The Beginning of the End of Residential Drug and Alcohol Treatment?


The Problem With Drug Rehab

Separately, I'm asked to review, for medically necessity and reimbursement purposes, the care of a 53-year-old woman. Like the young man in the above synopsis, she enters a world-class drug rehab in Florida, but this time for alcoholism. At the time of admission, she is also taking an SSRI antidepressant and a benzodiazepine anti-anxiety drug.

She spends 27 days in the facility. At various times during her admission, not unlike many individuals being weaned off alcohol, she complains of mood fluctuations, anxiety, sleeplessness and body aches. At the time of discharge, she has been taking -- and she is recommended to continue to take -- seven drugs: citalopram, an SSRI antidepressant; bupropion, an SNRI antidepressant; a small dose of an antipsychotic, aripiprazole, to augment the antidepressant effects of her two different antidepressants; a small dose of thyroid supplement, thyroxine, to do the same; gabapentin, an antiseizure medicine and clonazepam, both prescribed to decrease her anxiety; and carisoprodol, a centrally-acting anti-muscle spasm drug to minimize her musculoskeletal discomfort.

Capsulizing the above: A woman with alcohol dependence on one drug for depression is treated in rehab for almost a month (at a cost of a little more than $45,000) and is discharged on seven drugs, including not one, but two (clonazepam and carisoprodol) with significant habit-forming and addiction-enhancing characteristics.

Message to substance providers: We have a problem. Although addiction experts may justify these "treatments" because education and solace is provided to the patients, I believe that this mocks the purpose of (the very important and necessary) addiction treatment. There is little, if any, harm reduction, because the clients are prescribed the same or other addictive compounds during and after rehab. The clients are also prescribed new drugs, particular in the latter case of the alcoholic woman, whose potential for drug-drug interactions and future adverse events cannot be accurately predicted.

The clients are receiving expensive inpatient care for services and treatment that could easily be managed in cheaper and less-acute-care outpatient settings, like intensive outpatient or partial hospital programs. And, most importantly, the clients are continuing to rely heavily on pills to combat their anxieties, mood changes and addiction.

Problem? Relying on pills got them to rehab in the first place. So what's the point of attending and paying for -- or charging a commercial insurance carrier, Medicare or Medicaid, or any other third-party payer -- for an expensive retreat that leaves you in virtually the same mental place, or worse, than you started? Not that much.

Dr. Stefan Kruszewski is an addiction psychiatrist and CEO of Kruszewski & Associates, a Harrisburg, Pa., company that focuses on health care and financial fraud.

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