The traditional 28-day stint in a rehab facility for drug and alcohol addiction treatment is largely a thing of the past.
With managed care and rising costs, those struggling with opioid addictions are likely to spend no more than three to five days in an inpatient setting, if that.
"Even in our hospital, the average stay is four to five days," said Michael Steigmeyer, director of marketing with the Northeastern Center, which offers behavior health services in four northeast Indiana counties. "Then they go on."
According to the National Institute on Drug Abuse, though, research suggests that longer treatment times result in better outcomes, and that most people need at least three months in treatment to "reduce or stop their drug use."
Insurance companies have balked at inpatient treatment for drug addiction because it has not always been seen as fatal, said Jane Holliday, a care navigator with Parkview Behavioral Health.
But it is fatal, killing 28,000 Americans in 2014, according to the Centers for Disease Control and Prevention.
The traditional 28- or 30-day treatment program was developed in the 1970s for military purposes, according to a 2008 Los Angeles Times report. Military personnel need not be reassigned if they were away from duty no more than 30 days, the newspaper found. Insurers adopted the standard.
Under the Mental Health Parity and Addiction Equity Act of 2008, insurers are required to cover substance abuse at the same level of benefits as for medical/surgical care, according to the Indiana Department of Insurance.
Most treatment now is outpatient, said Thomas Allman, manager of addiction services at Park Center.
"It’s not really done inpatient," Allman said. "Inpatient is so expensive."
The Fort Wayne-Allen County Department of Health did not have a treatment bed count for the county. But the number of beds has steadily decreased over the last few decades for a number of reasons, said Megan C. Fisher, addictions services director for the Bowen Center in Warsaw.
Insurance approval for inpatient treatment is harder to obtain, but care is also moving toward an "integrated" model involving community resources, family and support groups, among other elements, Fisher responded in an email. Treatment has expanded to address mental health disorders and "other life difficulties" such as housing, employment and parenting, she said.
"As these pieces of the mosaic learn to work together toward a common goal, the ‘walls’ of treatment expand and the need for a single brick and mortar center is minimized," Fisher added.
Parkview Behavioral Health is reaching out to those who need inpatient treatment, regardless of insurance or requiring the underlying presence of other mental health issues, Holliday said.
But sometimes inpatient treatment is available only to those with a dual diagnosis: addiction and an underlying mental health issue, Steigmeyer said.
After the minimal inpatient treatment, the patients are transitioned into outpatient programs. That makes the recovery environment incredibly important, Allman said.
If the individual’s outpatient treatment does not promote the "recovery lifestyle," then providers look to what is available in the community to fill that gap.
The job of providing a "recovery environment" to those working through addiction now falls to halfway houses, residential facilities in the communities that provide supervised housing in a home-like setting among others struggling with the same issues.
In spite of all the talk about addiction and the need to treat it, there is still not an adequate number of halfway houses in the area to treat those who need something in between inpatient and full outpatient treatment.
Most halfway houses were "self pay" until a year or so ago, but residents were often not able to work while in treatment. Now they might be paid through Indiana’s Recovery Works program, but that requires the individual be an adult, have an income at 200 percent of the poverty level and a felony charge.
While Parkview doesn’t operate any halfway house-type programs, Holliday said they do work to make sure patients are aware of them if they need them.
According to Allman, halfway houses are not regulated and not subject to any real scrutiny with regards to the quality of living, though there are a few that are stable in what they provide.
But it’s what is available, and Allen County is in a better position than other communities in the area, Allman said.
For more rural counties, transportation is one of the largest barriers to treatment.
Northeastern Center has offices north of Fort Wayne in DeKalb, Noble, Steuben and LaGrange counties.
But those battling addiction are often "fairly stranded," according to Steigmeyer.
They might have lost their driver’s license, not be able to afford a vehicle, or have no one in their home who can bring them to treatment. Communities such as Albion, Ligonier and Orland do not have public transportation to larger towns and cities in their counties.
Northeastern Center has a fleet of vehicles that will pick people up for group therapy sessions and other treatments, Steigmeyer said.
They see transportation problems at Parkview Behavioral Health, as well, Holliday said.
"We get people who want to come in, and we get them started and they don’t show up the next day," she said. "There’s always barriers for these people to continue their treatment in outpatient treatment."