Well, I can't afford treatment at all. I'm trying to get stablized on methadone before I get a job so I can pay for it myself. My husband makes $475/week. With that he has to pay all our bills, in addition to 2 people's methadone treatment bill. ($800/month) We barely make it. As for a treatment facility like a 28 or more day program? Those costs are outrageous, and even if you do have the money, the wating list is through the roof. When I have inquired on them I usually get a response like, we take it on a priority basis. I'm still unsure what that means. Do they look and pick and choose which person is most addicted? Who has the most problem? Or do they reserve a bed for a big CEO or Politician rather than a regular Joe plumber.

Katie I don't know where you live but in California there is a system of public treatment facilities which cost very little. While services are being cut to some extent, and there will be a waiting list, the system will still be intact. I suggest you call your department of Health and Human Services to see what is offered in your area. Getting clean is hard work and our heads tell all the thing we can't do. It's time to find out the things you can do.

The article seems not to take into account the thousands of not-for-profit treatment and recovery facilities that don’t based acceptance into treatment on ability to pay. Even though the conditions of many of these facilities are Spartan compared to the “bells and whistles” treatment centers, they meet high standards for health, safety and professionalism and have comparable outcomes to the more lavish treatment “spas”. The federal government publishes a complete listing of all treatment and recovery facilities for each state called the “Nat’l Directory of Drug and Alcohol Abuse Treatment Programs” see www.samhsa.gov to view services in your area. Best to you.

Yes, there are thousands of non-profit treatment agencies (like ours) that operate on sliding scales, and in many states, such as Oregon, require that we refuse services to no one based on ability to pay. Unfortunately, our program, life most non-profit and publicly supported programs, is the mainstay for Children's Services and Corrections clients. Non-correctional clients, both adults and adolescents, don't mix well with correctional clients, so in effect are squeezed out of the treatment market, both by choice and by resources.

California does offer sliding scale and help for those who can't afford treatment. However, it is true that for 28 day + programs it is set up for profit unless you are in the legal system. It can be hard for people who have no insurance or money to get rehab. Some insurances won't even cover this disease.

We need to look a little more at what the answers really mean: 49% don't think treatment is worth what it costs. This could be explained by several things: they don't know that low-cost treatment is available; they don't place a high value on sobriety; they don't believe that treatment can deliver sobriety. This is a social marketing problem, but low-cost providers are low-cost in part because they don't have any excess profits to pay for marketing. So recovery advocacy is picking up some of that role. See you all at your local Rally for Recovery on September 12th!

Oh yeah, and let's not forget that both addiction and recovery have lots of what economists call "externalities" -- benefits and costs that affect people who are not part of the purchase decision (air pollution is an external cost; education has lots of external benefits). Goods and services with big externalities tend to be over-produced (somebody else pays the costs for drug addiction) or underproduced (recovery saves $7 for every treatment dollar, but there is no market mechanism to transfer those benefits to the producer). So we rely on non-market mechanisms (charity, moral persuasion, taxpayer-funded treatment, etc.). That may be one reason we hate addiction (somebody else has the fun, but I pay the costs) and don't think treatment is worth the price (somebody else benefits, but I pay the costs).

Substance abuse treatment has many layers. It is easy for people to feel discouraged when they are in the throws of detoxing. At that point thinking about counseling is often just too hard to consider. When they have assistance to reach a stable withdrawal state often they then can have a more positive view of treatment. In my patients I see it over and over that cost, lagistics and beliefs about treatment thwart the road to recovery When a person can connect with a recovery program that feels like a good fit it can be very positive experience. When medical care, including medications, education regarding the recovery process and counseling all work together it provides stable ground to get better. The cost of any chronic disease is an issue. Finding ways to stay as healthy, clean and sober, for as one can decreases health risks leading to greater cost. As I study health care reform I am not very encouraged about the prospect of mental health care and addiction treatment. Being active voices regarding policy efforts is more important than ever.