The opioid crisis or the opioid epidemic has been going on for decades due in part to the introduction of new opioids such as OxyContin. The crisis was accompanied by new waves of overdose deaths due to heroin and fentanyl. But opioids aren’t the only drugs out there, and drugs aren’t the only substance being abused. Stimulants such as cocaine and methamphetamine (meth), benzodiazepines (benzos) such as Xanax and Valium, and alcohol also can lead to dependence, addiction, and death. Using two substances at the same time greatly also increases the risk of complications. At some point, many people with addictions want to stop, due to financial cost or health and well-being concerns. A person who is dependent on drugs or alcohol may realize that quitting would benefit them, but find themselves unable to do so. The substance has rewired the brain so that quitting is almost impossible. Trying to stop or even reduce use leads to physical and mental withdrawal pains and symptoms. Others can’t find a treatment facility, especially an inpatient facility. Some just can’t find an affordable one.
Recovery Advice When Money Is ScarceSubstance use disorder is expensive in terms of its costs to individuals and society: lost jobs, lost productivity, lost relationships, lost health, and even lost lives. Addiction rehab treatment also can be expensive. Treatment for substance use disorder can be more expensive than continuing drug use, at least in the short-term. According to one source, 30 days of inpatient rehab treatment costs anywhere from $5,000 to $20,000 -- and five or six times as much for a luxury rehab. And treatment for 90 days or longer is usually recommended. Not that cost is the primary barrier. Of the almost 90% of those who needed rehab in 2015 but didn’t get it, 95% didn’t think they needed it. Still, considering how addiction affects judgment and finances, many people with a substance use disorder (SUD) probably don’t have access to that much cash. Fortunately, there are less expensive rehabs, programs, treatments, and other resources -- sometimes even free -- if you can find them.
Searching for Free Treatment Resources and ProgramsThere are many ways to begin your search for free rehab, beginning with:
- Health care providers. Because there are a lot of charlatans out there, you should ask someone you trust. Your primary care physician (PCP) may be able to point you in the right direction.
- Health insurance provider. The Patient Protection and Affordable Care Act (also known as the Affordable Care Act or the ACA) mandates that most health care plans cover mental health and substance abuse treatment. Find out if yours does, how much it covers, and which programs or facilities.
- State-funded programs. Part of the Delaware Health and Social Services (DHSS), the Division of Substance Abuse and Mental Health (DSAMH) helps connect individuals with appropriate treatment, mostly through private centers and providers.
- Federal-funded resources. There are several U.S. government agencies with resources on substance abuse and mental health disorders:
- Find a Health Center. Funded by the Health Resources & Services Administration (HRSA), this online tool directs you to community-based and patient-directed organizations in areas where barriers -- economic, geographic, cultural -- could limit access to affordable healthcare.
- Behavioral Health Treatment Services Locator. This U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) tool is dedicated to mental health and substance abuse disorders.
- National Helpline. Also from SAMHSA, this helpline directs callers to treatment facilities, support groups, and other resources in their area, as well as related free government publications. Call 800-662-4357 (HELP).
- Other online rehab locators. There are many sites on the web that say they can help you find a rehab. Some are legit, some are openly owned by rehab centers but still offer comprehensive information on their competitors, and some are suspect. In 2017, The Verge published an article on how to spot the shady ones, but the sites may have new tricks now.
- Peer support groups. While 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous (AA and NA) aren’t forms of rehab by themselves, they include people who are at various points in their addiction rehab experience. They may be a source of valuable firsthand information on which rehabs are trustworthy and effective.
Types of Substance Abuse Treatment ProgramsThere are two main types of treatment programs: inpatient and outpatient.
InpatientWith inpatient treatment, the client lives at the rehab center to make it easier to follow the program. As an inpatient, the client is under observation and has access to care 24 hours a day. If the client isn’t already sober, they may undergo medically monitored detoxification (detox). Medication-assisted treatment (MAT) with safer, replacement drugs may be used to ease the individual off of alcohol or drugs gradually, avoiding sudden withdrawal, which can in some cases be dangerous (particularly if there is heavy alcohol or benzodiazepine use). Once sober, the client is kept busy with therapy, lectures or classes, group activities, group counseling, and support groups. Due to the array of services provided, plus room and board, the cost of inpatient treatment is greater. With luxury rehabs, the cost increases.
OutpatientThe other main type of treatment program, outpatient treatment, is for clients who do not need detoxification services, 24-hour monitoring, or room and board. The client visits a rehab center or other health care facility for several hours daily but goes home at night. This seems to put the client at greater risk of relapse, but there are reasons besides cost to consider. One of the biggest causes of relapse is exposure to triggers in the environment: people and places associated with the client’s substance abuse. It is best to avoid these altogether, but that may not be possible. With outpatient treatment, the client can find support locally, including their friends and family network, and become desensitized to triggers over time. With inpatient treatment, clients are kept from the triggers for a week, month, three months, or however long rehab lasts, then may be suddenly exposed to them again. They have had no time to develop psychological antibodies, so they have less resistance, less immunity.
12-Step Programs and Non Religious ProgramsTwelve-step programs are among the best-known and first-tried remedies for substance abuse, but they are not treatments. They are peer support groups in which people who abuse the same substances meet. There are no membership rolls or fees, it is not required that they attend meetings or speak at them. They are anonymous, so it’s not possible to judge how effective they are by themselves. But it can help to talk with or listen to someone who is going through the same thing as you, to learn from their failures and successes, and to share your own stories. Sometimes it is the first step to seeking actual treatment. Besides, the meetings are free and held daily in larger cities, sometimes several times a day in several different locations.
- 12-step programs. A process conducted largely through faith-based meetings (though there are secular versions too). By working the steps of the programs, individuals with addictions and other behavioral disorders acknowledge their problems, work to improve or remove those problems, make amends to those they have wronged, and pay it forward by helping others with the same problems.
- Alcoholics Anonymous (AA). The original 12-step program, it still holds free meetings daily, with video and audio meetings the norm during the COVID-19 pandemic. Click for local AA meetings in Delaware.
- Narcotics Anonymous (NA). The umbrella group for various substance abuse problems (though there may be drug-specific groups in some areas). Click for local NA meetings in Delaware.
- Non religious programs. For various reasons, some people don’t feel comfortable in faith-based programs, so there are secular options. The best-known and organized one is SMART Recovery (Self-Management and Recovery Treatment Recovery), an evidence-based program with elements of motivational interviewing or motivational enhancement therapy and cognitive behavioral therapy (CBT).
Paying for Substance Abuse Treatment When It’s Not FreeNot that all rehabs will be free. Depending on your location, there may not be any free programs. On at least one free rehab listing site, five states, including Delaware, have no listings (although nearby Maryland, Pennsylvania, and New Jersey do). All states should have funds set aside for those who do not have health insurance and whose incomes fall below a certain level. In Delaware, call (302) 255-9399 or contact the Division of Substance Abuse and Mental Health (DSAMH). The state may not cover all costs, however. Even locator sites that do include Delaware may not really be free. They may charge less, accept insurance, or have sliding scales based on ability to pay. The article “Paying for Treatment” at FindTreatment.gov offers advice, including:
- Insurance. While the ACA requires mental health and substance abuse coverage in most instances, sometimes navigating the process is arcane and difficult. Once you have a rehab center in mind, the center may be able to work out the details with your insurer.
- Grants and scholarships. The nonprofit 10,000 Beds partners with treatment programs to provide substance abuse treatment scholarships to “applicants who are without resources and actively seeking help for addiction.” SAMHSA also has some grants available for individuals without insurance. So do some rehab centers (especially faith-based ones) or their corporate partners or owners.
- Payment plans. Some substance abuse treatment facilities will let you pay for your treatment over time. Check ahead of time and make sure the terms don’t charge excessive interest rates.
- Friends and family members. If you haven’t burned your bridges and damaged your relationships beyond repair, those closest to you may be able and willing to help you.
- Loans. If you have no other options and decent credit, a personal loan might be the way to go, or a home equity loan. Again, make sure you are getting good terms.
- Crowdfunding. This might be a long shot because crowdfunding works less well for problems such as addiction that may be stigmatized.
Other Resources and OptionsThere are other resources for substance abuse treatment besides formal rehab centers. Delaware Health and Human Services (DHHS) provides a Consumer Self-Help Center, including:
- Mental Health Self-Help Clearinghouse - “A peer-run national technical assistance and resource center.”
- National Alliance for Mental Illness in Delaware (NAMI)
- National Empowerment Center - An advocacy group run by and for people with mental health disorders.
- Mental Health Association in Delaware
- Alcoholics Anonymous
- Adult Children of Alcoholics
- Narcotics Anonymous
- Depression and Bipolar Support Alliance
- cdc.gov - Understanding the Epidemic
- help.org - How Much Does Rehab Cost?
- drugabuse.gov - How long does drug addiction treatment usually last?
- samhsa.gov - America’s Need for and Receipt of Substance Use Treatment in 2015
- dhss.delaware.gov - Substance Abuse
- findahealthcenter.hrsa.gov/ - Find a Health Center
- bphc.hrsa.gov - What Is a Health Center?
- findtreatment.samhsa.gov/ - Behavioral Health Treatment Services Locator
- samhsa.gov - National Helpline
- theverge.com - Searching for Help
- californiahealthline.org - Good Rehab Is Hard to Find
- delawareaa.org - Find an A.A. meeting in Delaware
- meetings.intherooms.com - Narcotics Anonymous Meetings in Delaware
- dhss.delaware.gov - Contact Information
- findtreatment.gov - Paying for treatment
- 10000beds.org - 10,000 Beds
- theatlantic.com - When GoFundMe Gets Ugly
- dhss.delaware.gov - Recovery Resources