Why is the Only Option a Lack of Options?

by Annie Bolthrunis, editor


I have always been aware that there aren’t many options for people suffering from mental health disorders and addiction problems. Insurance will cover a few days in a hospital or detox and send you home with a slew of prescriptions, appointments, and recommendations, still reeling from the experience of being in-patient in a hospital.

If a patient is able to maintain a medication and appointment schedule, they may be able to successfully navigate the world of recovery. However, more often than not, these inpatient hospitalizations merely physically stabilize a patient without taking into account the emotional problems which are the underlying cause of the hospitalization.

I have a close relative who has long suffered from alcoholism. She has been inpatient in detox units more times than I can remember, with the most recent hospitalization occurring shortly after the start of break in mid-December. In October, she had been in a detox center for five days. When she relapsed, my family tried to find a long-term treatment center that would take her and accept our insurance. There were many options, but we kept hitting the same roadblock:

Her insurance would only cover five to ten days of an inpatient hospitalization that should have lasted thirty to ninety days. The cost of treatment, per day, can be thousands of dollars. Who can afford that? But the larger question is; why are insurance companies willing to pay for several short hospitalizations a year, but not for one long-term treatment session that may lead to a much longer period of sobriety?

It’s impossible to know the answer to this question, but it’s worth thinking about in an age when health insurance coverage is such a big political issue and addiction is at the forefront of our minds, thanks to shows like A&E’s “Intervention” and “Celebrity Rehab with Dr. Drew” on VH1. Is it really cost effective to treat the same person several times as opposed to paying for one extended stay in a treatment center? Is it morally acceptable to keep bouncing a patient between home and detox without a clear set of tools to use as they eke out their recovery? Detox centers can be great places that offer a good deal of support for their patients, but when those patients are only there for three to five days, how much recovery can you really offer them?

AA and NA are options for a lot of people, but these programs can be overwhelming, especially for a new addict, or for someone who repeatedly relapses. It’s difficult for a person who one week appeared to be doing very well to go back to his or her familiar meeting and tell the group of people they’ve learned to trust that they’ve been lying; they fell off the wagon. Of course, all addicts know that addictions makes liars of everyone, and they will welcome the newly-sober-again member back with open arms, but it’s still emotionally difficult for someone just out of detox to face these emotions head on. This can lead to drinking or drugging. It’s a vicious cycle.

Along with the emotional problems associated with frequent relapse and ineffective treatment, patients may begin to experience negative effects on their health as they become more and more entrenched in the cycle of addiction. Problems such as alcoholic or drug induced dementia, vitamin deficiency, organ failure, malnutrition, and dehydration must all be treated by physicians, which costs the insurance companies yet again.

Overall, this is a very frustrating experience for patients and their families. Watching someone you love suffer repeatedly, and the cycle of repeated relapse and the effects it has on the family can cause enough stress to tear a family apart. I don’t know if there are easy solutions to these problems, but I know that the options available are NOT options. They pigeon-hole people into an ever-increasingly frustrating cycle which doesn’t seem to end – the proverbial snake eating its tail.

This is part of the reason why programs like CLTL are so important. Although CLTL is geared towards prisoners and not specifically addicts, a program that empowers people in a way that detox (and prison, of course) don’t is incredibly beneficial to society as a whole. Instead of breaking people down, a program like CLTL builds people up, giving them self esteem through showing them they have abilities they may not have recognized in themselves. Perhaps, using CLTL as a model, a program for addicts with relapse problems can be created, in conjunction with a hospital, where participants are treated on an outpatient basis (insurance companies may be more likely to cover this kind of program) and not only given tools to deal with their addictions, like so many partial hospital programs, but are given other tools, like self esteem. I think a book club component could be extremely beneficial in this context – as in CLTL, patients could be given a weekly reading assignment, and then have to come in the following week and discuss the text. Patients would get a feeling of accomplishment through starting and completing a task (reading the book or story) and a completely different feeling of accomplishment from participating in a meaningful discussion. Hopefully these discussions would relate to the addict’s experiences as an addict, and give them tools they may not receive in a short term inpatient setting.


It seems like this could be a perfect marriage between a long-term in patient hospitalization (which can be financially devastating or even impossible to afford at all) and a series of short term detoxes (which can physically orient a person again but only barely skims the surface of the emotional problems the patient is experiencing).


4 thoughts on “Why is the Only Option a Lack of Options?

  1. Annie: Yes, as you put it “…the larger question is; why are insurance companies willing to pay for several short hospitalizations a year, but not for one long-term treatment session that may lead to a much longer period of sobriety?” And, as you suggest, everyone should embrace the idea that reading and discussing good literature can provide an important dimension for most rehab programs ( as well as for life itself).

  2. I am Type 1 Diabetic, and my insurance company is willing to pay for only a certain number of testing strips. It is recommended that a diabetic tests their blood sugar 8-10 times a day, but they only provide coverage for 5 times a day. I also don’t understand why insurance companies don’t pay for long-term treatment that may lead to a much longer period of health. If I were allowed to test 10 times per day, I wouldn’t need the aid of my insurance for serious health complications later on.


  3. Annie,

    Nice job on the blog! I’ve lived through several books worth of alcohol horror shows between family and friends. As they decline they take others with them so it’s a multiple-person illness. The insurance companies should understand that it takes time to detox someone. And alcohol glorification by the media doesn’t help the situation

  4. Fascinating idea, and a good one.

    I admit ignorance on the subject of CLTL other than my own experience with literature and skimming Prof. Waxler’s account of the fledgling days of the program.

    I do have an intimate working knowledge about recovery, and my experience tells me that this type of program would actually compliment 12 step programs quite nicely. Let’s just say this: for long-term recovery the writings of Bill Wilson alone may grow tiresome.

    The critical question that comes to my mind: what bearing would the addiction component have on literature choice (as compared to the choices for criminals)? I expect there may be lots of overlap, but the focus might necessarily be recovery. There are certainly many volumes of excellent literature that deals with the throes of addiction, but I would love to hear ideas about literature confronting recovery. I’m imagining much of this would be contemporary memoir.

    Interesting stuff. We have lots of people in our prison system as a direct result of addiction.

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