Why is trusting addiction treatment providers a concern?

The practice of business and personal ethics is essential when providing treatment for addiction. When patients become commodities to be traded and paid for on the open market like cattle at an auction, how far does that message permeate the entire treatment milieu? When a referral sources/ interventionists are given exorbitant gifts or are secretly paid extraordinary fees for presentations, consultations or the like, how far away from the cattle auction have you strayed?

What is required to establish trust?

Treatment should be based on the elemental principal of effective therapy: TRUST. Building trust requires that our actions are consistently trustworthy. Respecting the people who ask us for help includes recommending services which are accessible, affordable and appropriate to their needs. Call centers and referral fees diminish patient identity and places patient need below financial incentive.

How do you find a trustworthy addiction treatment program?

In-network treatment providers are held accountable to Joint Commission standards and insurance contractual conditions. “Out-of-network” providers are not accountable for unnecessary or costly charges. How many times have we heard about a family being misled about the costs of treatment after the provider of treatment posted that they accept insurance? What the provider accepted was out-of-network revenues which are much less than the cost of treatment. The patient ends up paying a significantly higher bill having been led to believe that the insurance company should have covered more.

What should you expect in writing to establish a sense of trust?

Pre-admission informed consent provides patients and their families the costs, the benefits and the risks of engaging in a treatment program. Building trust from honest and transparent conversations, Twin Town staff inform treatment candidates about what they can expect. These realistic expectations become the basis from which a therapeutic relationship can develop. If patients and their families are misled or feel defrauded, no relationship is possible.

What can happen when a treatment provider is found not to be trustworthy?

How many families receive bad news twice when their loved one checks out of treatment early, and when the provider refused refund the unused portion of what was paid toward that treatment?

If a laboratory invites you to share in the proceeds for medically unnecessary and absurdly priced urinalysis testing schemes, do you excuse insurance abuse as “scholarships” for charity or “investments” of a business nature? How long will access to out-of-network PPO benefits survive under this type of abuse? Have you earned the trust of the patient, their family and the purchaser of care?

How does the addiction treatment program benefit by maintaining trustworthy standards?

Doing the right thing is not easy but it is what sobriety, recovery AND TREATMENT should be all about.

Twin Town encourages all providers to set and publish ethical standards on their website. Setting ethical standards helps establish public expectations while distinguishing the responsible provider from fraud.

What distinguishes trustworthy addiction treatment from those which are not trustworthy:

• Refusing to accept/ pay referral fees or contract with referral mills (internet websites) to increase rates of patient enrollment. The patient and family geographic location, and the clinical needs expressed by the patient and their family are always considered when forming disposition/ referral plans.

• Refusing to mislead patients and their families with statements such as, “We’ll take your insurance and we will accept payment arrangements for the unpaid balance”. In situations where the patient and their family are misled at enrollment, they are later shocked by bills which may exceed tens of thousands of dollars. The reality all along was that the insurance would have only paid for only a few days of residential or out-of-network treatment.

• Refusing to contract with the patient or family for a “flat case-rate” for the entire course of treatment. Under flat case rate agreements refunds are frequently refused and the unused funds are pocketed.

What guides the standards of trustworthy addiction treatment programs?

Set ethical standards, integrate them into your “brand” and publish them on your website. Twin Town Treatment Centers publishes the following www.twintowntreatmentcenters.com:

• Provide only cost-effective treatment which is quality monitored.
• Before admission, provide full financial and service disclosure, and secure voluntary informed consent. Avoid surprises.
• Seek to protect the dignity and confidentiality of each client patient and their family members.
• Document and provide the treatment that is billed.
• Respect and protect clinical relationships with current and/or prior caregivers.
• Avoid transferring clients from care of therapists, counselors, psychiatrists and/or physicians. COORDINATE care with community professionals rather than setting up competitive or fragmented systems of care.

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS. All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation. Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

Drug-impaired driving is more complex than alcohol-impaired driving for many reasons:

• Hundreds of different drugs can impair drivers.
• Some drugs that can impair driving are illegal to use, some are legal to use under certain conditions, and some are freely available over-the-counter.
• For many drugs the relations between a drug’s presence in the body, its effect on driving, and its effects on crash risk are complex, not understood well, and vary from driver to driver.
• It’s more difficult for law enforcement to detect drug impairment at the roadside than alcohol impairment.
• It’s more difficult to prosecute and convict a driver for DUID than for alcohol-impaired driving (DUI).

Drug-impaired driving is an increasingly critical issue for states and state highway safety offices. In 2015, the most recent year for which data are available, NHTSA’s Fatality Analysis Reporting System (FARS) reported that drugs were present in 43% of the fatally-injured drivers with a known test result, more frequently than alcohol was present (FARS, 2016). NHTSA’s 2013–2014 roadside survey found drugs in 22% of all drivers both on weekend nights and on weekday days (Berning et al., 2015). In particular, marijuana use is increasing. … Congress identified drug-impaired driving as a priority in the Fixing America’s Surface Transportation (FAST) Act of 2015 (https://www.fhwa.dot.gov/fastact/).

In 2015, at least one instance of 80 of these drugs was reported by states for fatally- injured drivers, together with other drugs not in the FARS list (FARS, 2016). The DRUID (Driving under the Influence of Drugs, Alcohol and Medicines) project, the extensive 19-nation European study of drugs and driving, lists 22 drugs and alcohol as the most common in European drivers (Schulze, 2012). A single drug can have different names and can take different chemical forms. For example, marijuana is the substance that’s smoked or swallowed while its principal psychoactive component is tetrahydrocannabinol (THC), or more precisely its main isomer Δ9-THC. FARS has separate codes for marijuana, THC, Δ9-THC, and Unknown Cannabinoid.

HOW FREQUENTLY ARE DRUGS PRESENT IN DRIVERS?

The best data come from fatal crashes because drivers in fatal crashes, especially fatally-injured drivers, are tested for drugs more frequently than drivers in non-fatal crashes. In 2015 nationwide, in the FARS annual report file, 57.0% of the fatally-injured drivers were tested for drugs. Of those tested, no drugs were detected in 55.4%, a drug in the FARS list was found in 34.3%, some other drug in 7.4%, and test results were unknown for 2.9%. Over one-third – 36.5% – of the identified drugs were marijuana in some form, followed by amphetamine at 9.3% (FARS, 2016).

Alcohol was present at somewhat lower levels. In the 2015 annual report file, 70.9% of the fatally-injured drivers were tested for alcohol. No alcohol was detected in 60.9% of those tested, alcohol at a positive BAC in 37.3%, and test results were unknown for 1.8%.

Fatally-injured drivers in Canada had similar drug and alcohol levels. In 2010, 34.2% were positive for drugs and 39.1% for alcohol, with marijuana present in 36.9% of the drug-positive drivers (Beirness, 2014b). In 2012, 39.2% were positive for drugs (Robertson et al., 2017).

Only 19.0% of surviving drivers were tested for drugs in 2015. They had somewhat lower drug levels: no drugs in 59.9% of those tested, a drug in the FARS list in 26.5%, some other drug in 4.8%, and unknown test results for 8.9%. For surviving drivers, 46.5% of the identified drugs were marijuana. Alcohol was tested in 28.4% of the surviving drivers in 2015. No alcohol was detected in 72.2%, alcohol at a positive BAC in 23.6%, and test results were unknown for 4.2%.

http://www.ghsa.org/resources/drugged-driving-2017

http://www.ghsa.org/sites/default/files/2017-04/GHSA_DruggedDriving2017_FINAL.pdf

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS. All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation. Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

A: Getting sober entails changing ideas, choices and behaviors. The first step toward recovery is a recognition that change is better than continuing the condition and direction you find yourself. To recognize that change is desired, you need to be open to new ideas.

Often, we defend ourselves in the face of actual or imagined challenges. If you defend your current condition and excuse away the difficulties you are encountering, you fight to remain the same. If instead you listen to other ideas and consider how they could apply to you, change may be possible.

Consider other feedback as an “invitation” to try something new rather than a demand toward which you will rebel.

Q: Does getting sober require accepting help from others?

A: If you can stop the behavior which is harming you and your loved ones and make long-lasting changes, seeking help may be secondary. If you have difficulty maintaining a new direction which produces better results for yourself and others, help is necessary.

People addicted to alcohol and drugs can sometimes cease drinking and using without help. Many times, other problematic feelings and behaviors arise because of their unassisted abstinence. Recovery can be enjoyable and rewarding if help is accepted. New supportive relationships can replace the void left by the drugs and alcohol. Cravings can be overcome by better coping and communication skills. That dreadful loneliness is replaced by connecting with others.

Q: How do I quit for good and never relapse on drugs or alcohol?

A: When making such a significant change as sobering up and engaging in a program of recovery, it is vital to take it slowly and not to overwhelm yourself. Eventually you will discover that the only thing you changed was everything. This amount of change doesn’t happen quickly and it never stops.

One Day at a Time
Take Only the Next Indicated Step
Life is Not a Race
Take it Easy
One Step at a Time

Q: Does recovery require moving into a treatment center and paying a lot of money for treatment?

A: No. When medical or behavioral risks of withdrawal or relapse require external monitoring and control, a brief inpatient stay may be recommended. Getting sober and engaging in recovery may require professional guidance and support but treatment doesn’t need to be expensive and often doesn’t require an inpatient or residential setting to provide it.

The changes made in recovery need to be made in your day to day life. If you don’t practice recovery at home with your loved ones and friends, it won’t last. Outpatient treatment can provide that guided practice while you live at home and participate in your personal activities and relationships.

Q: What are other essential ingredients toward achieving lasting recovery?

A: H.O.W.

Honesty
Openness
Willingness

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS. All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation. Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

If there’s not a buck to be made, an investment to pursue, or a luxury to indulge, why should we worry about helping less fortunate drunks and addicts anyway? Treating well-insured or wealthy addicts and alcoholics is a great business. Mark-up charges for residential treatment, create rationale why it is justified and the businessman has done his good deed for himself and his investors. Convince the family and the insurance company that the cost and level of care is necessary, you have half the battle won.

What about those poor alcoholics and addicts who only have HMO, EPO, Medicaid/ MediCal or no coverage at all? Haven’t they earned their misery in the first place? Why should we throw good money after bad trying to help them?

“Legislation being marked up Wednesday would phase out Obamacare’s Medicaid expansion, which covers 1.2 million Americans with serious mental illness and substance abuse problems, as well as scrap baseline coverage requirements. The change means certain beneficiaries would no longer get coverage for mental health and substance abuse treatments guaranteed under the Affordable Care Act.”

These sentiments emerge in the face of the largest and most deadly drug epidemic in national history. The “arrest and lock them up” war-on-drugs has proven not only ineffective, but massively more expensive than treatment. The block-grant system created a system where people died or are dying in cue, waiting for some form of help.

One hallmark of addiction is “denial”- the tendency to avoid the realization that a problem and a solution exists. Another trait is prioritizing inanimate objects (drugs/ alcohol) and feelings over taking care of loved ones and community. Yet another trademark of addiction is practicing the same behavior expecting different results.

A record number of people are now getting some form of addiction treatment so isn’t obvious that we should end such benefits? Isn’t it more important that we place dollars back in the pockets of the wealthy so that we can return to a system which served few and will increasingly serve fewer?

As a society, we are here. This is the age of personality, property and prestige. The object, the relief and the pleasure is prized over human life.

By the grace of a higher power, there exist mutual help organizations and congregations dedicated to helping those in need for no other return than continued sobriety and serenity. Unfortunately, not everyone has the capacity or willingness to access recovery through such voluntary means. Many alcoholics and addicts need professional engagement, prompting, guidance and case-management to connect with a new sober life.

Call a local non-profit, religiously-affiliated hospital and find out how they can provide detoxification and/or treatment for a Medicaid/ MediCal or indigent patient. Search the internet for a treatment program which can start treating a Medicaid/ MediCal or indigent patient tomorrow.

Next time someone pats your back or their own back for the amazing work being done to get people sober, first consider primary motives.

Everyone has family, friend or acquaintance who has personal losses due to drug and alcohol addiction. Everyone sees who are the most difficult to treat every day. What will be our next priority?

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS. All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation. Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

A: When drugs and/or alcohol have become the solution, the way to have fun, to feel good, to relieve stress and to relieve discomfort, there are many ways that people find to avoid facing the problems created by use.

Q: What ways do people find to avoid addressing drug and alcohol problems?

A: Some of the statements people misusing drugs and alcohol make to themselves are:

• My problem comes from someone else or is a bad circumstance;
• It’s not that bad;
• When I get through this, I’ll think about it;
• Just another couple of years and then I’ll deal with it;
• I’m stressed and work hard, I deserve a little fun;
• They just don’t understand;
• I’m different.

Q: Do people have to “hit bottom” before they are willing to get help with their alcohol and drug use?

A: Everyone has their own “bottom” and most continue to dig for a while. When faced with losing important things in their lives, people can often place their alcohol and drug use as their priority. When a problem drinker or drug user sees that there is hope on the other side of their trouble, facing their battle and “stop digging” becomes possible.

Q: How do I help someone face their problem and see that recovery is possible?

A: Finding someone for the problem alcohol or drug user to speak with who has been there, who relates to the feelings and ideas surrounding their issues, and who has made it to the other side of the hole, often helps. Professionals who work with addiction can also empathize and provide direction. Treatment programs are available to introduce the reticent alcohol or drug abuser to possible remedies are available if they are willing to talk.

Q: Once someone starts the road of recovery, why do they sometimes go back to their old ways?

A: Even though they eventually can create disaster, drugs and alcohol are potent relievers of pain, anxiety and boredom. If someone new to recovery loses sight of the eventual benefits of recovery, they can go back to their old ways. Old drinking or using buddies, triggers and infrequent use of recovery supports, like meetings can lead back to drinking and using. It’s a well-practiced habit.

Q: Can you “bring up” someone’s bottom and help them stop before they lose everything?

A: Treatment is designed to provide a “bridge” over the depths people can fall, during the addiction process. Unfortunately, it is very difficult to bring people to the awareness of their need for or the benefits of recovery. It is also very difficult to gauge helpfulness against enabling or neglect. Being helpful while not participating in the problem is the best balance to reach.

Q: Does treatment or recovery require a lot of time away from personal responsibilities and/or cost a lot of money:

A: No. Many routes can lead to recovery, many of which can be taken which require no time away from important obligations and cost no money at all.

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS. All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation. Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844