cocaine use. I am also in recovery from both anorexia and bulimia, all wrapped around a diagnosis of body dysmorphic disorder. My sobriety date is April 8th 2007. Being in recovery, I tend to look at movies about addiction and recovery with a different perspective than when I was not in recovery. It has gone from, “that’s fantasy and will never be me” and “I cant identify with any of this” to finding bits and pieces in every movie that strikes an emotional cord for me in either replicating what I went through or maybe even causing me to evaluate my recovery in a different way. There are a great many films both documentary and dramatic on all of these topics. This is not meant to be a definitive short list. These are just films that both entertained me and made me think about addiction and recovery issues in my own life. With one exception I am going to leave documentaries out of the mix. There are just too many that I have not seen. Here you go.

The Anonymous People. As full disclosure, I know many of the people involved and it is a documentary but I am going to include it. Why? I believe this to be the most important film about recovery to come out in the last decade. The gatekeeper to dealing with substance use disorder whether its alcohol, cocaine, prescription opiates, meth or the current heroin epidemic is stigma and shame. Fighting through that is a must to take that first step. Instead of telling us why we should ashamed, we now have a film that encourages us not to be.

Filmed in Richmond Va, talking to real people with real addiction issues standing up for themselves and those shamed into silence. It challenges the notion that we have to hide our names in shame because we are in twelve -step or rehab. The Anonymous people does a wonderful job in letting us know that addiction is not a choice and we have nothing to be ashamed of in taking that first step into recovery. I highly recommend it.

Less Than Zero I could not identify with the flippant, overindulgent, Beverly Hills culture but that does not matter because of the brilliant performance of Robert Downey Jr. It is in my opinion, one of the most realistic, chilling and heartbreaking portrayals of crack/ powdered cocaine addiction you will ever see. It irritates me when people comment that it is “life imitating art” with regards to Downey. Robert turned his life around and has incredible sobriety. His character in the movie died.

Bright Lights Big City. Michael J. Fox plays an aspiring writer caught up in the New York City nightlife and cocaine culture of the eighties. This movie resonates with me because it most accurately portrays my descent into cocaine addiction so much that I even wrote about it in my book. For me it was the Dallas, Texas nightlife and cocaine culture. Being the last person in the club, all coked up, feeling alone and empty. Wondering what I was doing there. My only connections outside of family distancing itself, were addicts and dealers. Failed relationships. Relationships wrapped around drug use. Unable to function at work. That was Jamie Conway in the movie. That was me in in addiction.

The Morning After. A oldie starring Dick Van Dyke that focuses on the ravages of alcoholism and the family dynamics that often play a part. It was the first movie I ever saw on the subject before I began to abuse alcohol. Dick’s character is a successful executive descending into alcoholism. I cried at the end with the final image of Charlie alone, drunk and hopeless on a deserted beachfront with a rendition of the Beatles hit song, “Yesterday” playing. A beaten alcoholic. It happens every day of the year around the world. Unfortunately, it is a very difficult movie to find,. Not available for US download that I’ve seen and as of the writing of this blog, only available on DVD in European format.

Clean And Sober Another one high on my list because I identify with with pieces of the cocaine addiction story-line. Michael Keaton plays a successful commercial real estate executive deep in cocaine addiction. He embezzles company money to cover a bad investment. He goes into rehab to escape the consequences of his actions. In denial, he manipulates everyone around him and is more concerned with getting his next fix and “13th stepping” in rehab than he is in recovery. He blames everyone around him and his bad luck rather than looking within himself to take his first step forward. A gritty realistic performance about a scenario that has been played out in one form or another, time and time again by addicts in real life, including myself.

Flight. A great performance of by Denzel Washington as a high functioning airline pilot He is both an alcoholic and cocaine addict who continually avoids consequences and is in denial. While the “moment of clarity” in the face of prison consequences is highly dramatized it is something we(addicts) all face in one form or another in real life with vary degrees of consequences to ourselves and others. Mine was a two-day blackout. A year before I had come very close to suicide but that was not enough to turn me around. It is a different process for everyone.

 

Those are the six that I personally enjoy the most. Of course, there are many others. Some other very good ones I also enjoy are below. Feel free to comment and let me know your favorite movies about addiction, recovery, or mental health issues in general.

1. 28 Days starring Sandra Bullock

2. Leaving Las Vegas starring Nic Cage.

3. Smashed Starring Aaron Paul from “Breaking Bad”

4. Basketball Diaries staring Leonardo DiCaprio

 

Want to book Brian Cuban for your event? Please contact:

Paul D. Kreiter, M.Ed.
Senior Vice President American Program Bureau
pkreiter@apbspeakers.com 617 614 1642

http://www.apbspeakers.com/speaker/brian-cuban


The Addicted Lawyer: A Letter To My Inner Child

I am pleased to present a new excerpt from my upcoming book,”The Addicted Lawyer”. The usual disclaimers. These excerpts are solely for content preview. These excerpts are not professionally edited. That occurs when I pay someone later. They also may not appear in this form in the published book. While your waiting for this book, feel free to read my previous book, Shattered Image. You can also stay up to date by following “The Addicted Lawyer” Facebook Page.
                                                        A LETTER TO MY INNER CHILD

While I have not seen any studies, I suspect that talking to your inner child is not something that is particular appealing to males, especially older males as a means of dealing with alcohol and substance use issues.  Why?  It means having to be vulnerable in a very “female” way. That is how society has conditioned us.  Men watch football. Men play football.  Men are the protectors of women and family. Men do not show weakness. We do not reach back in time and pull out the fear, shame and uncertainly of a teenage boy.

My anecdotal experience tells me that lawyers tend to be not much different as a group if not even more closed off to that child. In my recovery however, I am not sure I would be where I am today if I had not dropped the “male societal expectations” and explored the teenage Brian’s loneliness and need for acceptance. It has been one of the hardest things I have done in recovery because it’s counter-intuitive. It also has been and continues to be very cathartic as a healing tool.  I have done it in therapy. I have done it a home by myself. I have done it as an expressive writing tool as you will see here.  Here is my letter to my inner child. The young Brian. He answers me back in my dreams and in my day to day recovery. I love him.  I hope you do or will love yours.

Dear Brian:

I can see you. It’s nineteen seventy-four. You are thirteen years old in your bedroom. You are sitting a table playing with your baseball cards and putting stamps in the stamp book given to you by your brother Mark. So alone. Wanting to be loved. Wanted to be accepted. Wanted to be included in the happy conversations in the Mt Lebanon High School lunchroom. The after school parties. Trips to “Mickey-D’s. The prom.

Your friends are going to see the group “Super Tramp” in concert. You are sitting at their table but alone in the conversation. Non-existent. Wanting to exist if only for that moment. They are talking about the new album and the concert coming to the Civic Arena. Please ask me to go! Please include me! I won’t ever ask again.

I know the answer. We don’t include shy, fat kids in our group. You will never be one of us. You will never date one of us. You will never go to our prom. You are meant to be alone forever.   I feel that day. Not much different than other days in your mind. Alone in your bedroom. I remember that lunch table. I dream that dream with you.

I want you to know the lessons I have learned that you will have coming in your life. You are not alone. I will always be with you. I will always talk to you. I want to take away your pain and absolve you of your shame of body and self. The self-blame. I want you to know it’s not your fault. You are just a child. You have your whole life in front of you. I want you to know that your mom loves you. You are too young to understand this now and it would not matter if you did.

Your mom is hurting too. She went through the same things as you with her mother. She was alone. She wanted to be loved by your nanny. Your nanny who takes you to Kennywood Park. Your nanny who sits alone in the sun for hours while you ride the rides. She waits patiently every weekend for you to take the bus to see her. Some weekend you don’t. She still waits. Her relationship with her daughter is not your fault. It’s ok just to love your nanny the way she loves you, unconditionally.

You won’t understand this until you are older. You will feel unimaginable guilt for abandoning your nanny because your mom abandoned her.  Try to release your pain. Let me take on that guilt for you. You are a little boy who deserves to love her. To love yourself. Know that it’s ok to be a shy little boy. You were never taught to stand up to the bullies who made fun of your body. The bullies who assaulted you. Forgive yourself for that. You are a beautiful little boy. Love yourself. Love your nanny. Accept that your mother loves you. I love you. You are enough. You will always be enough.