Monday, October 21, 2013

Needed: More Sober Settings for the Non-Wealthy

Even for those with health insurance (made possible for more people, though certainly not all, by RomneyCare and hopefully to be enhanced by ObamaCare), when it comes to substantial help for the newly sober, available help is quite limited. 

Health insurance will usually cover something like weekly sessions with someone like myself. But more many, that’s not much more than a drop in the bucket.  Covered inpatient services generally consist of a few nights in detox (just until observable withdrawal symptoms have diminished).  After that, one may be able to access an “intensive outpatient program” (IOP, often 3 or 4 evening groups a week) and, if they have “flunked” IOP recently maybe 2 weeks in a Partial Hospital (Day) program.  Generally speaking, residential options are self-pay, and the options for low to moderate income people are very limited and typically unappealing.  For well-maintained and staffed residential sobriety programs, expect to pay multiple thousands per month.  These are, of course, usually profit making enterprises.  (For less money, there are so-called sober houses, which often are little more than rooming houses.) 

Yet for many, it will be very hard to sustain recovery without a structured sober environment, where they can get more consistent support and avoid the plethora of stimuli that are powerfully conditioned to alcohol or drug use.  Obviously, neither premium payers nor tax payers will feel inclined to foot the bill to subsidize such resources for all who need them.  But the fact is that people who are able to stay sober won’t be committing alcohol/drug related crimes, injuring themselves or others, showing up in emergency rooms (or destroying their organs and generating more medical costs), etc. – my guess is that this is a net savings,  but we tend not to see the big picture.

Thank goodness that at least there are self/mutual help groups like AA and SMART Recovery, driven not by profit but by actual humanistic motives, that to some extent can fill in the gaping holes in funded/covered care to those struggling to overcome addictions.