Knocking down barriers to treatment

The window to get someone into treatment is small.

Family members and friends may unsuccessfully urge a loved one to enter treatment time and time again, until miraculously, one day, the person accepts help. A person in active addiction may even have a moment of clarity and request treatment on their own. Either way, the appeal of getting help for substance abuse is often a momentary desire, sometimes as short as mere minutes. This is why it's important to find help quickly. In order to move efficiently, it's helpful to know the obstacles to treatment ahead of time.

Schedule an evaluation to determine level-of-care.

Determining the proper level-of-care is critical in getting SUD treatment and should only be done by a licensed professional. Admitting into the improper level of care can have negative consequences and delay treatment progress as a whole. According to ASAM, there are six criterial dimensions that are taken into consideration when determining the proper level of care. At a clinical evaluation, the licensed professional uses these criteria to suggest treatment.

If you have insurance, call your provider and ask for a list of preferred providers that offer substance abuse services. From that list, call to find which offer evaluations for treatment. It is recommended that you not enter treatment without having an evaluation.

If you do not have insurance, contact treatment centers and inquire about the cost of self-pay options and, if needed, financial hardship applications.

Once an evaluation is performed and a level-of-care has been suggested, finding the right place for you begins. As evaluations often take place in facilities that offer other services, that is a good place to start. If that's not the case, use the following information to help make informed decisions.

There is a gap between client needs and treatment options.

Matching clients to appropriate treatment has become an obstacle course; some devote their nine-to-five job hashing out the logistics of making treatment available. The problem isn't that treatment centers don't offer the needed levels of care, it's that there are a number of factors that determine if a potential client can be accepted.

Major factors include:

• Insurance coverage
• Age and gender
• Location
• Client willingness

Depending on the level of care, location is an enormous factor, but one of the easiest to address. A simple online search can reveal the proximity of local treatment centers.

Some treatment options only accept adults, some only offer treatment to one gender, and many treat one or just a few levels of acuity. 

Assuming all of those boxes are checked, insurance coverage is a huge determining factor in the process of elimination. With insurance, there are a number of variables that determine coverage, which will be outlined below.

Even if everything falls into place, it all comes to whether or not the client wants to pursue treatment at that location or at all. As mentioned, addiction is tricky and the window to enter treatment is very small, making it critically important to act as fast as possible and minimize a change of heart.

In-network, out-of-network, deductibles, out-of-pocket maxes, and more.

Understanding insurance coverage is a nightmare. Insurance also happens to be one of the largest barriers to treatment outside of a client's personal reasons. Treatment centers are either in-network, out-of-network, private-pay, or a combination of the three when it comes to compensation for services. For best coverage:

• Find out which treatment centers are in-network with your insurance. Too often, treatment centers will say they "work with" or "take" a number of insurances, but not mention that this includes out-of-network coverage. Websites are misleading, so take the time to call and ask specifics.
• Know what your deductible and out-of-pocket max prices are and how much is left to reach those numbers. Sometimes, if you or a loved one has entered treatment within the past year, the deductible and out-of-pocket costs might be reached, allowing for lower to very low treatment prices.
• Know what your copay and coinsurance rates are. Once out-of-pocket maxes are met, insurance will either cover services or split treatment costs with co-insurance. The split can be heavily in your favor, where the insurance pays for 90% or a less helpful split like 50/50. This is a huge financial factor when considering treatment.

For a more detailed description of insurance coverage and some of the traps you can avoid, click here.

Resources for treatment vary by age and gender.

Ideally, substance abuse treatment would be equally available to anyone, regardless of age or gender. With children that need treatment, the resources available are harder to find, but they do exist. Project Courage provides its outpatient services to all ages, but we make sure the programs run separately as differently aged populations require different types of care.

Inpatient treatment is where most of the age and gender barriers come into play due to the coexisting, 24/7 nature of service. Separation of gender in inpatient facilities is common so that proper treatment can be provided and any problems with the population mixing can be avoided. Entire facilities devoted to one gender are rare as there are plenty of resources for both men and women.

What is much more common than one-gender facilities are facilities that focus on a specific age group. There are several reasons for this separation:

•  The brain doesn't fully develop until around age 25. Fully developed brains think and behave differently than those that are not fully developed. This leads to a gap in understanding and communication between the two populations.
• Priorities and responsibilities change. Children, teens, and young adults each behave differently as do adults in their 30s compared to those in their 60s. As age changes, so do priorities and responsibilities, which are equally as important to address in providing treatment.
• People are more comfortable in their age groups. The differences in brain development, priorities, and responsibilities makes it harder for one age group to relate to another. Separating age groups makes focused care easier to provide.

Travel for treatment is common and, usually, manageable.

Travel for treatment and how tedious it can be varies greatly by treatment type. Once an evaluation is performed and treatment type is recommended, travel and distance are often considered one of the biggest barriers. However, there are things to consider:

• Thirty-day-rehabs, extended care facilities, and sober living are sometimes more effective with farther distance from home. A common saying in the recovery community is to change "people, places, and things" in order to get and stay sober. When live-in treatment is distant from home, the opportunity for a client to be picked up by a friend, leave and go somewhere familiar, or have the temptation to do either, is less. Also, these facilities don't require frequent travel, just a there-and-back journey, so numerous hours in commute aren't really a factor.
• Outpatient treatment requires more frequent travel. For outpatient treatment like therapy or intensive outpatient, each visit requires travel to and from the facility. Keep this in mind when choosing a place to minimize the amount of travel necessary.
• Some facilities provide transportation. While there is usually a catchment area, some facilities will provide transportation to and from treatment. It's more common to find this service with live-in settings due to the minimal frequent travel. It's always worth asking.

An important note about travel: if your treatment requires frequent visits, what may seem a feasible travel distance upfront can become a tedious challenge down the road. Keep this in mind when determining the distance you're willing to travel.

Remember: there is a reason you've arrived at this point.

Scheduling treatment is one thing, getting to the intake is another. Often, willingness suddenly drops when it's time to go and hesitation kicks in. Whether you are the one getting help or you are trying to get a loved one into treatment, it's important to act fast and minimize the time to dwell on things that are suddenly a higher priority. More time spent in hesitation increases the chances for cold feet and a last-minute bailout. 

When it's time to go, stay directed by:

• Remembering what has brought you to this moment. Don't forget what the driving force was and why there was a need for help in the first place.
• Taking action. Lingering thoughts can be quickly changed by jumping into action; move a muscle, change a thought.
• Encouraging affirmation. Positive motivators work much better in this situation than anything negativity will bring; promote health and well-being whether it's for yourself or someone else.

Knowing about hesitation ahead of time can minimize its impact if it does arrive. These treatment barriers don't always happen and sometimes things move quite smoothly, but using this information to break through treatment barriers, it's a good idea to plan ahead.