“You know, addiction didn’t ruin me financially, but my recovery did,” Chris Roden said as he folded his arms and leaned his chair back on two legs. It seemed as if he had just vocalized a thought that he’d been trying to say for some time. “Isn’t that something?” he said.
Roden is a burly man with green eyes and shaggy brown hair that swoops down over his head. His face is usually covered in a week’s worth of scruff. People often find him charming. He’s clean now, and he is ready to talk about his liaison with his heady mistress, heroin, who he left just 14 months ago.
Although statistics vary, most studies indicate that nearly half a million Americans are addicted to heroin. For a while Roden was just another figure in those numbers. But unlike many who become closely acquainted with heroin, Roden was able to get out alive.
His recovery came with a hefty price tag. It cost him his entire life savings.
The cost of rehabilitation varies depending on the facility. Some low-cost facilities charge anywhere from $7,500 to $10,000 a month. More luxurious rehab accommodations can charge as much as $120,000 a month according to rehab.com, an online resource for people looking to find a facility that suits their specific needs.
For addicts without insurance—roughly 41 million Americans are uninsured — the prospect of seeking help can seem financially hopeless. After all, for those in the grip of addiction, it’s much more cost effective to score more dope than to check into rehab, Roden explained. But why does rehab cost so much and how effective are some of these, private for-profit facilities?
A fateful chance encounter
“In many ways I felt like I was bartering for my own sobriety,” Roden said of his stint in rehab. “But I do consider myself very fortunate to have been able to squeeze out enough to foot the bill. I can’t imagine how it is for people who have nothing.”
Roden, originally from Gadsden, worked as a physician assistant at St. Vincent’s Orthopedic Center for about 10 years. He would also frequently pick up a weekend shift at Gadsden Regional Medical Center, where he had worked for three years before Birmingham.
On the evening of Oct. 26, 2013, Roden was working in Gadsden when his life changed. It’s a weird thing, Roden said, how “some moments can just sneak up behind you and climb in your head forever.”
He had stepped outside for a cigarette. “A man was out there next to me and we were just small talking. You know, basic stuff,” Roden said. “I remember that I mentioned it was colder than I thought outside and that I need to bring my jacket with me next time.
“We’re kind of looking the same way and I see him kind of moving around so I look at the guy — I could’ve reached out and touched him — and he pulls a gun out of his pocket, and just really deliberately puts it against his head and pulls the trigger,” Roden said.
In the days that followed, Roden had trouble sleeping and couldn’t shake the image that had been seared into his head. “What drove me crazy is not knowing why he did it,” Roden recalls. “That’s something I really struggled with afterward… just not knowing. It was like watching the Kennedy assassination over and over in my head.”
As a way to escape, he began taking painkillers. While growing up, Roden said, he had smoked a little marijuana but never used any hard drugs. Eventually though, after weeks of being unable to shake the violent movie playing in his head, Roden began using heroin to cope.
“I only ever snorted it, I never shot up,” he said.
“It was the only period in my life where I was using drugs consistently,” Roden said of the months that followed.
In time thoughts of the suicide began to subside, and Roden tried to cut back on his use of heroin. “That’s when the withdrawals happened. I knew then it had me hooked in, just like that,” he said. “Basically then I was having to use every day to not feel sick and to be able to go to work. And that went on until my girlfriend found it in my backpack…probably about eight months in to me using.”
At that point Roden decided it was time to get clean. He approached his boss at work and let him know he had been using for some time. “They had an obligation to report it to the state board, which wasn’t a surprise. But they gave me the option to self-report, which in the long run would look better if I turned myself in that way. So that’s what I did,” Roden said.
When he turned himself in, Roden had been clean for about two weeks. “Really what I was hoping for was some counseling to help me deal with the suicide,” he said.
On June 2, 2014, Roden was admitted to Bradford Health Services in Warrior for his initial consultation. He gave a urine sample and underwent several days of monitoring and meetings. At the end of his three-day stay, he was given his recommendation, which is the standard procedure for anyone who attends Bradford.
“I was expecting to get recommended for outpatient therapy, because at this point I had been clean for several weeks, I wasn’t going through withdrawals or anything, not to mention I tested clean,” Roden said. “They recommended me for 10 weeks at their facility. I was dumbfounded.”
How much you got?
As a private, for-profit facility, Bradford is able to set their own recommendations for how long patients should stay. Page Rubin, a Bradford representative with the Birmingham field office, said that prices can vary depending on the recommendation after the initial consultation.
“I would say the majority of patients go into our short-term programs, which can be anywhere from 14 to 21 days,” Rubin said. “For 28 days of inpatient and six weeks of outpatient, that can cost somewhere around $19,000 for someone without insurance.” Some treatment programs can cost much more, depending on the degree of intensity and duration.
But what accounts for the cost? Mostly lab screenings, medical expenses, food, room and board, therapy sessions and medication, Rubin said. Bradford also has a staff of nurses on hand 24 hours a day. “So anyone you see there, that cost is paying for their services,” Rubin said.
According to Rubin about 90 percent of patients coming through Bradford are covered by insurance. But not Roden, who was faced with paying for his 10 weeks at Bradford out of pocket because of a technicality with his Blue Cross-Blue Shield insurance plan.
“My insurance plan covers inpatient or outpatient treatment, whatever, if you meet Blue Cross’s criteria,” Roden said. “Because I was clean and I had a clean drug screen initially, I didn’t meet the criteria.
“I actually had someone from Blue Cross tell me that I would have been better off if I had used before I went and checked myself in. Can you believe that?” Roden said, throwing his arms up in the air.
Representatives with Blue Cross declined to comment.
For just the initial three-day consultation Roden owed $3,000. For his 10-week stay, the bill came to $42,000, which had to be paid in full before Bradford would sign off on his stay to the Alabama Board of Medical Examiners (ABME).
“I told them, ‘Hey I don’t have that kind of money just laying around somewhere.’ So they agreed to let me go for a couple of days to see if I could come up with the money,” Roden said. “Bradford was even encouraging me to ask family members for money.” They also gave him information on where to take out an unsecured loan at 8 percent interest to pay for his treatment.
He spent several fruitless days trying to wrangle some money. Then, Roden said, one of the therapists called to ask if he had the money yet. “I pick up the phone and the first thing I’m asked is if I had the money yet. I told them no and that if I had to change professions then so be it because I just didn’t have the money,” Roden said.
He hung up. A few minutes later, the phone rang again. The same therapist told him that she had talked to someone and Bradford would be willing to give him a discounted rate of $24,000 for his entire stay.
“That is another thing that really bothered me,” Roden said. “They weren’t going to come off of the $42,000 until they thought I wasn’t going to come back. And if they can do it for basically half the price, why is that not what I was initially asked to pay? It’s like they called my bluff.”
Roden ended up having to clean out his retirement fund to pay for his stay at Bradford, which after early withdrawal penalties, co-pays and other fees, ended up costing him close to $40,000.
“It just felt like a shakedown. I pleaded with the [ABME] and with Blue Cross, but they said there was nothing they could do about it. Basically, the rehab facility they required me to go to was asking me, ‘So how much you got?’ It just doesn’t seem right,” Roden said.
“We don’t want to mix them with thugs”
As a medical professional, Roden understood that he would be held to a higher standard of sobriety than other people who are looking to get treatment. Still, he said, it’s unrealistic to think that everyone who wants to check into rehab will be covered by insurance or have the money to pay out of pocket.
A recent Gallup poll suggests that 12.9 percent of Americans remain uninsured. In 2014, 14.5 of Alabamians were without health insurance, roughly 684,000.
Jeff Grimsley, director of physicians’ monitoring with ABME, said that what happened with Roden’s insurance is unfortunate. But the ABME’s main concern is the safety of the patients an addicted professional might be treating. Doctors and other professionals like Roden have to get their addictions under control or leave the practice of medicine.
Grimsley said that he has seen similar situations. “Yeah, I’ve seen that happen before, but at the end of the day, the doctor or the physician’s assistant is going to have to pay for it before they can get back to work. That’s just the way it is,” Grimsley said.
“If [Roden] turned himself in and had been clean for a couple days, then yeah, I’m sure he probably had clean urine. Usually it only stays in your system three days at most, five depending on your metabolism,” Grimsley explained. “As far as whether the insurance pays for it, they pay for it, their parents pay for it, I don’t get involved with that. I just make sure they get there or they go out of practice.”
The ABME has no exclusive contract with any facilities, Grimsley said, but they do have a list of “approved facilities” that they recommend. Bradford is an example. The reason for this, he said, is that some facilities cater more exclusively to professionals.
“I don’t like to put my doctors in with some junkie they just picked up off the street,” Grimsley said, “In some facilities they don’t separate them. I could have a doctor, a well distinguished doctor that could’ve been chief-of-staff at a hospital bringing in millions and millions of dollars to the hospital. I don’t want to put him in rehab with some thug that has been working the street for 10 years. I want to keep my professionals together.”
In Alabama, Grimsley said he sees “several dozen” instances each year of doctors and other healthcare professionals who decide to check themselves into a rehab facility. He’s seen everything from doctors writing prescriptions in the names of their dogs, to stealing pills from the pharmacy. More often than not, these doctors end up at Bradford.
Bradford is up front about being a for-profit facility. It has relationships with various companies and boards, but not exclusive contracts, Rubin said. “We are an approved facility for a lot of boards like the Alabama Bar Association or the [ABME]. There aren’t any specific contracts, but if they are being monitored by one of those entities, then we are one of the places they will come to get help.”
What you pay for
Roden describes Bradford’s approach as largely faith-based, and, in his view, inadequately focused on individual counseling. Most of his daily routine was based around group exercises and discussions.
“I would sit down with counselor for 20 minutes or so and they would just ask me how I was doing. It almost felt like they were just seeing if I was enjoying my stay instead of helping me work [expletive] out,” Roden said.
Despite that, Roden completed his time at Bradford and even an additional four weeks of intensive outpatient monitoring afterwards. But he came out of rehab with an entire new set of issues, he said. “I was angry. I was frustrated. I wanted to do right and get help, and what I got in return was an empty retirement. I was already clean. I just wanted a little more help staying that way. And for $40,000 I thought I should’ve had someone sitting across from me, talking to me, a little more than I did.”
The stigma
Despite the cost, facilities like Bradford are entitled to charge for their services, explained Dr. Caitlin Taylor, a professor of sociology and criminal justice at LaSalle University. She studies mass incarceration.
“One of the biggest factors in whether or not a person will be successful in rehab has to do with the duration of treatment,” she said. “There’s a lot of evidence to suggest that for a treatment to be effective, it needs to be at least 90 days in duration.”
The cost of long stays can add up quickly, she said.
“A lot of this has to do with the fact that it is residential and that also for treatments to be effective you have to have a staff that is well-trained. And that being the case, they are going to have to be paid a decent amount,” Taylor continued.
Unlike many people who become addicted, Roden had access to effective channels to seek help. Many addicts find themselves in prison before they can get help. In America, Taylor said, there is a stigma placed on addicts: drug addicts are criminals and therefore deserved to be locked up.
In part, this stigma arises from mandatory minimum sentencing being implemented in the 1970s for drug offenders, Taylor said. Once incarcerated, only about 10 percent of inmates who need some sort of substance abuse treatment will ever receive it, Taylor said, partly because anything done in a prison environment is going to cost a lot of money.
Also, there is what Taylor calls, “the principal of lesser eligibility.” That means that if a law-abiding citizen has to pay for drug or alcohol treatment, why should people who have broken the law get their treatment for free?
“We see criminals as being less eligible to receive this kind of treatment,” she said.
The criminalization of people who have become addicted to substances, be it alcohol, heroin or prescription pills, is at the heart of the problem, Taylor said. She acknowledged that solving it wouldn’t be simple.
“This is going to require a huge moral shift in how we as a society view people who have drug addictions as well as people who have committed a crime,” Taylor said. “We really kind of thrive on this ‘us versus them’ and the ‘good guy versus bad guy’ mentalities. But instead of seeing a person who has done a bad thing as deserving of punishment, if we move towards viewing them as someone who needs help, this type of cognitive shift, I think, would increase the likelihood of taxpayers supporting the idea of prison rehab programs and shorter sentencing for drug offenders. That would cut back on the overcrowded prisons.”
The cost of rehab won’t come down until the stigma is changed, Roden believes. “People just need to know that addicts aren’t bad people. I don’t think I’m a bad person. I had something that shook me and I turned to heroin to cope with it. And I paid for it,” Roden said, pausing momentarily. “I just hate to think about all the people who want help but just can’t pay for it.”
Though he is currently taking some time off from the medical field, Roden hopes to one day get back to work. “I miss the interaction and the feeling that I got from helping people,” he said, “We all need a little help sometimes.”