Rob Reiner's latest film is a very personal one.
"Being Charlie" tells the story of the 18-year-old son of a famous actor-turned-California gubernatorial candidate who bounces between rehab facilities for substance abuse treatment in the weeks before his father's election. The movie, penned by Reiner's son Nick with Matt Elisofon, is loosely based on their past troubles with addiction and quest for quality and effective health care.
"But it's a lot of stuff I experienced, a lot of stuff Matt experienced," Nick Reiner said on NPR's Weekend Edition. "And a lot of stuff that we witnessed people say and talk about."
Helping a loved one who struggles with alcohol abuse, drug addiction or both, is a challenge that millions of American families share with the Reiners. Almost 22 million people, or 8% of the population, have substance use disorders (SUDs), according to the Substance Abuse and Mental Health Services's (SAMHSA) most recent report. What most of those families probably don't have in common with the Hollywood clan: the ability to pay for treatment. Indeed SAMHSA has found that the single biggest impediment to getting help for substance abusers who want treatment is that they could not afford the cost.
If you or a loved one is struggling with drug or alcohol abuse, here's what you need to know about the problem, finding effective treatment and how to pay for it.
Scale of the Problem
By far, the most common substance abused is alcohol. Some 17.1 million people have alcohol use disorder, according to the the SAMHSA report, while 7.1 million dealt with an illicit drug use disorder. Another 2.6 million, or 12% of people with SUDs, abused both alcohol and drugs.
Recent adults, those aged 18 to 25, are particularly at risk for substance abuse. Almost 6 million young adults had SUDs in 2014, according to SAMHSA, which is almost a sixth of that age group. Substance abuse has been trending slightly downward among young adults since 2002—but this population is still the most likely to use and abuse alcohol and drugs.
For those suffering with substance abuse, finding affordable care is an ongoing challenge. Even those with health insurance have a difficult time finding providers in their coverage network, according to a recent report by the National Alliance on Mental Illness (NAMI). Among the privately insured, 22% said they couldn't locate a mental health or substance use therapist or counselor in their plan's network. That compares to 6% who couldn't find an in-network specialist for health issues not related to mental health.
"Most likely, these barriers are attributed both to severe shortages in qualified mental health professionals in most parts of the country and to inadequate provider networks maintained by mental health insurance plans," per the report.
More than half of the counties in the U.S. do not have practicing psychiatrists, psychologists or social workers, and only 55% of psychiatrists even take insurance compared to nearly 90% of physicians generally.
Rehab institutions are likewise difficult to access for many people in need of treatment. Using data collected from 2010 to 2013, SAMHSA found, in a separate report, that the biggest reason people who wanted substance abuse treatment, but didn't receive it, was they didn't have health coverage and couldn't afford the cost.
In total, 2.5 million people received treatment at a rehab center in 2013, according to SAMHSA's latest data, or 0.9% of the 12 and older population. That ratio has stayed consistent since 2002.
How did people pay? More than four in 10 used private health insurance, 41% dipped into their own savings or earnings, 29% used Medicaid and another 29% used public assistance other than Medicaid, while 27% used Medicare. Almost a quarter tapped family members for financial help.
The High Cost of Rehab
So many rely on funding from disparate sources because residential treatment centers can be prohibitively expensive.
Take the world-renowned Betty Ford Center. Patients with addiction disorders receive holistic, integrated medical care comprising various types of therapy, along with mental health assessments and medication management. Patients have a continuing care plan for a year following their discharge, where they keep in contact with Betty Ford staff.
What's the price tag? A 30-day inpatient stay costs more than $30,000, or about one year's tuition at the University of California-Berkeley. Insurance may ameliorate your burden, but out-of-pocket costs can still easily run to five figures.
Even more troublesome: You're not guaranteed to receive quality care for your money. A 2007 report from the Government Accountability Office "found thousands of allegations of abuse, some of which involved death, at residential treatment programs across the country and in American-owned and American-operated facilities abroad between the years 1990 and 2007," according to the report.
The GAO also found a pattern of programs employing untrained staff, lacking adequate nourishment for the patients (especially those in "tough love" programs), and reckless operating procedures.
Parents who are considering sending their child to a residential treatment center should rigorously research any prospective program. The National Association of Therapeutic Schools and Programs has a useful set of questions for parents to ask. Among them: Are you accredited by a mental health agency? What type of training is provided to your direct care staff? What is your success rate? And, What measures do you have in place to keep my child safe?
Strategies to Help with Payment
While families face considerable financial challenges getting help for substance abuse issues, there is some good news on that front: Insurance coverage for treatment is now more widely available now, thanks in large part to the Affordable Care Act. Building on the Mental Health Parity and Addiction Equity Act of 2008, the ACA requires all insurance plans to offer coverage and reimbursement of behavioral health treatment at the same rate as for any other medical problem; in addition, any plan bought on a state exchange must include mental health coverage. Meanwhile, the percentage of employers offering mental health and substance abuse coverage over the past five years has risen, according to the Society for Human Resource Management, from 82% in 2011 to 91% in 2015.
That's a boon for families looking for help in dealing with addiction. "Most substance abuse instances fall under the mental health benefit in employer sponsored health insurance plan," says SHRM's Bruce Elliot. If your child is struggling with addiction you'd do well to keep him or her on your plan until age 26, which is now allowed under another Affordable Care Act rule.
You should also take advantage of another workplace benefit: something called an employee assistance program (EAP). Almost 90% of large corporations offer an EAP, per Mercer, which helps employees and their family members address counseling needs, including for substance abuse, and direct you to long-term mental health providers.
Of course, insurance is of little use if your therapist doesn't actually take your insurance or is out of network. In this case, you pay the cost in full and then file a claim with your insurer later for reimbursement at out-of-network rates, if your plan allows you to go outside the pool of providers it works with. One big catch: If do receive some cash back, the amount won't be based on the actual bill but rather what your insurer deems "reasonable and customary," which is often substantially less.
You can negotiate with your insurer to let you pay the in-network cost for the therapy—known as a single-case agreement. You should also have a frank conversation with your therapist. See if you can work out a payment structure you can afford.
And save your bills for tax time—you can deduct your medical expenses if they exceed 10% of your adjusted gross income, or 7.5% for those over 65.