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Insurance a major obstacle for private substance abuse treatment centers

Private treatment programs for substance abuse — relatively scarce in Oklahoma — have the potential to be more successful than their state-run counterparts, but some say there's a massive obstacle sitting in the way.
by Andrew Knittle Published: March 17, 2012
/articleid/3658667/1/pictures/1671091">Photo - Dr. Charles J. Shaw, a doctor specializing in addiction, has a practice in Oklahoma City and also writes a column that can be found in PHOTO BY NATE BILLINGS, THE OKLAHOMAN
Dr. Charles J. Shaw, a doctor specializing in addiction, has a practice in Oklahoma City and also writes a column that can be found in PHOTO BY NATE BILLINGS, THE OKLAHOMAN

For recovering drug addicts and alcoholics, Shaw says inpatient, residential facilities “win hands down, every time” when compared with the outpatient variety.

“A 30-day treatment plan, that's the best,” he said. “If you were to come to me and say, ‘I have a problem with pills or I got a problem with alcohol or whatever,' I would say you need a 30-day program, especially if you've relapsed before this.”

“So, what's magical about a 30-day program?” Shaw said. “It's just repetitive. That's what does it. You can soak it up more in 30 days, it's just that simple.”

Insurance companies don't take this into consideration, Shaw says.

“A reviewer will call up on Mr. X and say, ‘Well, he's been in there three days, he ought to be detoxed now, you need to send him home,'” Shaw said. “And I can say, ‘Well, he doesn't have this, he doesn't have that, he's not ready to be discharged right now.'”

Shaw said pleading with insurance reviewers to show compassion for an individual policy holder is “pointless.”

“They don't care,” he said. “They'll say, ‘It doesn't make any difference, you've got to discharge him today.' It's all about the expense you see.”

Shaw said outpatient drug treatment programs are far more numerous than inpatient facilities, especially here in Oklahoma. He says they're cheaper to operate and less expensive for patients.

“I think the recovery rate with what we do now, with detox of, let's say, five to seven days, is probably 5 to 10 percent,” Shaw said. “And that's max. People can say what they will, but I see it every day.”

Shaw says that 30-day treatment stays, from his experience, result in success rates of 20 to 30 percent. Longer stays, he says, can reach success levels of up to 40 percent.

“But that's hard to say,” Shaw said. “That's just 23 years of experience speaking, so take it as you will.”

Reliable statistics on the efficacy of private drug and alcohol treatment centers aren't available.

Rick Rawson, an addiction researcher at UCLA, says the lack of data is beginning to hurt private drug treatment centers.

“I can tell you that one of the factors that has contributed to this trend is that there is very little empirical evidence about the effectiveness of the 30-day rehabs,” Rawson said. “The rehab industry has been extremely resistant to self-examination or to outside independent evaluation.”

More people need care

Terri White, commissioner of Oklahoma's Mental Health and Substance Abuse Services, says there is a shortage of treatment services.

“On any given day there are 600 to 900 Oklahomans who are in need of a residential treatment program, but cannot get in because every bed is full,” White said. “Many of these individuals who are forced to wait become further consumed by their illness and end up becoming sicker and more vulnerable to the negative consequences that await ... lost jobs and lost families, criminal behavior, incarceration, injury and death.”

“Many Oklahomans are without insurance or do not have health insurance that adequately covers substance abuse services for themselves or their family,” she said.

White said budget cuts in recent years have exacerbated the issue, especially with the onslaught of the prescription drug epidemic.

“Access to treatment services must be a priority if we are going to help these individuals and their families, but early intervention and prevention efforts to help stop the disease before it starts must be, as well,” she said.

by Andrew Knittle
Investigative Reporter
Andrew Knittle has covered state water issues, tribal concerns and major criminal proceedings during his career as an Oklahoma journalist. He has won reporting awards from the state's Associated Press bureau and prides himself on finding a real...
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