If a doctor delivers an unsettling diagnosis, your immediate thought might be: How much will this cost?
No one wants to forgo necessary medical attention, yet the expense can make people pause.
Those seeking help for substance use disorders face the same dilemma. The rise in opioid overdose fatalities has been widely reported, but the price of addiction care receives less attention.
The worry about cost applies to both insured and uninsured individuals, said Harry Nelson, chair of the Behavioral Health Association of Providers and author of the upcoming book, “The United States of Opioids: A Prescription for Liberating a Nation in Pain.” He explained that the wide variety of treatment choices and the emergence of new approaches contribute to the confusion.
“Prices are all over the map,” he said about program fees. “I’ve seen programs charging $80,000 per month and others where people pay $5,000 per month.”
If you’re thinking about treatment for drug dependence, or helping someone who is, understanding the financial hurdles can be difficult.
Below are the key things to know before you place that initial call.
Understanding Insurance Coverage
If you have health insurance, contact your plan to learn which providers and services are covered nearby. The Affordable Care Act mandates that all plans in the HealthCare.gov Marketplace include substance use disorder treatment.
When reviewing your plan or comparing Marketplace options, check under “behavioral health benefits.” Coverage differs by state and insurer, but Marketplace plans can’t deny coverage or charge higher rates because you already have a mental health or substance use condition.
Medicare plans also cover treatment for mental health and substance use disorders.
If you lack insurance, the SAMHSA National Helpline provides free, confidential referrals in English and Spanish at 800-662-HELP (4357).
Hotline staff can point you to intake centers or state-funded programs in your area. For uninsured callers, SAMHSA can refer you to state offices or clinics that use sliding-fee scales.
You can also search online using the SAMHSA treatment services locator. The listings note each facility’s accreditations and which payment methods, insurance plans, or funding sources they accept.
Choosing an Addiction Treatment Program
Dr. Michael Strolla, a psychiatrist based in Tampa Bay and medical director at two addiction treatment centers, warned against trusting advertisements that promise a fixed cure in a set timeframe. Addiction isn’t something that’s simply cured, and each person’s needs differ.
“When someone walks in the door, I never give them a time frame,” he said. “If a place is doing therapy and treatment right, they take it one day at a time.”
“Recovery requires acquiring many skills,” added Dr. Paul Earley, president-elect of the American Society of Addiction Medicine (ASAM). He likened someone recovering from addiction to a person with diabetes who must learn to manage their diet. A reputable program should emphasize that patients learn coping strategies and use terms like “recovery” or “remission” instead of claiming to “cure” addiction, Earley said.
Both Earley and Nelson highlighted the need to ask about evidence-based practices and the outcomes for patients who have completed a program or a physician’s recommended treatments.
Strolla suggests researching facilities that are in-network with your insurance. Read patient reviews but treat them cautiously—as you would reviews for any business. A clinic or provider pressuring patients into a single treatment path is a significant red flag, he noted.
Earley agreed: “No single approach works for everyone. If someone claims they have a one-size-fits-all method and no one else does it like they do, that’s not realistic.”
Medications are likely to come up during intake conversations. Research on the three FDA-approved medications for opioid use disorder indicates these medicines are “the single most important thing in the early process of attaining remission,” Earley said.
He noted that while exceptions exist, “almost all people with opioid use disorder should start on some form of medication — at least initially, and sometimes indefinitely.”
Strolla pointed out that these medicines can be very affordable and that clinicians use formularies—a list of medications and costs—to guide treatment decisions.
“Medication-assisted treatment (MAT) has been life-changing for some and very challenging for others,” Nelson said. “It’s not universally applicable.” He recommends patients step back and gather more information if they feel pressured into a specific treatment.
Achieving remission from drug use should be the primary aim of a program, Earley said. That work should be coordinated with ongoing mental health care for underlying issues such as trauma or depression.
Nonprofit vs. For-Profit, Inpatient vs. Outpatient
Some state-supported nonprofit programs offer short three- to five-day detoxes before transitioning people to outpatient care. Others provide longer residential stays when clinically necessary.
Strolla observed that patients at nonprofit centers often lack the resources to pay for private care; they may be homeless or facing housing instability. A nonprofit typically won’t turn someone away for lack of funds if space is available.
Private programs, by contrast, can often offer lengthier and more comprehensive care than many state-funded options. The detox phase may be extended depending on the individual’s needs.
Private centers were once strictly cash-only. “Not everyone could afford that level of care, and we lost people who couldn’t pay,” Strolla said.
As private programs began accepting insurance, “[we’ve] saved countless lives,” he said. People who previously had to choose between depleting their savings or forgoing treatment can now use insurance to access care.
Earley emphasized that whether a facility is for-profit or nonprofit shouldn’t be the only factor in your decision.
If cost is a concern, Nelson suggested starting with local nonprofit providers.
“There’s a trend of traveling far away for treatment,” Nelson said. “It can be beneficial to leave the immediate environment and peer group that facilitate drug access, but there are often quality, lower-cost options locally.”
Some individuals do well with a mix of inpatient and outpatient services, which can be less expensive. “Local recovery meetings like Narcotics Anonymous and free counseling groups don’t replace formal treatment, but they’re a vital component,” Nelson said. “Recovery doesn’t have to happen only at an expensive facility across the country.”
Act Promptly When Facing Opioid Addiction
Earley recommended doing thorough research and speaking up if a program isn’t meeting your needs. He also advises getting an independent evaluation from a board-certified addiction medicine physician or psychiatrist to ensure a comprehensive approach.
“If you’re not in a hospital setting, it can be hard to grasp how serious the situation is,” Strolla said.
But he urged people not to go it alone. “Ask questions. Do what you must, and don’t hold back. There’s no guarantee you’ll survive otherwise.”
If you’re worried about yourself or a loved one and don’t know where to begin, call the SAMHSA helpline. The National Suicide Prevention Lifeline (1-800-273-TALK) also provides free support to people struggling with substance use.
Alex Mercer is a senior health writer at Savinly.
