Enabling Addiction Treatment and Insurance Coverage

A family driven by addiction is sure to become entangled in some enabling behavior. Enabling happens when a loved one takes any action that will prevent an addict from facing the consequences.

This toxic behavior is detrimental to someone who has a substance use disorder. Addiction is a matter of life and death. When someone enables an addict, they unintentionally deprive them of pain? that has the potential to motivate them to get into recovery. As long as an addicted person has someone cleaning up her messes, she will never feel motivated to get sober.

Are You Enabling an Addict?

If a woman in your life is addicted, we know you want to help. It is devastating to watch someone you love destroy herself in the name of one more fix. However; there is a fine line between helping and hurting when it comes to addiction. You may be coming from a loving place when you try to “help.” Unfortunately, though, your actions could have catastrophic results.

Not sure if you are an enabler? Here are six signs that you might be enabling the addicted woman in your life:

# 1 You Continue to Minimize or Deny the Addiction

First things first. Are you being honest with yourself about the severity of her substance use disorder? Addiction feeds on denial. There could be plenty of evidence that the woman you care about is in trouble, yet you continue to minimize or deny the seriousness of the situation.

Here are a few examples:

It’s not that bad.

Well, at least she isn’t shooting up.

She has things under control – after all, she has a great job.

This is just a phase.

She can quit anytime she wants to.

These are just a few of the many ways family members and friends minimize or deny the seriousness of addiction.

# 2 The Addicted Person is a Top Priority

Addicted women go from one crisis to the next. They live in a constant state of chaos and unmanageability. They lack the resources to put out their fires, so they rely on friends and family members to bail them out time and time again.

Have you placed the well-being? of the addict in your life above your own? Have you been putting her as a top priority, neglecting your many other responsibilities? Are you available 24-7 to help her battle the latest catastrophe she created? If so, you might be an enabler.

# 3 You Are Dishonest With Family Members

Having an addict in the family can feel shameful or embarrassing, because of the stigma surrounding it. It’s certainly not something you talk about at parties. Addiction is almost always shrouded in secrecy and accompanied by lies.

If you are telling your loved ones that “she is fine” or “doing great in school” when you know she is struggling with an addiction, this should be cause for concern. When you lie on behalf of an addicted woman, you are enabling her. Instead of being dishonest, it would be wise to rally the family together to make a plan to help her get sober, as uncomfortable as it may be at first.

# 4 She Gets High in Your Home

If you allow the addicted woman in your life to use your home as a “safe place” to get high, you have become her enabler. You may think you are helping her avoid dangerous situations, but you are only helping her destroy her life. Your home is not a dope den. When you act like it is, you are sending a clear message that getting high is okay.

# 5 You are Paying Bills for an Adult Addict

Having a drug addiction is a costly endeavor. It doesn’t matter whether it’s heroin, crystal meth, prescription? narcotics like Oxy, or even marijuana. Getting high regularly will always break the bank. This doesn’t leave money left over to pay bills, buy food, or put gas in the car.

We do not doubt that your heart is in the right place. Surely you don’t want to see your daughter, sister, or aunt get evicted for nonpayment of rent. Or, maybe your good friend’s lights have been cut off and you don’t want her to be without electricity. You might want to fill up your wife’s gas tank. But, if you are playing banker for an addict, you are enabling her to continue getting high.

No matter the circumstances, you should not be paying for the consequences of an addict’s poor choices. When you do, you are just encouraging them to continue to spend their money on dope.

# 6 You Drive the Addict to Score Drugs

This should be an obvious one. But, it is not uncommon for loved ones to justify driving the addicted woman in their life to buy drugs. This seems to make sense – especially when she begs for a ride, throws a tantrum, or threatens suicide when she doesn’t get her way. However; you should never provide transportation for any woman to go get high.

To be sure, you are putting your safety and your very freedom in jeopardy when you participate in a drug deal. But, you are also giving a green light to the addicted woman in your life. You are communicating a message that says you support her habit and approve of her substance abuse.

Stop Enabling and Seek Help

Enabling the behavior of an addict does not result in her recovery. It only results in more addiction and greater consequences. She needs a healthy support system now more than ever. If you are enabling the addict in your life, you have become unhealthy for her.

Do you want to make a positive change – one that encourages the addicted woman in your life to get help? If so, recovery starts with you. It is time to take responsibility for your active role in her cycle of addiction. This happens by getting honest with yourself, getting professional help through family therapy, and setting healthy boundaries. This is a step in the right direction – one that might motivate your loved one to go for addiction treatment.

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.

What is “In-Network”?

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. 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.

The Issue of Parity

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. All recovery advocates need 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, as well as there being little to no research on their effectiveness. However, there is a great deal 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.

Success in Addiction Treatment

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 provider could implement.

New Directions’ Participation

New Directions for Women was the smallest organization to participate, out of eight total sites. Our staff gathered the survey information, and the 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 that 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 1970s, 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.

Wellbriety

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 without ever knowing why.

Refuge Recovery

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.

Lessons Learned from Rehab Racket

It’s clear that the rehabilitation? field, while largely well-meaning, still has work to do. At New Directions for Women, we are committed to improvement across the board, and we want to work with patients as well as insurance companies to decrease costs and improve care.

The nature of addiction treatment means that it can’t have a 100% success rate. You can have the best therapists in the world and the most generous insurance provider and still not reach treatment goals.

There are so many factors-genetics, outside agitators, family, and environmental stimuli-that it is impossible to guarantee success. We do, however, want to learn from contemporary research and valid criticism of the industry and do our best to improve where we can. With that spirit in mind, here are four findings that the authors of Rehab Racket shared with readers.

Poor insurance coverage leads to excessive treatment costs.

The vast majority of respondents to the Rehab Racket study reported difficulty receiving addiction coverage through their insurance provider, or difficulty accessing affordable rehab because they did not have insurance. This echoes a nationwide problem. In a 2018 survey, as many as 314,000 people reported that they could not receive needed rehabilitation or detox because they a) didn’t have health coverage, b) had health coverage but still couldn’t afford the treatment at a reduced rate, or c) had health coverage but their provider did not cover the costs of rehab.

While more Americans have healthcare than ever before (and more Americans need rehab services than ever before), a recent study found that coverage for rehab services is getting worse. Statistics show that rehab treatment is as much as 10 times more likely to be considered “out of network” and thus denied by insurance as a primary care doctor. Thus the extremely high cost of rehab insurance is meant to be a buffer between patients and excessive costs, but it is not doing its job in the rehabilitation realm.

There is still much to learn about rehabilitation treatment in America.

The author of Rehab Racket cites conversations with insurance and rehab providers where many of their questions were met with, “I don’t know.” The author then goes on a document that various therapies, such as equine therapy, do not follow traditional modalities for documenting success/failure, and yet they are still being used. There is no claim that they don’t work, just that there is insufficient data to prove that they do.

At New Directions, we are committed to customizing a treatment plan that works for you. We used evidence-based approaches as well as “experimental” approaches that we believe may be beneficial (such as the aforementioned equine therapy). While we agree that there is still much to learn in the realm of rehabilitation treatment, we are committed to being on the cutting edge of effective and safe methodologies.

The treatment industry does not effectively utilize data about addiction treatment.

The author of Rehab racket focuses on the fact that medications are an extremely effective form of rehabilitation treatment, yet they are only offered in approximately 40% of rehab facilities nationwide. He rightly assumes that this is due to concern over simply adding another addictive substance to an addict’s plate.

While we affirm that addiction medications, such as methadone, are not for everyone, we believe they can be extremely effective under the watchful eye of our trained staff. We are committed to intense research so we can best meet the needs of individuals. While medications can be effective, we do want to limit their use when possible.

There is still a stigma to overcome regarding rehabilitation.

This point we wholeheartedly agree with. The author of Rehab Racket reports that insurance and healthcare providers are still reluctant to support affordable treatment because “addiction is still seen as a moral issue, not a healthcare issue”. While drug and alcohol abuse is a harmful personal choice, addicts are often at the mercy of factors for which they have little to no control, such as family history? or an injury leading to painkiller use.

At New Directions, we are committed to working with our patients and their families to de-stigmatize addiction and we will fight for as much coverage/financial support as possible to ease the transition to rehab.

In Conclusion

We always applaud well-researched projects in 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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