While some businesses purchase insurance plans that include addiction treatment, often they select a one-size-fits-all plan rather than covering all treatment options, such as outreach services.

"We know a lot about what works," said Michael Flaherty, executive director of the Institute for Research, Education and Training in Addictions in Pittsburgh, Pa. "The science is 10 years ahead of practice and 15 years ahead of most policy."

Addiction coverage for businesses generally has limits on dollar reimbursement and time in treatment. A study by Eric Goplerud of Ensuring Solutions to Alcohol Problems at the George Washington University Medical Center found that 18 states limit coverage, while only seven require that alcohol treatment be covered at the same level as other diseases.

In much of the country, said Goplerud, "insurance either doesn't cover the treatment, or it doesn't cover the right things, or it doesn't cover enough of it."

Despite the high costs linked to alcohol misuse, many businesses believe that it may not be financially prudent to cover treatment.

"Employee replacement costs can vary from $25 to $150,000," said psychologist Norman Hoffmann of Brown University in Providence, R.I. "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."

On the other hand, Hoffman added, a fast-food chain could replace an employee with alcohol problems for the cost of a newspaper ad.

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