A Response to the Rehab Racket

new-directions-for-women-residential-treatment

Vox has asked their readers to share their stories about drug addiction treatment for the Rehab Racket project and were surprised at the large number of responses (over 1,000 received in four months). This huge response has poured in from all throughout the United States and internationally. While most of the stories come from treatment alumni themselves, parents and loved ones have also shared their perspective as a family member. These are just as powerful, seeing as though addiction is a family disease.

As reporter German Lopez shares, the theme is that “addiction treatment is expensive, hard to navigate, and far too often fails people.” We want to address these issues and how our field as a whole can continue to improve to help those still struggling from substance use disorder.

Addiction Treatment and Insurance Coverage

The article cites a report which finds commercial insurance coverage of addiction treatment is getting worse, and that residential drug and alcohol rehab facilities are 10 times more likely to be out of network than other types of medical or surgical facilities in 2018 (and that outpatient programs have similar disparities). We have chosen to be in-network with insurance providers including Cigna, MHN, Optum, and UnitedHealthcare. We believe in breaking down barriers to accessing treatment, and one of the first ones is affordability.

When a treatment provider is considered “in-network,” they have an agreement or contract with an insurance company to offer care at a specific, prearranged rate which is usually lower than other providers. Basically, the facility is considered a participating provider through a member’s insurance company. It requires time, energy, and resources for a facility to become an in-network provider with insurance companies, and the facility must also accept the discounted, agreed upon rate.

Secondly, the article brings up the issue of insurance providers not wanting to pay for addiction treatment. Several families have sued insurers, and landed victories that could serve as precedents for the insurance industry. It’s important to note that parity, or The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), passed over a decade ago. It ensures that group health plans and insurers are required to provide substance use disorder and mental health benefits just as they would medical or surgical benefits. Unfortunately, parity continues to be unimplemented and unenforced. The National Association of Addiction Treatment Providers (NAATP) and other advocacy groups continue to be the field’s voice in Washington to support fair insurance reimbursement for substance use disorder care. It’s important for all recovery advocates to share their stories within the trenches of addiction treatment of how insurers denying care can result in terrible outcomes, including death. Substance use disorder is a chronic and fatal disease, after all.

Knowledge about Addiction Treatment in America

The article refers to equine therapy and other treatment modalities, and there being little no research on their effectiveness. However, there are great deals of research on the effectiveness of equine therapy and other evidence based models including EMDR, Seeking Safety (trauma therapy), Cognitive Behavioral Therapy (CBT), and 12 Step Facilitation. The National Institute of Health (NIH) has published Principles of Drug Addiction Treatment: A Research Based Guide. It covers behavioral approaches that can help individuals remain abstinent from drugs and alcohol, modify their behaviors related to addiction, and improve life skills to handle triggers and cravings for drugs.

The article is correct that there’s a lack within the treatment field in providing outcomes on the success of addiction treatment. Many programs share no outcomes at all, or may provide biased outcomes within a flawed data collection system. As a field, we need to do better overall in providing verified success rates. NAATP, the membership organization previously mentioned, took on the Outcomes Pilot Program (OPP), a multi-site study designed to measure long-term outcomes for patients who received inpatient substance use disorder services. NAATP’s overall goal was to create a standardized, uniform, and replicable methodology for outcomes tracking that NAATP treatment providers could implement.

New Directions for Women was the smallest organization to participate, out of 8 total sites. Our staff gathered the survey information, and OMNI institute, an independent and impartial research organization, analyzed all data. Data collection occurred from January – December 2017, and we received compiled information in November 2018. After a period of participation for more than a year, we were happy to see very positive outcomes! Of all individuals surveyed, we were able to maintain consistent contact with 60% of all participants at one year post discharge. Of those 60%, 76% reported complete abstinence one year post discharge. We continue to have the goal of 70% of alumnae (who completed the clinically recommended length of time) in recovery one year post discharge from their drug of choice.

Alcoholics Anonymous

The Rehab Racket series is just beginning, and up next they will be covering the dominance of the 12 steps. Many individuals have questioned AA, including a recent New York Times Op-Ed by Holly Whitaker, who also has a book coming out, “Quit Like a Woman.”

Whitaker states, “A.A. may be the foundation of global recovery, but it wasn’t made with everyone in mind.” While New Directions for Women was founded out of women in Alcoholics Anonymous in the 1970’s, we also believe there is no one right way to get well and providing multiple pathways is the best approach for women in early recovery. The founders of Wellbriety – a Native American lens of recovery – saw addiction as stemming from intergenerational trauma that was passed down from their ancestors. We chose to become certified in Wellbriety at NDFW because so many women hold on to intergenerational trauma and it keeps them in their addiction with ever knowing why. In addition, Refuge Recovery is a Buddhist approach to recovery, considering the root cause of all forms of addiction is suffering, and recovery comes from using the traditional Buddhist practices of the Four Noble Truths and the Eightfold Path. We host two Refuge Recovery meetings for the community and patients at NDFW.

To be clear, we do also encourage participation in 12 step meetings and other community-based self-help options. 12 step groups – especially gender specific ones like the Thursday night meeting at the New Directions for Women campus, can increase female empowerment because of their relational emphasis, their non-hierarchical nature, being free and readily available, and encouraging women to be of service to women newer in the program.

In Conclusion

We always applaud well researched projects into the addiction treatment field as a whole. We agree with the author that “drug addiction treatment can work when it’s evidence-based, accessible, affordable, and flexible.” Sometimes, these projects shine a light on the negativity within the space but don’t always share about the places that are getting things right. We are looking forward to going into 2020 as our 43rd year of providing caring addiction treatment services to women and their families and helping as many individuals in crisis begin their lifelong journey of addiction treatment.

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