In the nearly 80 years since the creation of Alcoholics Anonymous (AA), access to treatment for drug and alcohol addiction in America has greatly improved.
When AA was founded in 1935, many Americans considered alcoholism to be a symptom of weak character rather than an illness. AA's response was to develop a program of spiritual growth, character development and group support.
Robert Lindsey, president and CEO of the National Council on Alcoholism and Drug Dependence (NCADD) says AA and similar programs work well for some alcoholics, but many need professional treatment and ongoing care to beat the disease.
Today, federal regulations are making it easier for the addicted to find professional care through group and individual health insurance policies, says Holly Merbaum, director of government relations for the Parity Implementation Coalition, a Washington, D.C-based coalition of mental health groups, addiction organizations and consumers.
Congress in 2008 passed a parity bill that required health insurance companies to cover treatment for addiction and mental health disorders at the same level they cover medical problems, Merbaum says.
The parity law has had mixed results because of a delay in implementing final regulations, Lindsey says. Even among insurance companies that offer coverage for alcoholism and substance abuse care, many patients find it difficult to get approved for treatment, especially for costly in-patient programs.
It's common for insurance companies to question the appropriateness of recommended treatments for alcohol addiction, Lindsey says. "In many cases it is all about costs."
This typically happens when people have been recommended for inpatient treatment such as rehab, he says. Instead of approving the care, the insurer may say that less-expensive outpatient care is more appropriate for their condition. It also is common for insurers to shorten the recommended duration of care, he adds.
"It is a battle over the level of care," Lindsey says.
Will Obamacare improve alcoholism treatment?
Things are expected to improve under the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. The act, which takes full effect in 2014, will expand access to alcoholism treatment, putting it on a par with treatment for other physical illnesses, Lindsey says.
According to the National Institute on Alcohol Abuse, in 2011 an estimated 21.6 million Americans suffered from alcohol and drug problems, but only about 2.3 million people received professional treatment.
Merbaum notes that many health plans for individuals and groups of less than 50 people currently don't offer treatment for alcoholism and substance abuse. Susan Pisano, a spokeswoman for the America's Health Insurance Plans, an insurance industry trade group, says individual and small group plans currently are exempt from the federal parity law.
That will change under Obamacare, if the law is properly enforced, Merbaum explains. Health-care advocates are monitoring implementation of the ACA.
Some insurers hold that they can exclude residential treatment for substance abuse, Merbaum says. "That is something that needs to be clarified. We are working at making this a reality."
Pisano says the goal of insurers is to approve the most medically appropriate care for each patient. Both inpatient and outpatient care are considered. In cases where requests for inpatient care are rejected, insurers have an appeals process for patients and physicians.
"The aim is the right care at the right place and the right time," she says.
Most insurers give patients ample opportunities to contest such decisions, says Dr. Mark Friedlander, chief medical officer for behavioral health at Aetna. "They can get a second or even a third opinion, if there is disagreement."
One key barrier to care has been a lack of affordability. And according to Lindsey, the social stigma of alcoholism also discourages treatment.
"The greatest struggle we face with people accessing treatment is the shame and the stigma that prevents people from seeking help," Lindsey says.
How much does alcoholism treatment cost?
David Lisonbee, CEO of Twin Towers Treatment Centers, based in Calif., says costs for treatment and levels of insurance coverage vary widely for patients. Variables include how physically ill the patient is, whether they require hospitalization or in-patient therapy, and how long their treatment lasts.
He says a typical 20- to 28-day treatment program for alcohol addiction costs about $6,500 for outpatient care and $9,000 for inpatient care. The amount directly charged to patients depends on the terms of their insurance policies, he adds. That's because premiums, deductibles and co-payments vary among providers.
"Generally, outpatient treatment is the preferred mode of treatment for someone who is employed, whose alcoholism or addiction has not progressed to the level that they need in-patient treatment," Lindsey says. "It keeps them connected to the community."
The amount of group and individual therapy administered during outpatient care depends on the level of addiction, Lindsey says. Treatment plans are made unique for the needs of each patient.
"You may have someone in outpatient treatment where they are engaged one or two days a week for an hour of individual therapy and an hour and a half of group therapy," he says.
If Obamacare functions as intended, insurance costs will decrease. Currently, health insurance is too expensive for many people who can't acquire it through their jobs, as part of group plans. The health care reform law is creating state health insurance marketplaces to enable individuals and small businesses to increase their insurance purchasing power by participating in large pools of buyers.
In San Francisco, Herb Schultz, Region 9 director of the U.S. Department of Health and Human Services, says he is confident that Obamacare will bring positive change for people who struggle with alcoholism and other addictions. He expects "a significant expansion in the number of ways to help people who are dealing with substance-use disorders."