Hannah Berkowitz is 20 years old. When she was a senior in high school, her life flew off the rails.
She was abusing drugs. She was suicidal. She moved into a therapeutic boarding school to get sober, but she could stay sober only while she was on campus during the week.
"I'd come home and try to stay sober really hard -- really, really hard," said Berkowitz, who had trouble staying away from old friends and bad habits. "Sometimes I'd make it through the weekend, and sometimes I just couldn't make it. It was white-knuckling it, just holding on."
The transition back home always triggered a relapse for Berkowitz.
"I thought it was just my fault and there was no hope," she said.
But Berkowitz did have luck. She had private health insurance and lived in Connecticut, where a startup company, Aware Recovery Care, had begun treating clients in the very environment where Hannah struggled to stay sober: her home.
A Chronic Disease Approach
Treating addiction is a growing business, and some treatments, especially inpatient care, can run tens of thousands of dollars. For many people, the help is only temporary. The National Institutes of Health estimates that 40 to 60 percent of people addicted to drugs relapse. But there is a way to help some people pay less for better results, said Matt Eacott, vice president of Aware Recovery Care.
"Ninety-nine percent of the industry really treats addiction as an acute problem -- like a rash on your arm that you rub lotion on and you're done," he said.
Rather than a bad rash, Aware treats addiction as a chronic illness that doesn't disappear just because symptoms are under control -- a cost-effective way of treating addiction, Eacott said.
Aware comes into clients' homes and connects them with a nurse, a primary care doctor, a therapist, peer support, 12-step meetings and a case manager. Clients hooked on opioids can get medication-assisted treatment. They can also submit to urine screening and GPS tracking, if that helps them stick with the program.
Hannah's mother, Lois Berkowitz, said the program is intense at first. But as Hannah built coping skills, the supports faded into the background.
"It's not like they're doing the work for the addict," said Lois Berkowitz. "They're just basically taking them by the hand and saying, 'Here are the places you need to go that will help you. And I'm going to go with you to start so it doesn't feel that uncomfortable. And then we're going to let you fly.'"
Before they fly, Aware clients have a pretty long runway. The treatment lasts a full year.
Aware has now expanded from its base in Connecticut into New Hampshire. The program is expensive: $38,000 a year. As of now, it's available only to private-pay clients and people insured through Anthem health insurance in New Hampshire and Connecticut.
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Anthem became the first insurer to pay Aware, because the treatment is based on hard science that's yielding solid results for clients, said Dr. Steven Korn, Anthem's behavioral health medical director. Science and results are rare in addiction treatment, he said.
"There are old, old notions that have hung pretty tough," said Korn. "When I was young, when I was in training and as soon as substance abuse was mentioned, the response of physicians was, 'Well, go to AA. That's not our problem. We don't treat that.'"
For a year of treatment, Anthem said, it's paying Aware about the same as the cost of a month or two of inpatient treatment. Anthem also says 72 percent of Aware clients are either sober at the end of one year or still in active treatment.
That's about twice the sobriety rate of people who check in to a facility for a month and then get no follow-up care, said Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine.
Treating addiction at home makes sense because it's the exact place where people learned their bad habits, Gitlow said.
"It's all based on this concept that addiction is not about the substance use but is about what led to the substance use in the first place. And you can't really get there without getting to know the patient," he added.
Aware said it's in negotiations with four more major insurers. It aims to have a couple of hundred clients in New Hampshire by the end of the year.
This story is part of a partnership that includes NHPR, NPR and Kaiser Health News.