Author: anonymous

…by Nick Jaworski…

After nearly 80 years, addiction treatment in America is slowly warming to the idea of multiple pathways to recovery, after viewing the 12 steps as the only “real” way to recover. MAT (medication-assisted treatment) is among the most promising.

This is a guest-post by Nick Jaworski, owner of Circle Social Inc., a marketing and consulting firm specializing in addiction treatment. (See bio information at bottom)

……………………

Quite recently, MAT has gained recognition as the gold standard for care in treating opioid use disorder (OUD) among researchers, legislators, and even the general populace. But the acceptance of MAT by the professional treatment community has not been nearly as fast.

Many providers I speak with are still very reluctant to accept MAT in their centers or as a viable component of treatment within the field in general. Even if facility leadership is on board, there’s a good chance staff or referral partners won’t be.

Other providers, such as Hazelden, were also reluctant at first but looked at the  research and made their own determination that they had to change their approach (other providers, even today, still look down upon them for it).

Congress and many States have also recognized the efficacy of MAT and so have begun to pump serious money into programs that offer it (like this large grant from SAMHSA). Insurance providers often prefer MAT as well.

Cost is a very significant factor for legislators and insurance providers. MAT protocols can be provided to those struggling with opioid addictions at a fraction of the cost of a residential program ($4,000 or less a year versus $28,000 a month for your average residential program).

Since the majority of those struggling with addiction lack resources or are on Medicaid, MAT also opens the doors for the demographic with the greatest need to access care.

There are two additional drivers of the increase in the use of MAT in the US — Wall Street and parents.

Wall Street has seen great opportunities because the opioid crisis is constantly in the news and the addiction treatment industry has an estimated market cap of at least $35 billion per year. These investors come from outside the field and do not have the same biases. They look at the data and see what’s effective and where trends are going.

And then there are the parents referring their adult children into treatment. Many parents, especially mothers, have become completely disenchanted with the addiction treatment industry as it has existed since the late 1990’s.

Their Children Are Dying from Overdoses, and Parents Aren’t Taking It Lying Down

The bottom-line is that length of care is one of the highest predictors of success for treatment, so any 28- to 90-day program has very slim chances of success for the first round or two of treatment, regardless of what model they are using. To move away from abusive substance use requires extensive development of new neural pathways that drive new habits and patterns of thought.

As outlined in my article on a Brief History of Addiction Treatment Marketing, it was not uncommon for these young adults to go through 10-plus rounds of treatment. My team and I actually just interviewed a client who was currently on his 27th round of treatment!

As you can imagine some parents have become extremely skeptical after 10-plus rounds of failed treatment (not to mention that they’re paying as much as $30,000 a pop). But, more importantly, many parents have lost children to opioid overdose. The 18-26-year-old age demographic has always had the highest prevalence of drug and alcohol abuse. Most of the time, this is alcohol or marijuana, with smaller percentages using meth, cocaine, and other substances.

However, with the rise in availability of opioid-derived prescription pills, more young adults were switching to these painkillers, which have a high potential for overdose when mixed with other drugs. A subset of these users would go on to heroin, especially when prescription regulations reduced the availability of legal drugs. As most readers know, the extremely high overdose rates of the last few years have been driven primarily by fentanyl-laced (or -replaced) heroin. Unlike in the past, when young adults using drugs or alcohol mostly survived to go on and live normal lives (probably like most of those reading this blog), these kids were dying instead.

So parents were sending their children to multiple rounds of rehab, paying tens of thousands of dollars, and then losing their children to overdose anyway. As you can imagine, this created a lot of anger and resentment.

But that was nothing compared to the anger many parents felt when they learned there was this option called MAT that decreased overdose deaths by roughly 40-60% and they had never heard about it! It’s not uncommon for parents who have lost a child to overdose to tell me that the first time they’d heard about MAT was after their child’s death.

Imagine how you would feel if you sent your child to the hospital and you weren’t even told of a readily available and cost-effective method of preventing your child’s death because the doctor personally didn’t care for the treatment.

This is the kind of anger we see from parents such as Gary Mendell, who created Shatterproof, or Justin Phillips, who created Overdose Lifeline. Parents are simply giving up on the traditional rehab industry as a whole because they feel lied to.

American Addiction Treatment Perspectives Are Shifting, But in What Direction?

All of this has started to open the window to different conversations surrounding effective addiction treatment. Programs relying solely on 12-step and abstinence-based models are regularly being called into question.

However, I am not yet seeing an attendant shift in the disease model of addiction. Conferences premised on non-disease models are still small, and advocates of this approach are still few and far between.

I am on the board of Above and Beyond Family Recovery Center in Chicago, one of the most innovative treatment programs in the country. We focus on providing free, high-level outpatient treatment to Chicago’s homeless and disadvantaged, but we have had a hard time gaining the support of other treatment programs in the city because we do not focus solely on 12-step programming or disease models of treatment (although these are offered alongside our other programs).

Americans have a long history of deterministic thinking when it comes to human behavior. Starting with Calvinistic predeterminism in colonial America and then evolving into Eugenics, the American view of genetic influences rarely goes beyond a limited and simplistic notion of Mendel’s pea experiments (perhaps a topic for a future blog post).

With this misconception, most Americans still view addiction as some kind of genetically predetermined disease, one that is chronic, progressive and incurable.

In the context of our conversation here, MAT is seen as some kind of fix for an ingrained defect, one that perhaps rebalances out-of-whack or deficient neurochemicals in the brain. What most Americans have not yet grasped is that MAT, or any other substance that alters the brain’s neurochemicals, simply combats symptoms, which is not so different from how cold medicines alleviate symptoms rather than cure the actual cold. The key difference here is that OUD symptoms induce so much suffering that users are often driven to continue using. Opioids are of course the best (if not only) way to control opioid withdrawal symptoms. In this respect, relieving symptoms, though not a cure, can change behavior patterns that exacerbate the underlying problem.

In order to truly find recovery, you must rewire the neurological pathways in the brain, which will, in turn, drive changes in neurochemical balances. Just as one cannot lose weight or get fit by taking a diet pill, individuals cannot overcome addiction by taking a prescription. The pill can help, but lasting behavioral change requires focused effort over extended periods of time, as Dr. Lewis has often pointed out.

It is only through an accurate understanding of the interplay between genes, environment, and human experience that we can create effective solutions which help individuals and communities. It’s a goal I strive towards every day and I hope others reading this will do the same. For a much more in-depth discussion on how unconscious processes involved in learning and development (rather than genes or choice) drive addictive behaviors, see my article You’re Thinking about Addiction and Choice All  Wrong.

………………………………

Nick Jaworski is an internationally recognized executive in the field of behavioral health marketing and operational consulting, with experience building organizations world-wide. As the owner of Circle Social Inc., he has helped healthcare organizations perform turnarounds and accelerate growth. He and his team spend most of their days in and out of treatment programs across the country. They do extensive analysis of trends, observe programs, interview patients and families, and analyze data from marketing campaigns. Nick is an advisor to the board for The Behavioral Health Association of Providers, and is also on the board for one of the most innovative treatment programs in the country – Above and Beyond Recovery.

…by Eric Nada…

This remarkable guest post dives back into the controversy surrounding the rigidity of the 12-step approach.

………………………………..

I left 12-step involvement after 20 years of committed membership. It was surprisingly difficult. Of course, it was difficult to stop shooting heroin too — so difficult that I eventually stopped trying to stop. By then, the course of my life was almost totally dictated by my rigid attachment to the heroin itself and by my overwhelming fear of withdrawal. By the time I finally quit, 24 years ago, I was homeless, panhandling for hours a day, supplementing my begging with daily theft, and facing a mandatory prison sentence on felony distribution charges. I had attended over a dozen rehabilitation and detoxification centers but made no progress with recovery — until I begrudgingly committed myself to the 12-step program. And while this worked, at least insofar as helping me break my bond to drugs, it did so at a cost: I had to join a powerful subculture that required me to ignore key elements of my personality and my beliefs.

(See Eric’s Guest Memoir, which conveys the details of his experience.)

In the beginning, I thrived through the social connections I developed. I felt understood, and supported for the first time in years. Following this initial connection to its members, I slowly began to accept other elements of the 12-step philosophy, allowing them to influence and shape my views on the nature of addiction and, in some ways, on my approach to life.

I estimate that I spent at least 5800 hours in meetings, not to mention the hours I spent both in sponsorship and casual conversation with other members. Meetings were spent in repeated discussions extolling the validity and certainty of 12-step truth — an almost daily feedback loop of self-reinforcement. This was carried out with others who, by the very nature of selection bias, were guaranteed to agree with me. Within a year, I was thoroughly conditioned. I came to believe that I was plagued by a fixed condition that required a very particular solution — a solution that didn’t evolve and was unaffected by any personal changes I might make along the way. It’s not an exaggeration to describe the basic 12-step formula as follows: You have an unchangeable condition, X, the cure for which is Y and only Y. If you stop doing Y, you will eventually die of X.

For almost two decades I believed in and applied this formula. But as I matured and grew, expanding my understanding of the mechanics of addiction and emotional development, I couldn’t help but begin to question its certainty. Eventually, I realized that I had developed a very real dilemma which pitted my evolving instincts against my 12-step training. I found myself at a crossroad: do I trust myself or do I continue to trust the 12-step message? Ultimately, I decided to trust myself.

The program had “programmed” me and I needed deprogramming. This was actually a precarious process and one that is rarely discussed, let alone studied. Immediately upon leaving, I felt a great relief. But any positive and encouraging feelings I had were initially accompanied by feelings of guilt, shame, and self-doubt. I became aware of a deep internal message that challenged the idea of trusting myself over the 12-step dogma I had lived by for so long. Also, from deep inside came a haunting temptation: to play out the scenario of relapse and a return to out-of-control drug use, viewed as the inevitable consequence of leaving the 12-step fold. It was an established meditation practice that helped hone my awareness. Only through the use of mindfulness was I able to decipher the 12-step message and avoid its prophecy. I also spent much time online scouring the internet for stories and forums written by others who had made similar moves. It has been over three years now, and although it is no longer acutely difficult, I am still sorting out and ridding myself of the last tendrils of doubt and conditioned 12-step messaging.

We are born to be conditioned. We are, indeed, conditioned even before we are born — molded by the experiences of the woman carrying us in her womb. Without conditioning there would only be chaos. There would be no tribe or community, no culture or customs. Our human egos need these containers to make sense of and navigate daily life. But obviously not all conditioning is healthy or optimal. We need to examine and upgrade our conditioning continuously as we grow and require different versions of containment. I have never been so conditioned, obsessed, or emotionally rigid as when I was using heroin. And certainly the conditioning I developed through my 12-step membership aided in breaking through this rigidity. It was a definite upgrade. But as I continued to grow, I didn’t take regular stock of whether I was still benefiting from my 12-step involvement; because, by its own definition, the 12-step approach can’t be outgrown.

I have often heard discussions suggesting that 12-step recovery would be more effective if it weren’t so rigid, if it were truly permissible for members to come and go without judgement. But I don’t think it would work. It’s the underlying rigidity that accompanies 12-step involvement that makes it potentially effective. Unfortunately, I commonly see this hard-lined rigidity follow long-term 12-step members into other areas of their lives.

Optimal mental health is found neither in rigidity nor in chaos, but in the nuanced flexibility that lies between these poles. Recovery, too, can be nuanced. There just isn’t a one-size that fits all, and recovery needs room to evolve, especially after the initial bond between person and drug has been broken. I still have moments when I deeply want those 20 years back, to live fully, untethered from the “program” that scripted so many precious hours of my life and prescribed so many of my relationships and personal interactions. I do not condemn the 12-step approach to addiction, and there are certainly other positive components that could be discussed. But ever-present is its underlying rigidity. And as I look back at its stifling influence over half of my life, I have yet to decide whether the benefits were worth the damage.

For years, Maia Szalavitz has been making insightful, practical, and evidence-based contributions to the struggle against “the War on Drugs” and the harmful policies that emerge from it. With her permission, and the permission of editor Will Godfrey, I’m posting passages from an article she published in Filter, a magazine covering drug use, drug policy and human rights, on October 8, 2018. This is the most important article on opioid addiction treatment I’ve ever read.

 

The following text is Maia’s writing, though I’ve spliced and diced it and extracted only the key components (in my view).

………………..

As panel after summit after commission after white paper is put forward claiming to solve the overdose crisis, you’d think that somewhere there’d be a short, sensible guide for how to improve our health care system to better manage addiction and pain.

But most of these reports and discussions dance around the edges and bureaucratic obstacles to change. Few address the fact that deep systemic change is needed.

1) Genuinely expand access to medication treatment—yesterday.

We have two drugs that are proven to cut the death rate from opioid addiction by half or more when used long term: methadone and buprenorphine. Anyone who is addicted to opioids and  wants to get even a single dose once should be able to access these medications on demand—in hospitals, doctor’s offices, emergency rooms and syringe exchange programs…. No urines or counseling or abstinence from opioids or other substances should be required to get these drugs, just as those barriers are not imposed on people with other disorders who need medication.

The DEA and state prosecutors also need to stop targeting buprenorphine prescribers, regardless of whether they are providing optimum care. Simple access to the medication saves lives: Get out of the way!

2) Stop forced tapering of pain patients and provide real access to proven alternatives.

In response to the overdose crisis, in 2016 the Centers for Disease Control released a set of guidelines intended to reduce overuse of opioids in the treatment of chronic pain in primary care…  [T]hese were rapidly “weaponized,” as Dr. Stefan Kertesz of the University of Alabama put it in an excellent paper.

Basically, the guidelines are now seen as the national standard of care—and stepping outside the maximum recommended dosages is viewed as flirting with medical board or even prosecutorial scrutiny, even for specialists. Their recommendations are being applied indiscriminately, with even some cancer and end-of-life patients being denied adequate pain relief.

Simultaneously…many doctors have simply decided to stop prescribing opioids, period. States are also creating rigid policies while insurers and pharmacies are increasingly restricting what they will allow… The result is tens of thousands of patients—many of whom were formerly medically stable—being left in pain, increased disability and withdrawal. Dozens of suicides by pain patients have been reported. People with addictions whose prescriptions are cut are not being helped either. This simply makes their addiction more dangerous by pushing them to street drugs. It is not treatment…

No evidence shows benefit from forced taper; some suggests severe harm.

3) Create a tiered system for addiction medication access.

For harm reduction, what’s needed is a welcoming place where people can simply get a dose of medication and see some friendly faces. This…provides rapid access and guidance into care for those who decide they do want additional help…If you are successfully managing any ongoing mental health issues, you don’t need to keep showing up at a clinic.

For stabilization, people who want to put their lives back together need easy access to services that meet their particular needs, such as counseling, medication-friendly peer support, psychiatric care, housing and job training…. [T]he goal is no use of non-prescribed opioids, but it is flexible and nonjudgmental. For example, in an effective system, non-medical marijuana use would be ignored…

After people have been stabilized, however, they will need the third track, which [avoids] interaction with people who are still actively addicted. If you have a job and family and are successfully managing any ongoing mental health issues, you don’t need to keep showing up at a clinic or get further counseling.  This track—sometimes called “medical maintenance”—basically requires a once-a-month check-in to get medication via a primary care doctor and ensure all is well.

5) Create and fund a full range of harm reduction services.  

In order to save lives, we need safer consumption spaces (or better yet,  call them “overdose prevention sites”) in areas where drug use and sales are concentrated…

We also need shelters and housing, separate from those aimed at stabilization and abstinence, for people who are actively addicted, many of whom are also mentally ill and have symptoms related to severe trauma. When people have safe places to live and to use drugs, they are both much more likely to survive and much more likely to find ways to sustained recovery.

6) Decouple “beds” from treatment.

People with addiction have a wide range of individual needs, and institutional “programs” will never be able to meet all of them. Moreover, once a treatment “bed” is labeled as such, it generally becomes more expensive than an ordinary, safe place to stay. “Sober homes” also tend to be based on a 12-step ideology, which is fine for those who find that pathway amenable, but not for those who don’t—and not when that ideology is interpreted to stigmatize and discourage medication use.

For most illnesses, medical and psychiatric, people recover better when they can stay in their own home with their friends and family nearby…….

The mental health field has recognized that institutionalization is generally harmful and that, when needed, should only be used for the shortest possible time. Addiction treatment needs to catch up.

We need a system that provides a menu of individualized options—not residences staffed mainly by non-medical people that charge inpatient hospital care rates.

9) Decriminalize drug possession.

Since possession arrests do not deter drug use, raise drug prices or treat addiction, every cent spent [arresting and jailing people for drug possession] is wasted. But it’s actually more harmful than that. People arrested and jailed for opioid addiction lose their tolerance and are three-to-five times more likely to overdose after release than if they had not been incarcerated.

Worse, the primary purpose of criminalization is to stigmatize drug use and people who take drugs—if criminalization is to deter people, it must stigmatize. And that stigma, of course, is a huge barrier to getting people into treatment whether for addiction or for overdose; to making treatment more effective; to expanding harm reduction; and basically to everything we need to do to end the crisis.

10) Make universal health care happen.

While having a national health care system in the US once seemed to be a pipe dream, the increasing embrace of “Medicare for all” by Democrats and the fact that majorities now support it in polls means that—providing we survive the current administration—it may soon be possible.

……………………….

Reprinted from an article by Maia Szalavitz, October 8, 2018. Please see the full article, published by Filter. Here is the direct link. You can follow Filter on Facebook or Twitter. Maia’s recent book is available at Amazon and other outlets.

 

 

I want to thank people for their very encouraging comments and suggestions following my last post. They have really inspired me. So…I’m going to keep the blog going for a while, and I’m going to enjoy it.

Now here’s that guest post I promised you–

 

…by Michael A…

After going through 28 rehabs within 3 years, I now carry 3½ years of sobriety. During my recovery attempts, I fell into an unforeseeable yet common addiction. I became addicted to rehab itself, sometimes called the “Treatment Shuffle.”

My addiction started as many commonly do – partying at a young age and going too far until I needed drugs every day to feel ok with all my insecurities. By the age of 21, I was crying for help, addicted to cocaine and opioids. Thanks to my mother and her insurance, we were confident we could find affordable treatment. Researching treatment revealed an overwhelming number of drug rehab centers, most of which looked like 5-star resorts. This appeared like a nice way to step away from my broken lifestyle. Neither I nor my mom knew how to appropriately vet treatment, and I chose the one that appealed to me aesthetically. My mom was just happy I was going somewhere safe, away from drugs.

 I was astonished by the luxury when I arrived, but still nervous about this life change. I was approached by a client who befriended me, giving me an education on the “how to screw the system” plan that most of the clients followed. I learned about abusing detox meds, how to act like the perfect client, and who to get real (illegal) drugs from, all within the first week.

After the detox and stabilization phase, I was sent to a less structured environment to transition back to normal life. This concept should work. However, this center, like many others, placed me in a low-income area surrounded by drug activity. Imagine 50 people from all over the country who just want to get high in a house where drugs are right over the fence. Most clients hopped the fence every day, got high, and hooked up with girls (it was a coed rehab). It was chaos. Being insecure, I fell right in. We’d get caught, sent back to detox, loaded up on suboxone and benzos (detox meds we’d get high on) and start treatment all over. The insurance billing cycle restarts and we would too. These types of centers benefit if you relapse because they can bill your insurance at a higher level of care.

I didn’t learn much at this 30-day treatment center. No healing took place, and all I wanted was to keep numbing my emotions with drugs. When I finished, I went to a sober living house, attempted AA, but continued to relapse. I still needed some real therapy. As time continued, I met more experienced users, got into new drugs, and learned more about how to use rehabs and detoxes to support my addiction.

I played out the same pattern for about 3 years. I’d get high until I ran out of money, then go to detox for a free (insurance covered) high on opioid-benzo detox cocktails. When I really needed a reset, I would check into luxury treatment centers to get food, sleep and “work the system.” My insurance was great, and I found sober living homes that welcomed me to live there for free and get high, as long as I attended their outpatient rehab program. Treatment centers got paid for every relapse, and my addiction got worse. I knew I needed something more. I had to get away from this lifestyle of rehab hopping. There had to be something different.

By talking to people who had sustained sobriety and success in life, I heard about different approaches to recovery: Centers that were long term (3-5 months), challenging physically and mentally, and forced you to confront your traumas and negative thinking patterns. Places that used alternative approaches to therapy, such as SMART recovery, Rational Emotive Behavior Therapy, fitness therapy, and other critical thinking techniques to heal an addicted brain. For an analytical, physically broken person like me, this sounded like what I needed. I was guided to a place called Tree House Recovery in California, which offered this alternative approach.

When I got to Tree House, I began a routine of daily fitness therapy, team based training in the ocean that forced the pre-frontal cortex (logic & connection) to be engaged, intense motivational interviewing and therapy, and an addiction education that was more in depth than any other center had offered. It was impossible for me not to heal here. My brain got rewired, I felt empowered, and began to love life sober. I would highly recommend exploring Tree House Recovery to get an idea of evidence-based treatment that works. This was the one that worked best for me, but I would suggest doing the appropriate research for each individual circumstance.

If you know someone struggling with addiction, whether it’s their first time looking for treatment or the 28th time, look through the options. DO NOT let someone pick the easiest route. Do not rush into the first one that will take someone. Spend the time necessary time to make this the only/last treatment needed. Ask the centers you’re looking at for their success rates, and ask how they define success. Is it graduation rates, or graduates that have remained sober for at least a year after treatment? Ask how they obtain this data and how often. Ask what methods are used for treating the biological, psychological, and societal aspects of addiction: how often and why? Most importantly, read a lot of testimonials from graduates and parents.

Rehabs do work if you go to the right one and follow a successful routine to maintain a healthy lifestyle. I got sober to succeed in life. I learned how to use my drive (once used on drug seeking) to find happiness,  to achieve excellence and follow my passions. Having an addictive disposition can be seen as an advantage in life when that “go go go” mentality is used for good. I love life today, and am fortunate I survived the “Treatment Shuffle.” 6 ½ years later, I can say success is possible.

 

 

 

 

Sorry I haven’t written much lately. My family and I just moved from the Netherlands back to Toronto for six months. Busy summer! But here’s a guest post that may be especially valuable for those of us who keep on keeping on.

…by Danielle Kunkle…

As a Medicare insurance broker, I’ve seen everything under the sun when it comes to healthcare. We’ve had clients who are who are 95 go to the gym every day and take not a single medication. We’ve also had people who are 45, on Medicare early due to disability, taking over 20 medications.

There are both acute and chronic health conditions, and of course, there are mental health conditions and substance use disorders.

Far more than you might think.

In fact, Medicare foots the bill for millions of dollars of substance use treatment every year. It also pays for treatment of depression in the elderly, which is very common. There are many aspects of depression in the elderly such as loneliness and isolation which can lead to addiction.

As we age, we have fewer opportunities. Our bodies and sometimes our brains aren’t as functional as they used to be. We might lose our sense of purpose once we retire. We start to lose people we’ve known and/or loved for a long time. Kids grow up and move away, creating a sense of emptiness. We also must shift from actively earning a living to stretching Social Security and savings to last the rest of our lives.

My grandmother used to say: “Growing old is for the birds, Dani.” She may have been right.

While grief or money woes can cause depression at any stage of life, there are specific factors that make older people who experience depression more vulnerable to addiction, which in turn may be harder to treat.

One factor is that it is particularly easy for elderly people to gain access to prescription medications that later become a problem. Medicare beneficiaries might begin using pain medication innocently enough, but they can easily become hooked on drugs like opioids for chronic pain or benzodiazepines to treat insomnia or anxiety.

Doctors are often willing to prescribe these potentially addictive drugs for sleep problems or for vague aches and pains. They also may not spot a developing addiction because it’s too easy to misdiagnose declining mental ability or a dishevelled appearance as being due to depression or dementia rather than substance use.

Because Medicare is not part of a health insurance network managed by an insurance carrier, it’s easier for elderly individuals to “doctor-shop” for more medication than they need. Physicians can’t easily see who else is prescribing the same or similar medications.

Drug addiction is especially dangerous because our metabolism slows as we age. Substances take longer to filter through the liver and may build up in the body. This puts older adults at greater risk of dangerous side effects or accidental overdoses.

Another factor is the limited social circles of many elderly individuals. Many older adults live in isolation after the death of their spouse, which makes addiction easier to fall into. What used to be a glass of wine after dinner can turn into an evening of drinking away one’s sorrows.

Not all of these individuals will have children or younger family members living nearby who see them often enough to spot the problem. Even if they do, they may dismiss the signs because they don’t really think of addiction as being a problem for elderly people.

Addicted people may also contribute to this oversight. They may be secretive in their drug or alcohol use. They may feel embarrassed or ashamed of their addiction and go to lengths to hide it. Because no one is aware of the problem, an elderly person may have a harder time climbing out of an addiction.

While all of these things point to a greater need to identify substance use disorders in the elderly, there seems to be less urgency to treat them, as if this would be a waste of resources. Indeed, not everyone considers an addiction to be entirely negative. Someone who is living out their last years may prefer to be addicted if this means they are free from physical pain.

Yet older adults deserve the option to seek treatment if they want help with a substance use disorder. Just like younger people, they can and do overcome addictions with proper counselling and support.

Treatment, as many readers here know, can be expensive and ineffective. However, Medicare does provide considerable benefits for available treatment modalities:

Medicare includes an annual screening for depression and substance misuse or addiction. Speak to the Medicare doctor and request a screening.

If risky behaviours are identified, you can ask a physician to make a referral to services. Medicare will cover therapy in an individual or group session as well as treatment in an outpatient clinic.

Some cases may require care in an inpatient psychiatric unit or residential treatment center, both of which would be covered by Medicare for up to 190 days in a person’s lifetime.

Part A hospital benefits may also cover methadone or Suboxone that you receive during an inpatient stay whereas these medications are unfortunately not covered when prescribed for addiction on an outpatient basis.

If the prescribed treatment plan calls for other types of outpatient medications, you’ll want to be enrolled in a Medicare Part D drug plan. All Medicare drug plans include some medications designed to treat addiction, withdrawal symptoms, and depression.

To take advantage of Medicare’s benefits for these services, you must receive treatment from healthcare providers who are in Medicare’s network. There are over 800,000 providers nationwide and programs covered by Medicare can be found online.

Be aware that Medicare requires the Medicare beneficiary to share in some of the costs of treatment. They are responsible for deductibles, coinsurance, and copays.  However, individuals with Medicare supplement coverage may find that their plan covers some or all of their cost-sharing responsibility.

Often, elderly clients are unaware of their Medicare benefits for mental health and substance use problems. Spreading the word might help someone near you find the support they need.

………………………

Danielle Kunkle is the co-founder of Boomer Benefits and is a licensed Medicare insurance agent in 47 states. She and her team of Medicare experts can be found at https://boomerbenefits.com.