This commentary was inspired by a comment on a Facebook post by The Addict’s Mom asking the question “Do you believe that recovery can only happen in a 12 step program?” My response got so long, that I decided to post it to my blog instead.
There is no one “right” thing that works for everyone. There needs to be more attention paid to alternatives. One reason 12-step is “pushed” is because it is free. Treatment plans, motivated by $$, include connection clients with community (read free) resources for post treatment support. Insurance has shaped the current treatment models, and even the legal system has bought into this notion that 12 step is the answer. It is good that the legal system is recognizing that treatment is essential, but again, 12-step and 12-step based program as not the only effective treatment modalities.
12-step self-help absolutely is the answer for many, but not all. It is interesting that 12-step is often considered treatment, rather than sober support. So how do we help the folks it doesn’t work for, without telling them they will die if they don’t embrace 12-step? Yes, I have actually heard this statement from counselors and UR (utilization review) people at treatment centers.
I confess I did work for an insurance company, Cigna for 5 years, and a learned a lot. I have been in the addiction field for more than 25 years, and have seen how insurance, and therefore money, impact conventional addiction treatment. I have also seen how treatment has influenced 12-step. It was inevitable, and not totally a bad thing, but with the influx of people “mandated” into 12-step programs, the meetings got larger, and also brought “treatment-isms” into the meetings. Conversely, there are many 12-step-isms brought into treatment, which of course makes sense, since the prevailing treatment modality covered by insurance and mandated by the legal system are “Minnesota Model” or 12-step based.
It is interesting that length of stay for inpatient rehab facilities is shorter for people using their insurance benefits. Most are shocked, because they expect the 30 days listed in their plan benefit. They don’t really know about the criteria for determining the length of stay is up to the insurance company. So in order to stay longer, patients and/or their families need to cough up the rest of the fee for any additional days, plus the copayment amounts for the covered days. This is often an unplanned expense and a hardship for many. For some, it is impossible, and the patient is discharged to a lower level of care that is covered, but that they might not yet be ready for. (Ex: intensive outpatient, of which I am a huge supporter, but I also know that some folks need some serious time in inpatient first to be able to succeed)
There is no insurance plan that I know of (disclaimer, there may be, but I don’t know of any) that covers long term treatment. That is, more than 28 or 30 days. So these facilities are covered by the patients and their families, faith based organizations, donations and sometimes, but the agency mandating the care. For example, in NJ, the child protection agency is DYFS (or was, they have changed their name and acronym). If DYFS mandates a parent, usually a mother, into long term treatment, or any treatment, they pay for it if the person doesn’t have the resources to pay for it.
Without splitting hairs here, the mother may be put on Medicaid to pay for it, I’m not sure if it actually comes out of the DYFS budget, but it is somewhere connected to public monies. That’s not what I am against; I think it is money very well spent. But isn’t the real question who determines what is the best type and level of care for the person?
This question will be addressed in Part 2.
Are 12-Step programs the only way, no. Yet almost any treatment program is going to recommend going to 12 Step programs after their program ends. Most of us (16+ years addiction free) need the long term support the programs offer to keep us reminded of what is in store if we relapse. It is a shame that the insurance companies have gotten into the recovery business as their motives are not too pure (my opinion).
Yes, Mark, we are on the same page, the motives of the insurance companies are not pure, at least not for the covered person. I rant about that every once in a while, and having worked for an insurance company, I know their motives. Let’s just say I kept getting moved around and lectured about approving too much treatment. They couldn’t really fire me, but I am sure management did the happy dance when I left. 🙂
Jerri,
Very interesting blog for me to read especially living in Canada.
I cannot wait to read part 2
Cheryl
I only know a little about treatment in Canada. I was invited to do a talk for a group of Canadian dental hygienist last year, and did some research. Private treatment is paid out of pocket, so no insurance interference there. I found some private rehabs that seemed to be 12-step based, but others that weren’t’, and some out of country rehabs that advertised to Canadian clients, those were a combination of alternative and 12-step based.
I had more difficulty finding out about publicly funded or available through the system, I think I just didn’t know how to find it. I assume that a referral needs to come from the primary physician, but I really wasn’t sure. I have friend who shared a real nightmare from a friend of hers who was trying to get treatment for her drug addicted son in Canada. You’ve inspired me to look into it again to have resources for my Canadian friends and colleagues. Thanks for commenting Cheryl!
Interesting blog Jerri.. such a shame money is the decider in someone’s recovery.
Rosemary
Yes, it’s bad enough when someone doesn’t have financial resources, but for many people, at least here in the US, they think they are covered because they have insurance and surprise! they aren’t covered they way they thought they were. I”m not sure what it’s like in the UK, I suspect it’s similar to Canada because of the socialized medicine. Private pay is on one side, and public on the other.
Are you familiar with the 16 Step program developed by Charlotte Kasl? I love it! It’s more empowerment based rather than shame based. It was designed specifically for disempowered groups like women, minorities, LGBT, etc. Check it out if you’re not familiar with it. It’s also a free program.. if you can find a group.
Yes Liz, I am very familiar with Charlotte Davis Kasl. I have been using her book as a reference for a long time and have integrated many of her ideas into how I work with women. Thanks! Jerri
I agree with Mark that the 12 step program is great when you start off in recovery, having the love and compassion of others who have been through what you have been through and a source that you can keep going back to to prevent relapse. In South Africa all government rehabs refer you to a 12 step program through and after your treatment. I truly believe that we have a daily reprieve which is dependent on our spiritual condition. In this respect we need to learn more about spirituality from other resources. What upsets me though are the 12 step rehabs that are making money off people who can get the same information for free and claiming from the medical aid benefits that are so scarce anyway. Waiting to hear what you have to say in Part 2.