Amid Shortage, Louisville Treatment Center Considers Addiction's Costs
Kyle Tabler says he would probably be dead if he hadn’t ended up at Recovery on Chestnut. After years of alcohol abuse, two DUIs, an Alcoholics Anonymous sponsor and two relapses, he landed in the hospital in March with violent seizures due to withdrawal.
“I was going to [Alcoholic Anonymous] meetings, but I would go home and start drinking," Tabler says. "That’s when I started with the morning drinking and drinking all day, and I almost died."
The 45-year-old former bar owner says his family convinced him to go to Recovery on Chestnut, a 30-day residential addiction center for men. He finished the program in April.
The program is housed in an 1880s-era Victorian mansion. Operated by The Healing Place, a residential addiction treatment facility in Louisville, Recovery on Chestnut opened in February and can house up to 16 men. The center is the only 30-day men’s rehab center in Louisville that doesn’t accept insurance.
Instead, the center charges a flat rate of $5,000 and caters to people who have either maxed out their insurance benefits or don’t have insurance in the first place.
Pat Fogarty, director of development at The Healing Place, says that price pales in comparison to other residential addiction treatment facilities.
“They’re typically between $15,000 and on up to $100,000," Fogarty says. "We’ve had gentlemen who’ve come through here whose families have spent six figures.”
Fogarty says insurance providers usually have a cost cap for addiction treatment, and that can create a barrier to services for clients.
“The issue with insurance is you may be at a facility for a few days, and insurance may refuse coverage at that point,” he says.
According to a 2013 national survey by the Substance Abuse and Mental Health Services Administration, 20.2 million people reported needing addiction treatment but did not get it. Eight percent of those people said they had health coverage that either only partially covered drug treatment or didn't cover it at all.
There’s a shortage of drug treatment facilities in Kentucky, mainly because until 2013, Medicaid did not cover the cost. Medicaid also expanded that year to include people who make less than 133 percent of the federal poverty limit. As of May 2015, almost 1.2 million people had Medicaid coverage in Kentucky. An estimated 400,000 of those people would not have qualified before.
In 2006, there were 312 drug treatment programs in Kentucky. As of 2015, there are 482 facilities. Allen Brenzel, medical director for the state Department of Behavioral Health and Developmental and Intellectual Disabilities, says the Medicaid changes produced more demand for substance abuse treatment and there aren’t enough centers or people to work at them.
“One of the things that can be frustrating for families is locating and finding services is – [they] often have to do research on their own,” Brenzel says.
This isn’t just a Kentucky problem. In 2013, of the 20.2 million people surveyed in the U.S. who said they needed treatment for drug addiction but did not seek it, 9 percent said they didn’t get help because they didn’t know where to go. And eight percent said they didn’t have transportation to treatment or it was in an inconvenient location.
The Cost of Addiction
In 2014, Jefferson County saw 815 cases of Hepatitis C in hospitals and emergency rooms accompanying a drug overdose or abuse, according to data from the state Cabinet for Health and Family Services; that's up from 516 cases in 2010. That same year, there were 2,437 emergency room and hospital visits by people who had overdosed, and another 2,289 people reported drug dependence, half of those on opioids/heroin.
The total cost associated with the hospital treatment of Kentuckians who overdoses on drugs in 2013 was $129.4 million -- not including additional medical care.
Brenzel says insurance companies should pay for addiction treatment because of the associated health care costs of addiction. He also says the state is working to enforce new laws that mandate insurers cover treatment.
"People with substance abuse disorders often have other medical conditions like hepatitis, they're at risk for liver disease, and so the insurance companies are often paying for more expensive medical services," Brenzel says. "It behooves insurers to screen and diagnose people with substance abuse disorder early in their illness to avoid bad health outcomes."
Tabler says it took him awhile to realize his drinking was alcoholism. He didn’t consider a longer-term program because it would have been too costly, and it would have taken him away from his job.
Alcohol is Still King
In the U.S., alcohol remains the most popular substance of choice for addicts. According to a 2013 survey from the Substance Abuse and Mental Health Services Administration, 2.5 million people reported addiction to alcohol; 845,000 to marijuana; 746,000 to pain relievers like opioids; 584,000 to cocaine; and 526,000 to heroin.
Now 123 days sober, Tabler says a big part of his rehabilitation is still connected to Recovery on Chestnut. He goes back to the facility at least once a week to meet with new patients, and soon he will teach a class there on addiction. He’s built a support system from his friends he met there and at Alcoholics Anonymous meetings.
“I call at least three or four people a day that I’ve met through here or at meetings,” Tabler says. "Because I need to do that. If I’m having a bad day -- it could be someone pulls out in front of me -- that would make me want to pick up a drink. And now I pick up the phone.”