The increase of individuals struggling with substance use and behavioral health disorders throughout the country has created a dire need for treatment services, and the access to quality services is extremely limited. One of the main reasons is cost, and the impression that families get is that the treatment centers are gouging them, and taking advantage of the system. The families are not necessarily wrong, and they are not completely right. The system of drug and alcohol treatment in the U.S has undergone quite a few significant changes over the last 7-10 years. Unfortunately, the cost of providing treatment is extremely expensive if a treatment center is going offer a quality service, and the ability to utilize insurance to pay for these services has helped families come up with the resources to get the help they need for their loved one. In addition, this has created the ability for unqualified individuals to open treatment centers without any type of regulatory oversight, and abuse the system for their own financial gain. Finally, with insurance companies cutting back on their reimbursements and the number of corrupt players that have tainted the reputation of the treatment field, families are finding it more difficult to get their loved ones into a facility that they can trust. I will cover the last two issues in my next article, and let’s break this down a little deeper to see how the cost adds up.
First, let’s look at a very simple breakdown of the minimum amount that it could cost someone to run a treatment center. Of course, this is just a bare-bones look at a center that I would not even send my worst enemy to, but they do exist. To have staff in your residential facility 24 hrs a day just monitoring the clients (usually called Techs, Resident Assistants or Resident Advisors), making sure they are safe, and paying them $13/hr for 8 hr shifts, would cost the owner approximately $9,360 per month on the lowest end. This is considering you only had 3 people covering 7 days per week. However, you usually need more than one person per shift if you are going to have more than five or six patients/clients in the house, and you also need back-ups to ensure you always have staff at the house. These types of employees are also the highest risk because they often don’t stay for very long, they don’t have enough experience to provide actual clinical care, and they are often the hardest to keep happy because they aren’t really making any money. In addition, they are usually looking to expand their career, and if openings are not available at a higher pay grade, they will move on. Turnover wise, these employees are constantly getting other opportunities and many centers end up being shorthanded on good quality staff at this level. While these are usually the lowest paid staff members, they are usually the most critical staff on your team because they are with the clients more than anyone else and can have the biggest impact on their success or failure in treatment. It’s a very fine line, and one of the most challenging aspects of staffing in treatment.
Now that we have these basic staff members, let’s consider some of the other necessary costs to run the facility. Again, we are talking about a facility that is barely decent, but meets the requirements of most states to qualify for licensure. The most critical piece to having a licensed residential treatment center is having a licensed therapist that is willing to put their license on the line for the facility. Usually, this would be your Clinical Director. Depending on the state, the economy and the qualifications of the individual, a facility would pay anywhere from $4K-$10Kper month. The Clinical Director may, or may not be at the facility full time, so the variation in cost can be quite broad. Facility owners decide how much or how little they would like to have Clinical Leadership at the facility. Then, you need to look at having other clinical staff; therapists or counselors (licensed or certified), possibly a doctor and a couple of nurses (RN’s or LVNs). You also need at least one administrative staff member to answer phones and handle paperwork. You also need to have someone that can handle the intakes and discharges of clients. This can be done in many different ways and the quality of these two functions is absolutely critical to the impact of the overall experience of the client. Finally, you often need ancillary staff to offer additional clinical services and facilitators to run groups. These costs will add up depending on the quality of the care you are hoping to provide. The better the quality, the higher the expenses. As you can probably see, this is the bulk of the overhead expenses that really challenge treatment centers in keeping their doors open. We haven’t even discussed the actual facility and other logistical operating expenses.
Let’s look at the cost of running the facility. Rent, utilities, insurance, unemployment, attorney fees, automobiles and the associated expenses that come with that, in addition to other expenses that arise in the day to day operations. Will the facility be providing food for the clients? If so, who is going to prepare the food? What kind of food, snacks, drinks, etc. are you going to be offering? These are just a few of the considerations, only regarding food.
After adding up all of these costs, a minimum cost per month of no less than $70,000 per month, which is on the VERY low end of expenses, would be a very reasonable expectation. For the sake of this article, I am trying to provide the customer with a view of what thebest-case scenario would befor a facility to even get up and running;and the best-case scenario for a facility is usually the worst case for the client, because they typically, would not be receiving quality care. In California, a residential facility is only allowed to have a maximum of 6 beds at one residential address. Of course, there are ways to get additional beds if the facility has room and meets specific requirements (an additional cost). As you can imagine, with the cost of living in CA and the limitations that are put upon facility owners, they need to come up with a large amount of revenue just to cover their expenses. For a 6-bed facility in California, you are usually looking at operating expenses around $100K-$120K per month. With 6 beds filled every month, they would have to charge around $20K just to cover their cost to keep the doors open. This is assuming, of course, that the facility has all 6 beds filled every single month. Of course, every state is different and has different regulations, so that needs to be taken into consideration, as well, but no matter how you look at it, the financial obligation and responsibility is substantial.
Please keep in mind, the current scenario I have laid out is just the first part of the treatment process, the first 30 days. This scenario is also one of many variations to how treatment is structured. Most individuals in our country will leave treatment at this point, having spent everything they’ve got to get help. After 30 days, they are leaving treatment and going back to the very place that sent them to treatment. This is not a substantial amount of time to get the real tools that are needed to live a life of sustainable recovery. Research shows that individuals who are able to stay in treatment, or get the support they need for at least 6 months to a year, have a much higher probability of staying in recovery for at least five years. Unfortunately, with the current treatment system and the cost of running treatment facilities, only 1-2% of our country can afford to make it happen for that period of time. Even many of those families end up tapping all of their resources, too.
As you can see, with the operating costs involved in running a treatment center, it is very clear why the cost for individuals to get treatment is high. So, what are the alternatives to going to treatment? There are other options for individuals to get help if they are highly committed to do what it takes to recover. When starting on this journey, the individual needs to be stabilized. This means going to a hospital, doctor, detox or acute care facility before they embark on the recovery path, to ensure that they are physically capable of getting through the initial phase of recovery without any withdrawl symptoms causing serious damage, or even death. Once that has been handled, community-based recovery is always one of the primary facets to almost all treatment centers. These organizations are usually free, or accept donations. Many individuals can get stabilized and begin attending these meetings, but that only takes up a few hours of someone’s day. If there are clinical issues, such as depression, anxiety, bipolar disorder, etc., that needs to be taken into consideration, as well. It is imperative that the family understands this because drugs and alcohol are often the “medicine” that is helping the individual deal with those issues. Once that is gone, this can leave the person very raw and vulnerable, which is usually part of the underlying reason for the drug and alcohol abuse, in the first place. Depending on the level of containment someone needs, will be what determines whether or not treatment is necessary. That is where it is up to the family and the individual to be rigorously honest about what they are committed to doing. If the financial obligation for treatment is absolutely not possible, options like intensive therapy, coaching and other types of support services can be extremely valuable, and can be utilized over a much longer period of time; but, again, they are all conditional upon the commitment of the individual to their recovery when the services are not being offered, and they are free to do whatever they want.
In closing, take time to research the facilities you are looking to send yourself or a loved one! If you don’t know what to ask, consult with a treatment advocate or professional. Feel free to go to www.citizensinrecovery.com to see the types of services I offer, as well. I am happy to answer questions and help guide families in the best possible direction I can. These viewpoints are completely subjective and part of my experience working in the field. There will be many opinions and, possibly, alternative viewpoints to what I have said. I advise anyone who reads this to gather as much information as possible and assess for themselves what they believe to be true for them. The goal this article was to offer insight to why the cost of treatment can be so expensive, and is only meant to be educational and informative, and is not meant to sway people away from going to an addiction treatment facility. Instead, it should help the readers to make more informed decisions to get the proper help for their loved ones, or themselves. In my next article, I will discuss some of the ways that insurance has helped, and hindered society’s access to addiction treatment. Recovery is possible!