Utahns, battling an epidemic of adolescent substance abuse, have found themselves caught in a vicious spiral.
More teens are seeking "highs" from alcohol and drugs. Yet, fewer funds are now available for the intensive - and expensive - treatment of chemical dependency.Some 7 1/2 percent of Utah teens between age 12 and 17 have either a serious or extreme problem with drugs or alcohol, said Dr. Lewis B. Hancock, director of the Dayspring Program at Wasatch Canyon's Hospital. Hancock was quoting statistics from the 1984 Incidences and Prevalence Study from the State Division of Substance Abuse.
"That's 13,000 kids in Utah who are really struggling with a daily problem with alcohol and drugs," he said. "Generally that's a third lower than the rest of the nation. We have less drug abuse than in most places, but that's not saying much when you consider how far it has gone."
How far has it gone? The statistics are startling.
Only about 10 percent of teens make it to their senior year without using some drug, according to a National Institute on Drug Abuse study. About half of high school students and a fourth of junior high student are using some drug on a regular basis.
Many cannot get professional help - despite the surge of psychiatric hospitals along the Wasatch Front during the past two years.
While one person can walk in to a treatment facility and have 100 percent insurance coverage, Hancock said another person, insured by a reputable company, could - for many reasons - have no coverage for the same affliction.
Many employers, including several school districts who contract insurance for their teachers, are enrolling in plans that exclude drug and alcohol treatment. It's one way, they say, of cutting skyrocketing medical costs.
And enrollees, for the most part, don't read the fine print.
"No one plans for their child to grow up to have the disease of alcoholism or drug dependency," Hancock said. "It's something you would never plan for."
Some companies, like Public Employees Health Program, IHC Care, and Deseret Mutual Benefits Association, have been more aggressive than most other insurance companies, and have developed a variety of "co-payment" chemical dependency plans. The company pays for a portion of the treatment; parents pay the rest.
Still the family is looking at a large out-of-pocket expense. The average cost of intensive drug or alcohol treatment is $10,000. It can go much higher.
"You don't want to equate the life of a person with money, but we have to look at the financial aspects because if you cause a family bankruptcy, you haven't helped. You have made their life worse," said Mary Ann Blanford, utilization manager for emotional illness at DMBA.
To stay solvent, insurance companies also have to contain costs. Thus DMBA initiated a chemical dependency benefit program two years ago "cautiously."
"We want to evaluate how extensively it is used, what kinds of benefits it is providing, and at some time in the future, we will probably re-evaluate it," said Michael J Stapley, DMBA vice president, benefits administration.
"We only want to provide treatment to people who are legitimately in need of it. Otherwise it will just blow our expenditures out of the water," he said. "We have to monitor it, and one way of doing that is to ensure the participant has a financial investment in the program.
"If they are willing to dip into their own pockets and come out with some kind of a contribution, then it is a validation to us that they feel it is important."
Drug and alcohol treatment, Hancock said, is not only important, but essential if chemically dependent teens are to return to healthy lifestyles.
He explains that effective treatment is expensive because it's intensive.
"There is no short-cut. If you are seeing a kid once a week on an outpatient basis, and the kid is using (drugs) several times a week, you have a one in 20 chance of that kid being drug-free a year from now," he said. "Some of our cancer treatments have higher success rates than some treatments for chemical dependency. Yet it is the most crippling disease of our teenagers today."
To combat the disease, the state has joined with private enterprise.
Three state supported agencies - Salt Lake Valley Mental Health, Community Counseling Center and Odyssey House - provide treatment on a sliding scale.
But Hancock predicts that by mid-fall these programs will be glutted with kids, and then there will be waiting lists to get in.
"I think everyone needs to realize that it just can't be the state who picks up the expenses," he stressed. "It (chemical dependency) is a physical disease, and I really feel strongly that medical insurance ought to cover treatment for it."
Hancock, sympathetic to the concerns of insurance agencies, has identified alternative ways to treating these teens - besides admitting them to expensive inpatient units.
Residential care, he said, is half the cost of inpatient treatment. Day treatment, where the teens are treated in the facility during and go home at night, is a third the cost.
"There must be carefully chosen alternative methods where you have a continuum of care from inpatient to residential, to day treatment to straight out-patient. That would make sense for insurance companies and parents to get the most services out of their dollars," he said.
Something has to be done, Hancock said. And, fast.
"Last year state programs probably treated upwards of 300 kids, and private programs treated more than 500 kids in Utah," he said. "That means that out of 13,000 teens needing help, less than 1,000 received any treatment for drug and alcohol abuse."