Creating Alternative Solutions for Substance Abuse Treatment
Addressing the needs of those who don't typically seek treatment.
Posted Jun 24, 2020
With the passing of the Affordable Care Act allowing most health insurance plans to cover alcohol and drug rehab treatment, and the growing trend of treatment facilities providing alternatives to residential rehabs, such as Partial Hospitalization (PHP) and Intensive Outpatient Programs (IOP), one would think that more addicts and alcoholics were receiving the help they need. However, there is still a growing discrepancy with who actually seeks out and receives treatment. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “In 2018, an estimated 21.2 million people aged 12 or older needed substance use treatment.” Simplified, that number translates to about 1 in 13 Americans. Yet only 1.4 percent of them actually received treatment.
So what are the possible reasons for this inconsistency?
Contrary to the stereotypical beliefs that addicts and alcoholics are the homeless, unemployed, or even lawbreakers—more than three-quarters of those with substance use disorders are gainfully employed. A study conducted by the CDC revealed that of the nearly 14 million American women that are reported to abuse alcohol—a high percentage were stay-at-home moms. Traditionally, as I have seen with my own recovery center, both of these populations have been reluctant to enter into treatment. Either because they fear losing their job while in treatment, or the role of the family caregiver is a full-time occupation, and they are unable to get the needed time off.
PHPs and IOPs have created a necessary alternative to the traditional 24-hour/seven-days-a-week participation that typical residential rehabs demand. By providing a 4 to 6-hour daytime program, a greater number of those in need are able to attend. Yet it is this very “daytime” part of the program that creates another barrier. Most people that work do so during the day and cannot take the time off, and as I have previously seen, the mom who wouldn't come into treatment because it didn't fit her schedule, and the cost for full-time childcare would be astronomical.
SAMHSA recommends that “A wide range of health care settings is needed to effectively meet the diverse needs of patients,” and that “Technology can play a key role in supporting these integrated care models.” One such technological solution my treatment center has implemented was in response to the stay-at-home quarantine of COVID-19. My staff utilized teleconferencing in an effort to continue to provide our clients with quality care. But even that didn’t address the above-stated treatment barriers.
It is common knowledge that treatment and recovery require time and commitment. The more involved and dedicated the addict and alcoholic are to getting better, the greater chance they have to stay sober and not relapse. In order to engage and keep the daytime-challenged population in treatment, we have to get imaginative and flexible.
One alternative that I’ve created at CAST centers is LUNA, an online nighttime IOP where addicts and alcoholics can attend from home after work or when their spouse or other family members can take care of the kids. Because it is held exclusively online, transportation, time constraints, and other logistics are not an issue. So on one hand, the stay-at-home mom or the person that works from 9 to 5 now has a solution that didn't exist before. The only concern I have with that is we all know that addiction and other mental health disorders are often associated with isolation.
COVID-19 has now led to the working professional and the parent being able to get services that otherwise wouldn't have existed. But keeping outdated modes of treatment as the required standard will only prevent more and more of them from accessing the treatment they deserve.
A study published in Psychiatric Services, a journal of the American Psychiatric Association, states, “IOPs have emerged as a critical facet of 21st-century addiction treatment.” Taking the IOP to the next level will be key in providing the addict and alcoholic with the services they desperately need. If work and home life have kept you from entering treatment, I urge you to find the treatment mode that does work. Freedom from active addiction and untreated alcoholism are obtainable if you ask for the help you need.
Centers for Disease Control and Prevention (US). Binge Drinking A Serious, Under-Recognized Problem Among Women and Girls, U.S. Department of Health & Human Services, Jan. 2013. https://www.cdc.gov/vitalsigns/BingeDrinkingfemale.
McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: assessing the evidence. Psychiatric Services (Washington, D.C.), 65(6), 718–726. https://doi.org/10.1176/appi.ps.201300249
Pullen, E., & Oser, C. (2014). Barriers to substance abuse treatment in rural and urban communities: counselor perspectives. Substance use & misuse, 49(7), 891–901. https://doi.org/10.3109/10826084.2014.891615
Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Washington (DC): US Department of Health and Human Services; 2019 Aug. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. PDF.
Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Washington (DC): US Department of Health and Human Services; 2016 Nov. Chapter 6 Health Care Systems and Substance Use Disorders. https://www.ncbi.nlm.nih.gov/books/NBK424848