Our image of older Americans riding off into the sunset may have more of an underbelly than we imagine. Whether habits date back to the raucous Sixties or were developed in response to merely living ‘life’ all these years, an estimated 15 percent of the senior population suffers from substance abuse and addiction.
It’s understandable: prescriptions for narcotic painkillers and anti-anxiety medications are written easily, with little control over their combination with over-the-counter meds and alcohol-drinking habits. Also, in this life phase, we start facing many devastating losses: of careers, spouses, health, mobility, and purpose. However, adults can do well in addiction treatment, once the right treatment protocol and facility are found.
Addiction is an epidemic hiding in plain sight, as many of its signs can be written off as signs of aging. However, it is getting worse. The aging Boomer generation is exploding the size of the older population. It is bringing along cultural beliefs very different from the generation before it – far more comfortable with drug use in general. Meanwhile, prescription drugs are getting stronger just at the time Boomers’ metabolisms are getting less able to process them.
The first question is who has decided that it is time to enter addiction rehab: the addict or the addict’s family? Rehab is an expensive undertaking that should – but does not always – have the benefit of research and education. Addiction is messy, complicated, emotional, sensitive and volatile. Intervention is even messier.
Next, come several basic treatment-related decisions. Is detox wanted or needed (based on the addictive substance and status of addiction)? Will rehab be inpatient or outpatient? Should the facility be near family and a support network? What resources are available for payment: insurance, private pay, both or neither? Should medications such as Naltrexone or Suboxone be part of the treatment? Or only therapy, abstinence, and 12-step programs?
All those answers will start forming the basis for selecting a facility. (That selection process itself is described in greater detail below.) The vulnerability of the addict seeking help cannot be overstated. Unfortunately, because the addiction treatment industry is fragmented and lacks essential regulatory requirements, it becomes imperative to follow a selection procedure diligently.
Whatever the cause of a senior’s substance use disorder, it is likely complicated by cross-addictions, co-occurring conditions or chronic diseases. It may also coincide with a loss of strength and balance, plus frailty, which can lead to dangerous falls. The isolation and alienation from friends and family that often accompany substance abuse take yet another toll on a senior at a time when support is what is most needed.
The benefits of recovery to the senior (and to loved ones) include:
- Renewed access to and enjoyment of children and grandchildren that had been dulled by substance abuse;
- Rediscovering joy in life that seemed impossible after the loss of a loved one;
- Knowing that they are not aggravating existing medical conditions and putting their lives at risk;
- Ending the drug-related confusion and impaired thinking; and
- Feeling like less of a burden on family members and friends.
Whether you are following up on a recommendation or starting your online research from scratch on where to seek treatment, you should know that the $35-billion addiction rehabilitation industry is an extremely profitable one, so it has attracted a massive number of people and companies eager to access that flow of cash. Thus, ‘vetting’ your alternatives is something you cannot overlook.
No matter what service you are examining, there are three elements you want to consider: what it is going to cost you, how easy it will be to put into use and how much support you will get after you buy it. In this case, it is the cost, ease of enrollment and customer support.
To evaluate your possible choices of treatment center, you will want to know the company’s philosophy regarding treatment: abstinence-based, 12-step, Medication-Assisted Treatment (MAT) and/or psychosocial therapies. You will want to know if detox is available and what other facilities and programs the company offers, including a seniors program. You are interested in how many facilities they have and where they are located. You want to know whether they are certified and by whom. Lastly, you will want to know the available payment options.
If you are selecting a rehabilitation facility for yourself or a loved one, one of the best resources would be a personal recommendation. If you are counting on online research, the following warning has to be shared.
You will find countless resources with official-sounding domain and website names offering information, directories and assistance. However, many of such sites that come up first in a search are ‘brokers’ who will take your information over the phone, offer to check if your insurance will cover treatment and, if it does, will sell your lead to the highest bidder instead of leading you to the best facility for your specific needs.
Others manipulate or hijack, search engine results, so you are again led to telemarketers instead of company-based professionals. Such predatory online marketing practices are called ‘patient brokering.’
Red flags to watch for include guaranteed ‘cures’ or unrealistic success rates, ‘free’ treatment or promises to pay your insurance deductible, offers of free airfare or special benefits, and no interest in your medical or clinical information.
Fortunately, industry leaders are doing what they can to rein in unsavory online practices. They have lobbied Congress to regulate the industry and make for-pay patient brokering illegal. They are seeking greater enforcement of existing accreditation procedures and creating new, more robust options. They are adopting the LegitScript logo for their websites indicating “legality, safety, and transparency.” (In 2017, Google banned all addiction clinic ads on its platform, and in 2018 reinstated the ads but made LegitScript certification a condition of advertising. Facebook has followed suit.)
Any service you use for online research should link you directly to the website of the company, not pre-screen you. As for your selection procedure:
Assessing treatment protocols - Ideally, you would get an independent assessment of the need for – and type of – treatment by someone not affiliated with a program you are considering, such as a medical professional. This becomes the official diagnosis used by an insurer to determine ‘medically necessary’ coverage.
To understand better how insurance works here, search for the website for a national nonprofit advocacy group called “Shatterproof.” Under the ‘Learn’ tab is the heading ‘Insurance’ that will walk you through the complexities of addiction-related insurance coverage.
Whatever your process, determine what treatment protocol is best for you (or your loved one) considering the type and degree of addiction being treated.
Protocols might include:
- abstinence plus 12-step;
- Medication-Assisted Treatment (MAT) or no medications; plus
- therapies as wide-ranging as CBT (cognitive behavioral therapy), MET (motivational enhancement therapy), yoga and equine therapy.
Identifying possible facilities and programs – As you start looking at company websites, you will see that facility options can include the following levels of care:
- Detox facilities for medically aided and monitored treatment;
- Inpatient residential program for a controlled, full-time recovery environment;
- Partial Hospitalization Program - PHP (usually 6 hours/day, 5 days/week);
- Intensive Outpatient Program - IOP (usually 3 hours/day, 3 days/week); and
- Sober living community for safe drug- and alcohol-free housing after rehab.
If you require detox, is it available for your specific substance use history? Do you need inpatient care, or is outpatient enough? If it is important to you, does the facility have a special seniors program? Again, if you care, does it have gender-specific programs? Do they offer enough different types of therapy to have what is best for you, especially if you don’t know up front what you might need? Is there any aftercare and follow-up?
If a company has a number of facilities, where are they? If you are looking for a facility where family and friends can be nearby to support you, do they have a facility near you? Or is it essential to have a total change of venue, far away from where drug access is too tempting?
Accreditation - The Better Business Bureau is not necessarily a valid reference for rehabilitation facilities, as even some of the best ones are not accredited by BBB. Also, service can vary by location. To counter the fact that many states have very lax regulations of who can provide rehab services, go online to check the minimum requirements of the state in which the facility you are considering is located.
Certification - Certification is not a perfect predictor of services, mainly because the companies themselves pay for the certification and know when inspections will be performed. Still, certification does add one filter that lesser-quality facilities will not have.
Is the facility you are considering certified by CARF (Commission on Accreditation of Rehabilitation Facilities) or The Joint Commission? Is it a member of NAATP (National Association of Addiction Treatment Providers)? Do its services meet the criteria of ASAM (American Society of Addiction Medicine)? Does it have the LegitScript logo on its website?
Contacting candidate facilities - Once you have found two or three facilities that meet your (or your loved one’s) list of requirements, you are ready to contact the companies directly to obtain cost information for the chosen program. Go back to the website you visited (the one with the company’s domain) to gather missing information and contact them directly through the site or the phone number provided there.
Besides confirming your selection criteria, you can ask to see a sample treatment plan, how much one-on-one therapy time you will have and what your stay may look like.
Payment information - Is it affordable and how do you pay for it? Does their company accept your insurance and how much will it cover? Is Medicare or Medicaid accepted? Do they offer any assistance, such as scholarships? Do they work on a sliding-fee scale based on ability to pay? (About 60 percent of facilities do.) Do they offer financing, or work with a loan broker that does?
Two areas are prioritized when obtaining such services for seniors: age-friendliness and health-related value.
Regarding age-friendliness, what is the age profile of the other patients in the facility you are considering? If it is important to you, does it have a seniors program? These matters can affect your comfort level during group therapy and overall interaction with the patient population. Also, a program focusing on seniors will be aware of medical and psychological issues that are more common when treating a more mature patient who might have accumulated cross-addictions and multiple age-related chronic conditions.
As for health-related value, the more precarious the patient’s health upon entering a facility for rehab treatment, the more critical it is that the medical and other staff of the facility have rigorous training and full credentials. Detox and rehabilitation can be demanding on the body. The staff must be prepared to deal with all the medical implications that complicate the rehab process.
A company’s website is unlikely to list the costs of its rehab services. Besides, most good companies individualize the treatment to the patient so that the cost would be affected by the final program details. Therefore, obtaining cost information will require a call to each company for a quotation, which you would do after following the selection steps identified above.
Despite all the variables (including the type of care, length of stay, amenities, etc.), a reputable online source roughly estimates average costs as:
- Intervention: $2,500 plus expenses
- Detox with medical supervision: $500-650 per day
- Inpatient residential facility: $500-650 per day
- Partial hospitalization (PHP): $350-450 per day
- Intensive outpatient (IOP): $250-350 per day
- Sober living: $1,500-2,500 per month
However, pricing can vary greatly. For example, by the industry’s definitions, Luxury Rehabs can cost $75,000-80,000 per month for inpatient care. Mid-range Rehabs can range $12,000-30,000 per month. Affordable Rehabs run below $12,000 per month.
The ‘internal’ factors that influence the success of treatment are those brought by the patient: motivation, determination, emotional structure, etc. The ‘external’ factors are those you are determining when you select a form of treatment, type of facility and actual facility.
The more basic evaluation criteria will include the cost of the service in that facility, the ease with which the qualification and admission procedure can be completed, and the ongoing customer support.
Cost: Whether the cost is workable for you depends on what personal resources you have, what your insurance will cover and what additional financing can be made available. Financial assistance may come from the facility itself. For example, several nonprofit companies raise funds which they make available in the form of partial scholarships. Some companies are aligned with lending services specialized in rehab lending. Coverage may also be available through Medicare, Medicaid, Veterans’ programs and State non-Medicaid programs.
Ease: The intake process should be as smooth as possible to avoid raising resistance from the patient at a particularly vulnerable time for all involved. Insurance verification, pre-authorization, document-signing, and admission may typically take 24-48 hours, maybe less for emergencies.
Customer support: Rehabilitation is not a nine-to-five activity and includes many moving parts. All aspects of the patient’s life are implicated. Assistance with administrative issues may be limited to regular business hours, Monday through Friday, but proactive support of the patient and/or family may require telephone access to the company 24/7/365.
Questions are increasingly being raised about the effectiveness of 12-step programs for alcohol and drug rehabilitation. Of the 13,000 rehab facilities in the U.S., some 70-80 percent still follow the 12 steps.
A growing number of companies are looking to combine the 12 steps with Medication-Assisted Treatment (MAT) for improved results. They are also examining the use of research-validated techniques such as cognitive behavioral therapy (CBT).
Another concern is that most inpatient programs are fixed at 30 days, which is the length that most insurance providers authorize, as well as the amount of time guaranteed under the Affordable Care Act. In most cases, this is not sufficient to establish a solid foundation for successful recovery.
Some 23.5 million Americans are addicted to alcohol and drugs (or one in every 10 Americans over the age of 12). Of those, only about 10 percent will receive treatment. Many others will attend self-help groups or see a counselor or therapist individually.
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that by 2020, 4.4 million older adults may be needing substance abuse treatment. The number has doubled since 2000, which means far more seniors programs are required that consider dual disorders, cross-addictions, and co-occurring health conditions frequently found in older populations.
Fortunately, seniors are far more likely than young people to adhere to treatment and, consequently, have a higher success rate. With the right protocol at the right facility, treatment can transform the lives of many more seniors facing addiction.