By Susan Brink
Drinking problems are costing business billions. Why not pay for treatment?
Lynn Cooper knew it as she stood in the glow of the refrigerator light against the early evening darkness. She knew it as the warmth of her house penetrated her winter coat and hat, knew it as she reached for the wine bottle in her still-gloved, trembling hand. She knew--as she greedily poured the first of the evening's multiple glasses of wine--that she had a serious drinking problem. "I was standing there with a full glass of wine in my hand," she recalls, "and I hadn't even taken my gloves off."
When she had her epiphany 14 years ago, she was a company vice president. She supervised a large staff. She made a lot of money. As she says: "I was a functional alcoholic."
But often, particularly on Mondays, she didn't function well at all. She'd wake up late, her head pounding, her guts roiling, and she'd call in sick. Today, she seldom misses a day of work. But she still recalls that when she was drinking, the 15 annual sick days she had coming were never near enough to cover the leave she needed for hangovers.
Alcohol abuse costs American businesses an estimated $ 134 billion a year. People with untreated alcohol problems use twice as much sick leave as other employees. They have more on-the-job accidents. They are five times as likely to file a workers' compensation claim.
Addiction research is steadily making progress in identifying the kinds of treatment programs that work for people with a variety of drinking problems. But unhappily, the accumulating scientific evidence on treatment effectiveness rarely translates into appropriate insurance coverage for such addictions. Indeed, addiction coverage typically has caps on both dollar reimbursement and time in treatment. What's more, patients, when they get treatment at all, are often steered into one-size-fits-all programs that don't fit the majority of those in need.
When it comes to treatment for alcohol problems, geography rules. A study by Eric Goplerud of the George Washington University Medical Center found that only seven states require alcohol treatment to be covered at the same level as diabetes, heart disease, and other life-threatening illnesses. And although addicts in those states are more likely to get the treatment they need, even there the mandates are often ignored. Eighteen states have limits on coverage for alcohol problems. In Texas, for example, coverage is required for three "episodes" in a lifetime. Arkansas law sets a lifetime figure of $ 12,000 for alcohol treatment, and Ohio mandates $ 550 a year. In much of the country, "insurance either doesn't cover the treatment, or it doesn't cover the right things, or it doesn't cover enough of it," says Goplerud.
Cooper was lucky. Her insurance covered a form of treatment that allowed her to keep working. She never went into a residential treatment program--the type that can keep someone off the job and away from home for 28 days or more. "I was in a 90-day treatment program. I would work until 4 o'clock, then go for treatment from 5 to 9, four days a week. After the first month, it was two days a week," she says. And while Alcoholics Anonymous has been a successful support group for millions, she found meetings with Women For Sobriety to be a better match for her after treatment. "I'm here to tell you that if all they offered me was a 28-day program and AA, I'd still be drinking," says the 48-year-old Cooper. She now represents drug and alcohol treatment providers at the Pennsylvania Community Providers Association in Harrisburg, Pa.
The treatment program that worked for Cooper is just one of those described by the American Society of Addiction Medicine. But the problem is that few people have access to such individualized care. "We know a lot about what works," says Michael Flaherty, executive director of the Institute for Research, Education and Training in Addictions, in Pittsburgh. "The science is 10 years ahead of practice and 15 years ahead of most policy."
Everybody's different. Treatment needs vary greatly. Some people need residential treatment for a month or so. Others could benefit from simply using their two weeks of vacation leave for residential treatment, then continuing with outpatient treatment. Still others need less frequent but longer-term outpatient treatment. New medications like the FDA-approved naltrexone and Acamprosate (not yet approved by the agency) can help some drinkers by targeting pathways in the brain and blocking the high that alcoholics seek. Some adults, and almost all adolescents, need social or psychiatric services as well. Women often need child care and generally do better in female-only treatment programs. And almost everyone has family members who need professional guidance in sorting out the tangle of issues that come with loving an addict.
Employers who purchase insurance plans typically don't buy coverage for all the options. And their workplaces reflect the nation's drinking problems. For example, a corporation with 10,000 workers will have an average of 600 employees with alcohol problems. Of those, 30 will receive treatment in a given year, and 22 will be employable a year later. But a company's human resources department could choose differently. It could pay the insurance company to provide outreach services, which would identify twice as many problem drinkers and encourage them to seek treatment. The net result for the company would be 40 employees still on the job a year later. "We know the relationship between amount of services and aftercare and outcomes. We know if we want 40 of 60 people employable, [insurers] have to fund six months of aftercare," says psychologist Norman Hoffmann of Brown University. Hoffmann helped develop widely used criteria for diagnosis and treatment of alcoholism. Unfortunately, few employers are even aware of the variety of treatment options they should be shopping for when choosing an insurer, says David Mee-Lee, chair of ASAM and editor of the organization's treatment guidelines.
Accounting. The cruel irony is that despite the high cost of alcohol abuse to businesses, it isn't always in the financial interest of an employer to cover addiction treatment. "Employee replacement costs can vary from $ 25 to $ 150,000," says Hoffman. "If it's going to cost you $ 150,000 to replace somebody who runs a train or fixes an airplane, you can afford to spend some money to keep that person well and on the job." But a fast-food chain could replace an alcoholic worker for the cost of a newspaper ad.
Ironically, the medical consequences associated with heavy drinking, such as cancer, stroke, cirrhosis of the liver, and injuries from falls and traffic accidents, are all typically covered by insurance. Indeed, alcohol abuse adds $ 23 billion to the nation's annual medical tab. When Cooper was drinking heavily, she underwent a brain scan as physicians tried to figure out why she had chronic headaches. She also had numerous tests to unravel the medical mystery of her gastrointestinal disorders. And she fell on several occasions, sometimes requiring medical treatment. At the peak of her drinking, she was downing several bottles of wine a day. Not coincidentally, she says, "My medical file was 8 inches thick."
Bottom Lines
The real cost of drinking, according to alcoholcostcalculator.org:
Copyright 2004, Used with permission from U.S.News & World Report.
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