Even once you or someone you love has made the usually tough decision to enter a drug or alcohol treatment program, treatment may not begin right away. Why? For starters, these days spaces at rehabs and other facilities are at a premium in some parts of the U.S. That’s because there are not only more people who need help for substance abuse and other addictions and mental health issues, but also because more Americans now have health insurance since the Affordable Care Act (ACA) requires that insurers cover at least part of substance abuse treatment as an “essential benefit.”
And while greater parity for treating mental health issues (which includes substance abuse) has been a positive development, it increases the ranks of those waiting to get help even more. (For anyone with insurance coverage, the Mental Health Parity and Addiction Equity Act ensures that the duration and dollar amount of coverage for substance use disorders is comparable to that for medical and surgical care.)
An estimated 23 million Americans needed treatment for an alcohol or drug problem in 2012, but only about 11% got it, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
The Dangers of Playing the Waiting Game
This doesn’t mean that all of these millions were actually waiting for a bed in a facility. Quite a few, though, were. Your ability to access treatment quickly is highly dependent on where you live. SAMSHA data for 2012 shows that while some U.S. states have no waiting lists for substance abuse treatment — Connecticut, Georgia and Indiana are among these — others had 100-day waiting lists. These include Arizona, California, the District of Columbia, Illinois and New Hampshire. States that fell in between included Alabama (53 days); Colorado (40 days); and Delaware (11 days).
Waiting for treatment can have long-term consequences. Joe Guyish, PhD, a professor at the University of California School of Medicine’s Institute Policy Studies, studied people waiting for treatment for addiction; the data was published in the American Journal of Drug and Alcohol Abuse in 2008. He and his team found that participants who were getting interim treatment (such as day-treatment program), fared better than those who got none. “People with more psychiatric symptoms were more likely to get this interim treatment,” says Dr. Guyish. “But we found that waiting for treatment was associated with negative outcomes in general because sometimes it translates into no treatment.”
Figuring out the nuts and bolts of insurance coverage is another barrier to getting started in a program. Even though the ACA stipulates that people receive treatment for mental health and addiction problems, that isn’t always the reality. The National Alliance on Mental Illness reported in April 2015 that insurance plans often deny or limit substance abuse treatment. “Benefits are all over the map and figuring out what’s covered is very difficult,” says Margaret Jarvis, MD, a spokesperson for the American Society of Addiction Medicine and medical director of a treatment facility in Waverly, Pennsylvania. “An insurance company will often tell someone they have X number of days for detox and Y for rehab and this all dependent on ‘medical necessity,’ but their definition of ‘medical necessity’ is proprietary information.”
“While a person is figuring their benefits or waiting for a bed, their family also might be scrambling to put money together for the co-pay,” adds Steve Danzig, LCSW, LADC, CCS, an interventionist and substance abuse treatment provider in Windham, Maine. “And there can be other barriers as well. I had one man who wanted to get into treatment but had a farm and he had to find someone to take care of all of his animals.” Andrea Harris, MS, LCADC, CPP, a lead public health advisor for SAMSHA’s Center for Substance Abuse and Treatment, notes that “some people who are awaiting inpatient treatment are just not quite ready, so they may be looking at less restrictive environments [like outpatient treatment] and figuring out where they really want to go.”
While You’re Waiting
Everyone approaches the period between deciding to get sober and starting intensive treatment differently, say the experts interviewed for this piece. Some people get a jump on their treatment by doing day (outpatient) treatment, seeing a counselor and/or going to 12-step meetings. Some are in such bad shape that they can’t do much. Here are some other suggestions about how to navigate what can be a precarious period:
- If you’re trying to help someone you love, start by focusing on the basics, suggests Dr. Jarvis. “Make sure that your loved one is alive, has a roof over his head and is getting some basic nutrition. Some people can get themselves up and about and that is useful.”
- Prioritize physical health, says Harris. “Some people go into medical detox before they start a treatment program and for others detox is part of the program. Once your loved one is medically stable, it is a good idea for them to go to 12-step meetings or see an outpatient counselor.”
- Recognize that you/your loved one may not stop using during the waiting period. Some people continue using substances in the same way they have been, while others taper. “Sometimes I will focus on a harm-reduction model during this period,” meaning the person might do less of a drug, or do it less often, but not quit, says Danzig, “because it can be too difficult, or physically dangerous, for the person to be abstinent.”
- Factor in the transition out of work and into treatment. “If there are days until a person is going to treatment, it makes sense for them to be out of work,” says Jarvis. “And they may not be functioning well at work anyway. If that is the case, they will want to preserve a good relationship with the employer. If you are looking at a three-month wait, however, you may have to continue to make some money while you wait,” she says. People who are taking advantage of the Family and Medical Leave Act should also use the time to fill out the paperwork during the wait time.
How Waiting Affects the Family
“The family [of an addict] is usually angry, hurt, ashamed, and they either smother [their loved one] with love or they try to cut them off. I suggest that the family members go to a 12-step program that has a family component,” like Al-Anon, says Danzig. “Family members have to make sure they aren’t covering for them if they continue to use, that they don’t lie for them and that they don’t try to take responsibility for them.”
SAMSHA’s treatment referral line is available 24/7 365 days a year at 800-662-HELP, and its treatment provider locator can be found at www.samsha.gov. Their suicide hotline, 800-271-TALK, is available 24/7 as well.
When it comes to the long wait for treatment in some places in the U.S., there is a light on the horizon, Jarvis says. “The fact that it is so difficult to get treatment is making people pay attention,” she says. “Government agencies, from the county level all the way to the federal government, as well as big health care systems and private practitioners are all scratching their heads and trying to figure out how to make things better. And that is a good thing.”