The Real Tab for Rehab: Inside the Addiction Treatment Biz

In what feels like the umpteenth time, singers Whitney Houston and Amy Winehouse, both famously drug addicted, checked back into rehab in May. The rich and famous, of course, have the means to bounce in and out of pricey addiction-treatment centers, but what's the real cost of rehab for regular folks trying clean up their lives?

It can be anywhere from free to up to $2,000 per day of treatment. Promises, where both Britney and Lindsay have logged stays, can cost up to $100,000 for a month in a beach-view private suite with private physicians. A month-long in-patient stay at Hazelden, one the country's oldest and most respected facilities, costs $28,500. Out-patient treatment there costs $10,000 a month. The Loft, a sober-living facility in Brooklyn, N.Y., runs $8,500 for a 30-day stay. Even a single intervention with a drug or alcohol specialist can cost hundreds of dollars.

"I don't think that paying more guarantees a better result," Joe Schrank, who founded The Loft and has worked at Promises, told DailyFinance. "People who are willing to throw $120,000 at a problem are going to have exacting standards that will create some kind of imperfection and unhappiness."

What Is the Value of Rehab?

The addiction treatment industry in America is expected to have revenues of $34 billion by 2014, an increase of 55% from 2005. The vast majority of that spending -- nearly 80% -- is underwritten by public funding, and the remaining portion paid for by insurance or private fees. There are are more 11,000 addiction-treatment centers in the United States, according to the Substance Abuse and Mental Health Services Administration. Shows like Celebrity Rehab and Intervention have shed more light than ever on the recovery process, but some experts in the industry worry that all that attention places too much focus on the amenities and drama, rather than the actual mental and physical healing.

Dr. Marvin Seppala, the chief medical officer at Hazelden, suggests the prevalence of drug and alcohol problems in the entertainment industry, where discretion and luxury have high value, has driven the growth of expensive treatment centers.

But for people who need help for addiction, Dr. Seppala says it's not cost but quality of care and counseling staff that should be the priority. "Programs that promise 'remarkable outcomes' and 90% sobriety success rate after a year or a cure are exaggerated results that people should not believe," he says. "If the emphasis is on amenities of program or thread-count, get out quick."

The severity of the addiction should drive decision making. Out-patient treatment and counseling may work for some, Dr. Seppala says, while clients who have long-standing or multiple addictions may need the around-the-clock medical treatment a residential program provides.

John Fitzgerald, a leading psychologist specializing in addiction, says premium-priced residential programs aren't necessarily worth the cost, especially for families that are already struggling financially. Insurance coverage for rehab is limited and often only covers a fraction of what a long-term residential program costs.

"If you have a ton of money, some residential programs do a great job," he says. "But I really struggle when families mortgage the house or drain their retirement funds to send a loved one to a residential program. That same $30,000 can pay for great out-patient care over a much longer period of time."

A Place to Get Some Distance

Centers typically require a minimum 28-day stay and are rigorous programs with substance-abuse counseling, therapy and medical care. Detox may or may not be conducted on site. While good food is important, increasingly other amenities such as spa treatments, private rooms, and art classes are available in some tiers of residential treatment. Good weather is a big seller, which is why there are so many facilities in Florida and California.




Jonathan K., a freelance web designer who lives in Brooklyn, N.Y., will celebrate six years sober this July. At 43, his battle for sobriety has been hard fought, and included six stints in rehab.

After calling a crisis hotline, his journey started in 2003 at a state-run facility in Tennessee. It was followed by a second stay at a Southern estate complete with "prime-rib nights and equestrian therapy." He visited three more "cinder block" facilities in New York and Florida. Financially speaking, he's one of the lucky ones. Thanks to a combination of insurance, "scholarships" and Medicaid, his tab for rehab was zero.

Having experienced the gamut of treatment centers, Jonathan doesn't think the ones with high-end amenities offered better care. He does, however, feel rehab was valuable because it gave him the fellowship and perspective he needed to recover from alcoholism.

"The privileges you can purchase with money can get in the way of getting effective treatment," says Jonathan. "If you can afford a private room, you may be depriving yourself of an important piece of the process."

A Consumer's Guide to Getting Clean

Maer Roshan, creator and executive editor of the new website, TheFix, dedicated to covering clean-and-sober lifestyles, says the lack of consumer information about residential addiction-treatment centers is surprising considering the importance of what happens there. To pull back that curtain, he created a Zagat-like rehab review on his website which breaks down price, quality of the food, environment and other factors.

"Anonymity doesn't need to be given to people running multimillion dollar companies. They should be scrutinized in some way," he says. "There are some people who are doing incredible work and don't make a ton of money, but increasingly you have people profiting off it in a huge way."

One of the most slippery aspects to recovery from drug and alcohol addiction is that there is no easy way to measure success. Relapses are common and long-term sobriety is measured over years and by quality of life, which is harder to gauge. Addiction experts emphasize that treatment must be looked at as a continuum. The disease of addiction is a chronic condition that must be managed with a lifetime of care, which is why many programs suggest after-care that includes attendance at 12-step meetings.

Fitzgerald also advocates for increasing treatment in the primary health care system. "We know that brief interventions and medications can be very effective in the right time and context," he says. "Most people don't need thousands of dollars in programs."

More resources where you can find information about getting help with addiction:

• Partnership for a Drug-Free America
  
• Substance Abuse & Mental Health Services Administration
  
• American Society of Addiction Medicine
  
  

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