Wall Street Journal Story 3-8-2018
After Addiction Comes Families Second Blow – Crushing Cost 0f Rehab
Michelle and Darin Vandecar have spent nearly all their time and energy in recent years trying to help their drug-addicted sons stay clean. They’ve spent nearly all their money, too. The Salt Lake City-area couple amassed $120,000 of credit-card debt, took out a home-equity loan and cleaned out part of their 401(k) to pay for multiple rounds of addiction treatment for their three sons, aged 18, 20 and 23. Their insurance covered some of the costs, but because their out-of-pocket expenses were so steep, they sold motorcycles and other belongings to raise cash. Lasting results have eluded them. The Vandecars’ oldest son just entered his third round of rehab for heroin after more than a year of homelessness. Their middle and youngest sons are smoking pot and attempting to stay off other drugs that have caused multiple overdoses. “We have incurred so much debt, but I know that if we didn’t do everything we could then I would always wonder if we didn’t do enough to help them,” Ms. Vandecar says.
The addiction crisis that is killing tens of thousands of Americans every year is also creating a financial crisis for many families, compounding the anguish caused by a loved one’s destructive illness. Families are burning through savings and amassing huge debt paying for rehab that often doesn’t work. The predicament reflects both the difficulty of treating addiction and the haphazard rehab and insurance system many patients face. The rehab field is highly fragmented, with thousands of small providers offering treatment that After Addiction Comes Families’ Second Blow: The Crushing Cost of Rehab Out-of-pocket expenses to save loved ones are soaring beyond what many can afford, especially when addicts go through multiple rounds of treatment March 8, 2018 12:07 p.m. ET By Jeanne Whalen often isn’t grounded in science. Some lack medical professionals or licensed counselors, reflecting the field’s roots in 12-step sobriety principles rather than medicine. Yet rehab services often cost big money, which insurers don’t always cover. Parents and family members desperate to keep their loved ones from overdosing find themselves shelling out again and again through rounds of recovery and relapse.
Federal data show that 22.5% of admissions for substance-abuse treatment involve someone who has already had one previous round of treatment. Another 21% involve people who have had two or three previous rounds, and 20.2% are for those who have had four or more, according to the Substance Abuse and Mental Health Services Administration. The insurance claims of Americans with employer-provided coverage show the rising burden.
From 2012 through 2016, spending for substance-use admissions to inpatient facilities rose 54% per person in this group, which includes about half the U.S. population, according to an analysis of insurance claims by the nonprofit Health Care Cost Institute. Total health-care spending per person in this population grew 15%. Consumers’ out-of-pocket spending for these substance-use admissions soared 80% per person, versus 12% growth for their health-care services over all. For some families, bankruptcy is the outcome.
Theo Haskins, a 57-year-old accountant in the Salt Lake City area, says her son’s yearslong fight with addiction contributed to her bankruptcy filing in 2013. She says she spent tens of thousands of dollars on nearly a dozen rounds of rehab, even after insurers kicked in more than $300,000. Michelle and Darin Vandecar, shown with photos of their children, are struggling with the financial burden of treating their three sons’ drug addiction.
Last year, her son Mitchell died of an overdose. “I spent literally every penny I had,” Ms. Haskins says. “After all this, I failed.” Addiction experts say the system is too ineffective to cope with the growing health crisis. One common approach involves sending addicts to 30- or 60-day residential programs, or to short-term detox, and then releasing them with little follow-up care, which specialists say isn’t enough time and support to have a lasting impact. “We have an institutionalized addiction treatment system that really can’t provide the kind of care that we now know is appropriate,” says Thomas McLellan, former deputy director of the White House Office of National Drug Control Policy, who is part of a public-private task force attempting to impose some standards on the field. A better system would treat addiction like a chronic disease, he said, with regular primary-care visits, drug-testing, counseling and medication.
The medical expenses don’t relate just to rehab treatment—many parents are shelling out for ER visits when a child overdoses, sober-living homes where they can live long-term with others in recovery and plane tickets to fly loved ones to treatment centers in other states. In a panic, parents sometimes send their children to the first rehab with a vacancy, even if it’s outside their insurer’s network, adding to the cost. “You are in an extreme hurry because your kid is on heroin. I had to find a place, not knowing anything, within 48 hours, or he was going to go and start using,” says Susan Carlton Oquendo, a Utah mother who took about $50,000 from her retirement savings to fly her son to a Florida rehab facility she found online after a frantic Google search. When they are sober, people suffering from addiction often express guilt over the toll on their loved ones. Betsy LeGallais of Pensacola, Fla., estimates she and her mother have spent $120,000 over the years on addiction treatment for her 25-year-old daughter, Anna Lewis, who started using heroin in her late teens and then turned to alcohol.
A few months ago, copayments for Ms. Lewis’s latest round of detox took what little savings Ms. LeGallais had begun to build back up again. She sat down at her laptop to write her daughter a letter. “I would give the last breath that I breathe to make you happy and healthy but I know that that has to come from you,” she wrote. “We are tired and funds have been exhausted.” On a recent afternoon near Birmingham, Ala., where she is in a sober-living home, Ms. Lewis teared up, saying the letter felt like “a blow to the knees.” She said she is painfully aware of the money her mother and grandmother have spent, and has felt obligated to pay back what she could when she has been able to work. “I think that I always will,” she said. The Vandecars’ medical crisis began in 2012, when their middle son, Colton, was hospitalized after attempting suicide. Repeated ambulance rides and high copays for inpatient stays to treat his suicidal tendencies and drug use began to add up. Their financial stress worsened in 2013, when Colton and his younger brother Jake entered residential addiction treatment around the same time. Jake had just overdosed on a powerful cough medication containing dextromethorphan, which can generate euphoria and hallucinations. His mother found him collapsed on the sofa taking rapid, shallow breaths, and called an ambulance. Colton had previously overdosed on the same drug and was also abusing it with his brother that day.
“You just feel like a failure,” Ms. Vandecar says, her voice breaking as she recalls that day. “You never think it’s going to be your kids.” She took out her frustrations by writing a faux Christmas letter she never sent, summarizing her sons’ year of drug and alcohol use and the “enormous pile of tissues from all the tears that I have cried.” A local hospital recommended a treatment facility called Youth Care, which is part of Acadia Healthcare Co. , a Tennessee-based mental-health-care provider in 39 states. It required an upfront payment of $12,000, which equaled the family’s annual out-of-pocket spending limit on their insurance. “The treatment centers would check with insurers and say, ‘what is the maximum out-of-pocket?’ And then they wanted that upfront,” Mr. Vandecar says. They used what was left in their health-savings account, and then a combination of savings and credit cards to make the payment—and did the same again a few months later, in January 2014, when their sons were still in treatment. The insurance calendar-year had reset, with a new $12,000 limit to meet. Ms. Vandecar said the treatment facility seemed well-run, and she was “very hopeful it would work.” It didn’t, she thinks, because “my boys really did not want to get clean.”
Trina Packard, chief executive of Youth Care, said relapse is part of the treatment process, particularly among adolescents not ready to give up substances. “We see a very high rate of families who do need treatment more than once for addiction,” she said, adding that a family’s upfront costs depend on their insurance plan. After the brothers left residential treatment, Jake attended a Youth Care day program that included therapy and school, but was kicked out for coming to class high after snorting prescription drugs and abusing marijuana and cough medicine, his mother says. Colton also started using again, and would soon branch out to cocaine, methamphetamine, heroin and acid. The Vandecars put another $10,000 on their credit cards to pay for weekly counseling sessions at home for the family, which their insurer, UnitedHealthcare, wouldn’t cover, they say.
Mr. Vandecar was earning more than $150,000 a year at the time as an executive at an information-technology company, but the couple also had two daughters to feed, along with mortgage and car payments. They started tapping their 401(k) to pay down some of the card balances, Mr. Vandecar says. Over the years they drained about $300,000 total from retirement to pay credit-card bills and other expenses, including legal fees related to their sons’ troubles with the law, he says. Undermining their retirement savings didn’t feel good, the 53-year-old says, but they decided “we’ve got to put the life of our boys first.” In late 2014, a drug court ordered Jake back to rehab, after he failed a drug test and overdosed on alcohol. He entered a state-run facility about an hour from Salt Lake City, where he stayed till the summer of 2015. Halfway through the facility sent the Vandecars a bill for $15,000. After opening it, “I just sat in the car and cried,” Ms. Vandecar, 45, says. “We’d just already paid so much.” The Vandecars enrolled their sons in a variety of treatment programs, including Youth Care, near Salt Lake City.
They eventually got that bill reduced through court proceedings, but they were struggling. “For a long time food bills went on the credit card because we didn’t have the money to pay for it,” Ms. Vandecar says. At one point, when they needed to pay a medical bill, they decided, “What can we sell?” Mr. Vandecar remembers. They settled on his KTM motorcycles, a pair of Austrian bikes that sold for $8,000 on a local website. In 2015 they moved to a less-expensive home—and then took out a home-equity loan on the new house to pay down more of their credit-card debt. Around the same time, drug problems were becoming worse for their oldest son, Zak. He had begun using marijuana in middle school and progressed to prescription medication, acid and then oxycodone when he got a prescription for the painkiller after breaking his big toe. Eventually one of Zak’s brothers told his parents he was using heroin. In early 2016, the then-21-year-old went to a small rehab run by privately held Turning Point Centers, which was one of the few places insurance would cover in the Salt Lake City area under a new job Mr. Vandecar had started. The couple used a credit card to pay $2,500 upfront—their annual out-of-pocket maximum per family member at the time. Zak stayed for about a month and then moved home, but within a few weeks his mother found needles in the garbage can. He had relapsed. Zak returned to Turning Point. The insurance stopped paying after about 12 days. His parents A photo shows the Vandecar family as the parents eat dinner in their Salt Lake City-area home with their youngest daughter.
The parents moved him to a sober-living home that cost them $600 a month. He soon relapsed again. Turning Point offers residential and outpatient treatment and recommends that patients commit to 90 days of care, but families and insurers don’t always follow that advice, said Chris Mackintosh, chief executive of Turning Point. He said relapses are common in most chronic diseases. When the Vandecars needed a rehab facility again, they chose a different institution. This time it was for Colton, who had been abusing a variety of drugs, including heroin, since his last round of residential addiction treatment in 2014. In mid-2016 Jake found him on the floor choking on his own vomit after an overdose, his mother says. His parents sent him to Recovery Ways, a facility partially owned by private-equity firm Chicago Pacific Founders. Colton went through three separate monthlong stays there. After each visit he would go to a sober-living house, relapse, and repeat the now-familiar cycle, accumulating thousands of dollars in more copays and fees. After he got out of rehab at the end of August, Colton says he tried to overdose on drugs in an attempt to end his life. When he didn’t succeed, he says he decided to strive for sobriety. He drew inspiration from a fellow patient at Recovery Ways who had spoken glowingly about a previous period of abstinence. Since then Colton says he has been smoking pot but staying off other drugs. “It’s the only part of the last few years that has been worth living, that I can remember,” he says. His friend from rehab recently died of an overdose, he says. Michelle Vandecar, right, with Jake and one of her daughters, says she has run up tens of thousands of dollars in credit-card debt on rehab for her sons.
Andrew Sidoli, executive clinical director of Recovery Ways, says the facility delivers the “highest quality” care, with a staff including an addiction psychiatrist and masters-level therapists. Jake, whose use of meth last year landed him in the ER, is living at home. His mother says he acknowledges smoking pot but is trying to stay off other substances. He declined to comment. In late 2016 the Vandecars kicked Zak out of the house for using drugs and stealing their belongings, which they said he was pawning for cash. Zak spent about a year living in his car. After getting caught shoplifting for food, he recently began another round of treatment, this time at Recovery Ways—where Colton had relapsed and returned several times. He wasn’t reachable for comment there. “We always want to keep trying,” says Ms. Vandecar. “I think it’s just desperation, hoping this time it will work.”
Write to Jeanne Whalen at firstname.lastname@example.org Appeared in the March 9, 2018, print edition as ‘Rehab Costs Add to Anguish of Addiction.’
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