James Regan

In 2019, the National Survey on Drug Use and Health estimated that more than 20 million Americans over the age of 12 suffered from a substance use disorder (SUD) within the past year. Unfortunately, fewer than 21% of these individuals received treatment for their condition.1 One of the main reasons people are unable to receive the addiction treatment they require is the financial burden of treatment. Many people with drug or alcohol addictions do not have healthcare or the funds to cover rehabilitation.1 Fortunately, there are state-funded rehabilitation (rehab) facilities that are able to provide affordable or no-cost treatment to some low-income individuals or people with no health insurance. What Is State-Funded Rehab? Substance use disorders (SUDs) are chronic but treatable brain conditions that impact our behaviors. Like with many other types of chronic illness, individuals suffering from addiction may experience periods of remission and relapse, with relapses signaling a potential need for additional treatment or adjustments to existing recovery efforts.2 For those who are looking for addiction treatment but are struggling to find ways to afford it, state-funded rehab facilities may be an option. There are several ways that states are provided with funding to combat drug and alcohol addiction among those who cannot afford to pay for treatment on their own or with the help of insurance. For example, states may access funding provided through:3 Federal mental health block grants. Funding allocated from state and local budgets. Government health programs (Medicaid). Does Medicare or Medicaid Cover Rehab? Both Medicare and Medicaid are government-funded programs that provide healthcare coverage and assistance, respectively. While frequently confused, they are different services:4 Medicare is federal healthcare insurance for seniors and some younger people with disabilities or permanent kidney failure. Medicaid is a federal-state assistance program for low-income individuals and families. Not all rehab centers accept Medicaid or Medicare. People shouldn’t be discouraged by this, as there are often other treatment options available for people on these government-funded programs seeking drug and alcohol treatment, including inpatient and outpatient care. The minimum coverage provided through Medicaid and Medicare varies between states and individuals should check with their healthcare providers and a rehab facility before they commit to any facility. How Does the Affordable Care Act Help Cover Rehab? The Affordable Care Act (ACA) is a healthcare act enacted in 2010. This act expands access to healthcare and provides additional rights and protections.5 Included in its provisions is the inability for healthcare companies and government-funded healthcare to refuse treatment based on any pre-existing conditions, including addiction and other mental health issues.6, 7 ACA marketplace plans cover mental and behavioral health treatments, including substance abuse treatment. The specific level of coverage provided varies depending on the state and the particular plan chosen; however, ACA insurance generally covers:8 Behavioral health services, including psychotherapy and counseling. Inpatient care. Outpatient care. The ACA also prevents charging clients at a different rate for substance use and mental health treatment than for other healthcare treatment.8 Who Qualifies for Government Sponsored Rehab Programs? Eligibility requirements for government rehab programs vary depending on the state. Generally, these requirements are very strict. These state rehab facilities may also prioritize service for people from certain demographics such as pregnant or single mothers: individuals with severe addictions to needle drugs; and people with infectious diseases, such as HIV/AIDS or tuberculosis, etc.9, 10 How Quickly Can I Enter a Government-Funded Rehab? Unfortunately, low or no-cost treatment for drug and alcohol rehab is in high demand and therefore spaces in inpatient or outpatient facilities are often very limited. Because of this, many of the people accepted in these government-sponsored rehab programs may have to be on a waiting list for periods lasting weeks or months.11 How to Find State-Funded Rehab Near Me The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the Behavioral Health Treatment Services Locator on their website, a helpful tool for locating rehab facilities across the United States. They also provide a directory for Single State Agencies (SSA) for Substance Use Services, which shares the contact information for the state government agencies that coordinate and provide addiction treatment services to those who are uninsured or low income. State agencies can provide info about government-funded treatment centers where individuals might qualify for treatment. Private vs State-Sponsored Rehab Private and state-funded rehabs both function in many of the same ways and have the same goal. Not all private or state-funded rehab centers are the same, but there are some key differences that often exist between them. State-funded rehab facilities may be more bare bones than private rehab. Private rehab programs often offer more amenities (gourmet meals, private rooms, etc.) than state-run facilities, because private rehab is usually covered by insurance or private pay, allowing for facilities to provide greater comfort, services, and amenities. However, these differences may extend deeper than simple luxuries: State-funded programs may only be able to provide basic evidence-based services (detox, counseling, group therapy, etc.).3 Private facilities provide these necessities for effective treatment and additionally provide alternative and supplemental therapy methods. Examples of these methods include:12-14 Horse-assisted therapy. Yoga therapy. Music and art therapy. State-funded treatment programs are significantly less expensive. This doesn’t mean these facilities are low quality—treatment methods at state-run facilities are evidence-based and are effective at treating drug and alcohol addiction. Of course, many individuals will not qualify for state-funded rehabilitation. The vast majority of people who receive state-funded treatment are young and poor.3 State funding for rehab can be limited, and there is a high demand for limited spaces, so it might take weeks to months before a space opens for admission.11 Private rehab can have shorter wait times for admission and provide more individually based care based on lower patient-to-staff ratios. While the programs may differ, both private and state-funded rehab facilities provide effective treatment that helps patients address their problematic substance use and start working toward recovery. American Addiction Centers (AAC) provides quality SUD treatment and is dedicated to helping all who are dealing with alcohol or drug addiction. If you are unsure about the steps you need to take to pursue treatment, call our detox hotline to speak with our admissions navigators today, at [phone]. They will be able to provide you with confidential, in-depth information that can help you start on your path toward recovery. If you do have insurance, and you are wondering what it covers, click here, or fill out the form below. [vob] Addiction is a serious and chronic mental health issue. However, with the right treatment—often a combination of behavioral therapies and medications, when appropriate—many people are able to achieve long-lasting recovery.2 Both private and state-funded rehabilitation are valuable options to have. The right tool depends on the needs of the individual seeking treatment. Sources Substance Abuse and Mental Health Services Administration. (2020). 2019 National Survey on Drug Use and Health. National Institute on Drug Abuse. (2018). Principles of effective treatment. Substance Abuse and Mental Health Services Administration. (2015). Funding and Characteristics of Single State Agencies for Substance Abuse Services and State Mental Health Agencies, 2015. U.S. Department of Health & Human Services. What is the difference between Medicare and Medicaid? Healthcare.gov. (n.d.). Affordable Care Act (ACA). Healthcare.gov. (n.d.). Coverage for pre-existing conditions. Abraham, A. J., Andrews, C. M., Grogan, C. M., D'Aunno, T., Humphreys, K. N. & Pollack, H. A. (2017). The Affordable Care Act Transformation of Substance Use Disorder Treatment. American Journal of Public Health. 107(1), 31–32. Healthcare.gov. (n.d.). Mental health & substance abuse coverage. Substance Abuse and Mental Health Administration. (2020). Substance abuse prevention and treatment block grant. Substance Abuse and Mental Health Services Administration. (2018). Paying for treatment. Democratic Staff of the Senate Committee on Finance. (2016). Dying Waiting for Treatment. Brenna, Ida H., Arnevik, Espen A., Kern-Godal Ann, Ravndal, Edle. (2016). More Than Just a Break from Treatment: How Substance Use Disorder Patients Experience the Stable Environment in Horse-Assisted Therapy. Subst Abuse, 10: 99-108. Balhara, Y., Gupta, A., Kuppili, P. P., Parmar, A., (2018). Role of Yoga in Management of Substance-use Disorders: A Narrative Review. J Neurosci Rural Pract, 9(1), 117-122. Aletraris, L., Bride, B. E., Edmond, M. B., Paino, M., Roman, P. M., (2014). The use of art and music therapy in substance abuse treatment programs. Journal of addictions nursing, 25(4), 190–196. ...

Drug and alcohol addictions are incredibly common in the United States. In 2019, the National Survey on Drug Use and Health (NSDUH) estimated that over 20 million Americans over the age of 12 (7.4%) had a substance use disorder (SUD) in the past year.1 Addiction affects the person struggling with this chronic brain illness—and their friends and family as well.2 Although being partnered in a relationship is generally a protective factor from developing a substance use disorder, the impact that addiction has can be detrimental when it is experienced by two people who are in a romantic relationship, live together, or are married.13-15 Fortunately, SUD is a treatable illness.2 For couples who are suffering from addiction, it can be beneficial for both individuals to participate in couples’ addiction treatment, which is provided at many rehabilitation facilities. Couples and Addiction Addiction is a chronic disease that affects the way the brain works, characterized by an individual’s compulsive use of  drugs or alcohol despite negative consequences on their health, career, mind, and relationships.3 When a family member is addicted to drugs, it often affects the entire household. The situation may foster a codependent relationship between family members and someone with an SUD. Codependency involves a loved one becoming overinvolved with an individual’s addiction process in a way that is detrimental.4 This overinvolvement consists of behavior patterns that enable the drug or alcohol addiction to continue. It also often decreases the loved one’s health and participation in life.4 Enablers, another name for codependent loved ones, may often be in conflict with each other over the best way to “help” the addicted individual, and while these disagreements persist, the substance abuser continues their addiction behavior without obstacles. Not all people who are in an intimate relationship with someone who has a substance abuse problem would be considered codependent, but there are instances where both partners struggle with SUDs. One study found that a co-occurring substance use disorder was five times more common among the spouses of husbands who had an SUD vs. spouses of husbands who did not have an SUD.17 In these situations, it is vital that both partners seek treatment simultaneously. When only one of two partners attempts sobriety, it often causes conflict that threatens both the relationship and the patient’s recovery.6 What is Codependency? There is some debate as to how codependency should be categorized—either as a disease, a personality type, or through an interactionist perspective.5 Ultimately, codependency is a condition that should be diagnosed by a mental health professional. However, several main elements are frequently used to describe codependent individuals. These include:5 Desire to control others and interpersonal conflict. Constantly focusing outward. Self-sacrifice. Restricting emotions. These criteria lack clear definition, but there are many warning signs of codependent behavior to look out for. Characteristics of codependency may include the following:7 Feeling guilty when being assertive. Difficulty trusting oneself or others. Consistently doing more than one’s fair share. Fear of abandonment. Constantly seeking approval and being hurt when it is not given. Feeling responsible for other’s actions. Codependency and Substance Abuse Warning Signs in Couples In a codependent relationship where substances are abused by one person, the presence of substance abuse and subsequent enabling behavior are the warning signs. It’s very important for a couple to identify the enabling behaviors. Loved ones acting as enablers typically fall into two categories: supportive or hostile.18 A supportive enabler often exhibits the following behaviors:18 Rescuing the individual from the consequences of their behavior. Providing assistance including bail, lodging, and money for rent. Lying to others for the individual, including bosses and landlords. While these behaviors may appear to help the individual in the short term, they can cause long-term harm and permit the user to continue their substance abuse without facing any repercussions.18  A hostile enabler often exhibits the following behaviors:18 Treating the individual with anger, disrespect, or aggression. Communicating unexpressed resentments about past failures and other feelings connected to the addiction. These behaviors may be regretted by the enabler, but they may also create additional feelings of guilt, embarrassment, and shame in the substance abuser—feelings that may further motivate addictive behavior.18 While the two types of enablers may exhibit different behaviors, neither helps a person who is struggling with addiction start and participate in treatment and recovery.18 Couples Addiction Treatment For many years, addiction was seen as an individual problem; however, evidence shows treatment for an individual is more effective when it involves the family in some capacity.6 There are three approaches toward treating drug or alcohol abuse in families:6 The family disease approach. In this approach, an SUD is a disease that causes the whole family to suffer. Through therapy, each family member individually confronts their issues with either substance use or codependency and enabling behaviors.. The family systems approach. This approach is driven by an understanding that behavior is influenced by the interaction of various factors working together within the family unit. Treatment explores the ways the patient’s drug or alcohol use becomes part of the family dynamic and seeks to eliminate or modify these factors. Clustered behavioral approaches. This final approach assumes that interactions within the family support behaviors associated with drug or alcohol use . With therapy, all family members work to recognize and change these behaviors to ones that nurture abstinence. These behavioral conceptions of substance use provide the foundation for behavioral couples therapy (BCT).6 Dually Addicted Couples Of course, there are also situations in which both individuals in a relationship have a substance use problem, and research is somewhat lacking on effective methods in treating “dually addicted” couples.8 An exploratory 2006 study identified three obstacles in the way of sobriety for dually addicted couples. These include:8 In addition to the difficulties individuals face when trying to get sober, dually addicted couples often collude with each other to acquire substances. Many facilities do not allow couples to enter detoxification or residential treatment together. Dually addicted couples tend to have less conflict related to drug use when compared to relationships where only one person has a drug or alcohol problem. Because these couples tend to report higher relationship satisfaction when they both use drugs together, when one partner attempts to quit without the other it can cause conflict, resulting in a breakup or relapse.8 To combat the failings of conventional, individual-targeted rehabilitation in treating dually addicted pairs, some rehabilitation facilities offer inpatient or outpatient treatment programs couples can join together. Behavioral Couples Therapy Behavioral couples therapy (BCT) and alcohol behavioral couples therapy (ABCT) have become the standards for treating drug and alcohol abuse among couples who live together, where one of the two individuals has a substance abuse problem.6 The primary goals of BCT are to encourage abstinence from substance use and the healthy functioning of the relationship. BCT functions on the assertion that an addicted person’s family member can reward the patient’s abstinence.9 BCT is successful at:9 Reinforcing the cessation of drug or alcohol abuse. Improving how a relationship functions through healthy communication. Reducing instances of domestic violence. Mitigating the emotional harm done to children. Each day, the addicted individual and their spouse or live-in partner draft a “Recovery Contract.” This contract involves the patient in recovery making a daily promise to abstain from using alcohol or drugs while the partner promises to support their efforts.8 The contract may also involve specifics, such as:9 Taking prescribed medicine. Attending self-help meetings. Submitting urine toxicity tests. Applying communication techniques. Is Couples Treatment Effective? While BCT, ABCT, and couples’ rehabilitation programs have many proven benefits, these methods aren’t appropriate for everyone. There are many benefits of BCT for cohabitating couples, including:9 Long-term abstinence supported by positive behavioral changes. Reduced chances of separation or divorce. The elimination of many other negative behaviors in their relationship caused by substance abuse. Improved communication, which in turn leads to happiness and satisfaction in the relationship. Learning to enjoy new non-destructive activities that don’t involve substance use. BCT is successful in treating heterosexual couples and gay and lesbian couples by both reducing substance intake and increasing relationship satisfaction.11 When is Couples Rehabilitation Appropriate? Drug or alcohol rehabilitation for couples is only beneficial when:8 Both patients are committed to recovery. If only one person is ready to get sober, it can threaten both the relationship and their partner’s recovery. Both patients are committed to the relationship. Recovery requires a supportive, nurturing environment during and after formal treatment ends. The rehabilitation facility recognizes the intricacies of interpersonal dynamics and how they can support or threaten sobriety. Risks involved with couples’ rehabilitation include:8 Being denied acceptance. Not all facilities accept couples. Unfortunately, pervasive stereotypes about all relationships between two substance-addicted people being unhealthy and non-conducive to sobriety remain. Possible dissolution of the relationship. When one person is committed to recovery and their partner isn’t, it can cause irreconcilable conflicts. A partner becoming a significant obstacle toward a patient’s recovery. Just as one non-committed member of a couple can threaten a relationship, they can also impede long-term recovery. Continued Recovery for Couples after Treatment Aftercare is an important part of recovery for most people with SUDs. Addiction is a chronic illness, meaning people with this disorder are prone to relapse.2 Aftercare is vital to reduce the chances of relapsing.11 However, it’s important to note that relapse does not equal failure—it is often just part of recovery. In many cases, a relapse means treatment needs to be adjusted.1,18 The most common forms of aftercare relapse prevention programs are mutual help groups. These groups take several different forms: 12-step programs. Perhaps the best-known form of aftercare, 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) require the patient to:12 Acknowledge their substance use problem and its control over their life. Trust in a greater power to help them stay sober. Accept responsibility for their past mistakes, admit their faults, and attempt to make amends. Secular support groups. Because 12-step programs require patients to acknowledge a higher power, they may not work for individuals with a different set of beliefs. There are many secular programs that still provide peer support for people in recovery. These include: Smart Management and Recovery Training (SMART). LifeRing. Women for Sobriety (WFS). Secular Organizations for Sobriety (SOS). Alumni networks. Many treatment centers foster a network of peers who completed treatment at the same facility. Alumni networks allow individuals and couples to reach out to one another for support after their formal rehabilitation treatment at an inpatient or outpatient facility ends. Often, these networks will throw events and meetings where former patients can meet up. Some events encourage former patients to bring their friends and family. A substance use disorder is a serious problem for individuals as well as their romantic partners and family. Fortunately, it is treatable, and many patients and their loved ones live fulfilling lives together after completing a rehabilitation program. There are several methods for treating substance abuse in couples and in families that have proven success. If you and your partner are interested in addiction treatment for couples, consider reaching out to one of our admissions navigator. They are available 24/7 and can provide the support, guidance, and information you need to help you or your loved one start on the path toward recovery. Sources Substance Abuse and Mental Health Services Administration. (2020). 2019 National Survey on Drug Use and Health. National Institute on Drug Abuse. (2018). Principles of effective treatment. National Institute on Drug Abuse. (2018). Understanding Drug Use and Addiction DrugFacts. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer. Bacon, I., McKay, E., Reynolds, F. The Lived Experience of Codependency: an Interpretative Phenomenological Analysis.Int J Ment Health Addiction (18):754–771. Birchler, G. R., Fals-Stewart, W. & O'Farrell, T. J. (2004). Behavioral couples therapy for substance abuse: rationale, methods, and findings. Science & practice perspectives, 2(2): 30–41. Mental Health America. (2020). Co-dependency. Simmons J. (2006). The interplay between interpersonal dynamics, treatment barriers, and larger social forces: an exploratory study of drug-using couples in Hartford, CT. Substance abuse treatment, prevention, and policy.1-12. Fals-Stewart & W. O'Farrell, T. J. (2000). Behavioral couples therapy for alcoholism and drug abuse. Journal of substance abuse treatment. 18(1): 51–54. Fals-Stewart, W., Lam, W. K. & O'Farrell, T. J.(2009). Behavioral couple therapy for gay and lesbian couples with alcohol use disorders.Journal of substance abuse treatment. 37(4): 379–387. McKay J. R. (2009). Continuing care research: what we have learned and where we are going.Journal of substance abuse treatment, 36(2): 131–145. Medola, A. & Gibson, R. L.. Addiction, 12-Step Programs, and Evidentiary Standards for Ethically and Clinically Sound Treatment Recommendations: What Should Clinicians Do? AMA J Ethics. 18(6): 646-655. Homish, G.G., Leonard, K.E., Kearns-Bodkin, J.N. (2006). Alcohol use, alcohol problems, and depressive symptomatology among newly married couples. Drug Alcohol Depend, 83(3): 185-192. Fleming, C.B., White, H.R., Catalano, R.F. (2010). Romantic Relationships and Substance Use in Early Adulthood: An Examination of the Influences of Relationship Type, Partner Substance Use, and Relationship Quality. J Health Soc Behav, 51(2): 153-167. Starks, T.J., Robles, G., Bosco, S.C., Doyle, K.M., Dellucci, T.V. (2018). Relationship functioning and substance use in same-sex male couples. Drug Alcohol Depend, 201: 101-108. Cornelius, J.R., Kirisci, L., Reynolds, M., Homish, G.G., Clark, D.B. (2008). Husbands' SUD is associated with higher levels of co-occurring but not non-co-occurring psychiatric disorders among their wives. Addict Behav, 33(9): 1231-1234. Miller, S.C., Fiellin, D.A., Rosenthal, R.N., Saitz, R. (2018). The ASAM Principles of Addiction Medicine, Sixty Edition. Lippincott Williams & Wilkins. O’Farrell, T.J., Choquette, K.A., Cutter, H.S., Brown, E.D., McCourt, W.F. (1993). Behavioral marital therapy with and without additional couples relapse prevention sessions for alcoholics and their wives. J Stud Alcohol, 54(6): 652-666. ...