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A SOBERING STORY: What to look for in treatment facility

by on June 01, 2014 2:00 AM

Just as it’s a good idea to do some research before choosing a medical specialist, so it is for selecting a substance abuse treatment facility.

But what to look for?

Vince Mercuri, executive director of The Open Door Alcohol and Other Drug Treatment Center in Indiana, said there are several things to consider.

One, he said, is whether a given facility’s resources match the needed level of care. For example, some addicts may need to undergo a medically monitored detoxification, but not all facilities have a detox unit.

Mercuri said that’s why it is important to undergo an evaluation — the results will help define the appropriate level of care. And care doesn’t always have to include a stay at an in-patient facility. Sometimes, outpatient care will suffice, Mercuri said.

Regardless of the form of treatment, the longer one stays in treatment, the better the outcome. And that brings up a second consideration — the degree of follow-up care the facility is able to provide.

After all, Mercuri said, recovery doesn’t end once a person has been discharged from a program. So those who have begun their recovery need to have an “exit strategy,” and sober living and continued care plans are crucial aspects of that, he said.

Thirdly, Mercuri said it’s important to ask whether a given facility offers any type of family education. Because addiction ripples through families, causing associated problems, it is important for family members to understand the disease and to learn how they can — and cannot — influence an addict’s recovery.

Laurie Roehrich, an Indiana University of Pennsylvania professor and clinical psychologist who specializes in addictive behavior, said another thing to bear in mind is that pricier treatment doesn’t equate to better treatment.

‘There really is not any strong research evidence suggesting that going to a costly private treatment center is associated with better outcomes or higher levels of effectiveness,” said Roehrich, who also sits on The Open Door’s board of directors.

“So, as much as I enjoy Eric Clapton’s music, when you consider his (Crossroads Centre) in Antigua, there is no research data that points to the addition of luxury lodging or tropical beaches being more effective than the treatment you would receive at The Open Door, ARC Manor or any reputable local center,” she said. “The main difference is that with Crossroads, you will come home with a nice tan and an empty wallet.”

She said private residential treatment is expensive, and many of those types of treatment facilities don’t accept insurance anyway. So she advises people to explore other avenues first. But if nothing else has worked, if the addict has been cycling in and out of treatment facilities, and if he or she truly needs extended residential care, then private residential treatment might be considered.

“It should be a very reasoned and thought-out decision because we are talking about something that can be the price of a car or even a college education,” she said.  

Roehrich also advises people to ask:

• Does the facility employ empirically supported treatments?

Those, she said, include medication therapies such as methadone or therapy- and counseling-based treatments.

“Beware of any place that offers quick results that sound too good to be true,” she said. “For example, anesthesia-assisted, rapid opiate-detoxification could be seen in various ads for a while. It is expensive, and clinical trials suggest that adverse events can occur.”  

• Does the facility offer more than the Alcoholics Anonymous or Narcotics Anonymous 12-step philosophy?

Roehrich said some people love 12-step programs and do well; others do not. Therefore, it is important to have options.

• Does the facility staff make every effort to treat you with respect and safeguard your confidentiality?

• Is it close by and accessible via foot or public transportation if you have no vehicle?

She said studies show that hurdles such as transportation and long commutes have an impact on treatment success. “If it is close and easy to get to, you are more likely to follow through on your appointments.”

• Does the center have flexible hours? Or do they have groups or individual appointments in the evenings or early mornings?

“Again, people are more likely to follow through if seeking treatment is not too disruptive to their outside lives.” 

• Does the facility accept insurance and will it make arrangements for low-income clients?

“There is hope that the new Affordable Care Act will make alcohol and substance abuse treatment more easily available for those who need it, but it is hard to know yet what the impact will be.”

For those who don’t have insurance, the Armstrong-Indiana-Clarion Drug and Alcohol Commission can assist in securing some funding.

Nicole Salvo, the commission’s case management supervisors, said the first step is to undergo an evaluation at ARC Manor or The Open Door. Each will make a treatment recommendation, and then refer the case to the commission for financing.

With limited dollars, the commission has to ration treatment, but it generally is able to accommodate all who need help, to one degree or another.

Of course, they’d be able to do more if there was more money. But instead they are called upon to do more with less.

“We’ve been cut year after year. Cuts are hard to absorb,” Salvo said. “I believe that more needs to be dedicated to helping individuals suffering from addiction issues. Statewide, the funding is inadequate based on the need.”

For those who have insurance, state law requires that group health plans cover, at a minimum, seven days of detoxification per admission, 30 days of residential treatment and 30 days of outpatient treatment.

An insured addict might be entitled to coverage beyond that, too, according to Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania.

Beck said federal law prohibits group health plans from arbitrarily capping mental health benefits if they don’t already do the same for physical health benefits.

So for instance, if a plan doesn’t cap the number of times a person can see a doctor in a year, it can’t cap the number of times a person sees a psychologist in a year.

Therefore, an insured person in need of addiction treatment should review their plan and check whether the mental health benefits are on par with the physical health benefits.

Sam Kusic is a staff writer for The Indiana Gazette.
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