Politics stymies alcohol treatment

Getting past denial, public stigma just the first battle in alcohol abuse recovery

Kirby Krueger’s hard-working, hard-drinking Wisconsin roots are entwined with a history of alcoholism on both sides of his German-Polish family.

Krueger’s mother, Janet, 72, remembers as a child running to the corner tavern in Milwaukee with a metal lunch pail to pick up beer for her grandfather.

“I didn’t think anything of it,” she said. “That’s just how I grew up.”

So while Janet Krueger didn’t ignore her son’s underage drinking when he was developing into one of Appleton’s premier teenage athletes 35 years ago, she thought he would grow out of it.

“I was raised in a family where you knew who drank too much and who didn’t, but no one got treatment,” she said. “If you had a problem, you pulled yourself up by your bootstraps. I thought he would figure it out.”

But for a long time, Krueger didn't figure it out or seek treatment. Denial cost him his dreams of playing big-league baseball, a marriage and his health, causing him decades of misery.

“In Wisconsin, if you make it to work every day, even with a hangover, and pay your bills and show up for family gatherings with a smiling face, you’re not (perceived as) an alcoholic,” said Krueger, now 50.

His story speaks to Wisconsin’s alcohol-ingrained culture, which not only can engender problem drinking but also can obscure the need for treatment. A toxic brew of drinker’s denial, limited access to services, costly co-pays and public stigma keeps many Wisconsinites who battle the bottle from getting treatment they require.

Those who do recognize they have an addiction often find treatment prohibitively expensive.

Only 10 percent to 12 percent of those Wisconsinites who need help actually get it, said Dr. Richard Brown of the University of Wisconsin-Madison.

“We lead the nation in risky drinking and, for the most part, people don’t get treatment,” Brown said.

Over the past five years, Wisconsin has averaged the fifth-highest rate of alcohol dependence or abuse in the nation. Nearly 10 percent of the state’s population has an alcohol problem, according to the National Survey on Drug Use and Health. Additionally, the state averages the fifth-highest rate of people needing but not receiving treatment for an alcohol problem, the same survey shows.

Brown is clinical director of the Wisconsin Initiative to Promote Healthy Lifestyles, a $12.6-million project to improve alcohol and drug screening, intervention, referral and treatment in the state’s primary care clinics, including early participant UW Health-Fox Valley Family Medicine in Appleton.

“People with alcohol problems don’t realize they have a problem and earnestly don’t believe they need help,” he said, “and then once they realize it and try to get help very often they can’t.”
Badger tradition

Krueger guzzled Boone’s Farm wine when he was 16. His addiction deepened while he was in college.

“You believe alcohol goes with everything,” he said. “You go to a ballgame, you drink. You go out with the guys, you drink. You go to a family reunion, and you’ve got a kegger tapped.”

For his addictions, Krueger has required nearly a dozen treatments since age 16. Drinking led to out-of-control boozing and then to hard drugs and then, finally, to prison.

He has been convicted of drunken driving five times and has been arrested more than once for using crack cocaine.

In some ways, running afoul of the law was a blessing.

“I would never had gotten help if I hadn’t been forced to, to appease the courts,” he said.

In a state where drinking is an inextricable part of the fabric of life, recognizing alcohol abuse, especially in yourself, is difficult.

“People believe it’s no problem,” Krueger said. “Like me, they say I can handle this. I’ll just stop tomorrow.”

But denial isn’t the only barrier to treatment. An even bigger obstacle, Brown believes, is a lack of insurance parity. Treatment costs often go under-funded because addiction is not covered on the same level as other illnesses.

“You’d never tell a diabetic: ‘Your blood sugar is too high but sorry, we won’t treat you anymore because you’ve exceeded your treatment cap,’” Brown said. “But that’s what we tell people here about alcohol all the time.”

Wisconsin is one of fewer than a dozen states that do not provide for some form of insurance parity for substance abuse and mental illness, which often overlap. Under Wisconsin law, group health insurers can cap coverage at $7,000 per year for mental health and substance abuse treatment, including inpatient, outpatient and transition services.

That amount has not increased since it was set 23 years ago, said Sarah Bowen, executive director of the Wisconsin Psychological Association and co-chairwoman of the Coalition for Fairness in Mental Health and Substance Abuse Insurance.

“In 1985, when the state mandate was established at $7,000, you could purchase about 30 days of inpatient care with that,” Bowen said.

That’s no longer true.
Caught up in politics

The renowned Hazelden treatment facility in Center City, Minn., costs about $26,000 for a 28-day stay. Rogers Memorial Hospital in Oconomowoc runs $16,000.

NOVA, one of the state’s few inpatient rehab centers, charges $4,000 for a 28-day stay. Most clients pay out of their own pockets, said executive director Marcia Larson.

“I couldn’t have afforded that,” Krueger said.

Without adequate insurance coverage, cost is a big deterrent for many of those who might seek treatment.

“It is difficult to afford treatment if they have health insurance and almost impossible if they don’t have health insurance,” said Kristene Stacker, executive director of Fox Cities Community Health Center, which serves the uninsured and underinsured in Calumet, Outagamie and Winnebago counties.

“About the only way they can get in for treatment for detox is if it becomes a legal situation and they go in on a 72-hour hold.”

Bowen’s coalition, which wants mental health and substance abuse treatment covered under the same conditions and terms as any other medical problem, is trying to educate employers about how they could save money if Wisconsin had parity. Savings would come from reductions in absenteeism, turnover, on-the-job mistakes and overall medical expenses.

The group repeatedly has run into a buzz saw in Madison, however, and Bowen isn’t optimistic.

“We have been caught up in politics and the fact that key people in the state Assembly don’t believe in government enacting laws telling employers what benefits to give employees,” she said.

Rep. Steve Wieckert, R-Appleton, who serves on the state assembly’s health committee, said parity comes up periodically. But, while there is bipartisan support for measures to get tougher with drunken drivers, treatment is a harder sell.

Some legislators cite questionable success rates as a waste of taxpayer money.

Legislator Gregg Underheim, (R-Oshkosh), who chaired the Assembly’s Health Committee, said: “Efficacy (of treatment) is a big issue but there is also the question of how do you properly allocate the costs for treatment. This is clearly a social policy decision. Why hide the cost in private insurance?”
Treatment costs

The cost of treatment has been a major obstacle for families of students with alcohol and drug issues who would like to get help, said Deb Larson, a recently retired social worker with Appleton Central High School. Larson worked with students at risk of not graduating, often because of underlying substance abuse issues.

“It’s very frustrating for us, knowing the sooner we can intervene the better,” she said. “Often, it doesn’t get addressed until they land in the county system and request intervention at some point or the county steps in and requires it.”

Options Treatment Programs in Grand Chute specializes in adolescent and adult outpatient treatment and relies on client co-pays, insurance reimbursement, county funding and Medicaid.

Executive Director Jim Webb said depression and substance-abuse counseling cost as little as $300 for six weeks of individual sessions. The cost of 14 weeks of day treatment is $3,000 or less.

There are no waiting lists, however.

“We do our very best,” he said, “but it can be a challenge with some insurance companies, and we spend a lot of time on the phone.”

Options is one of few outpatient agencies that accept low-income clients on Medical Assistance. The government reimbursement rate is poor, Webb said.

“Where an insurance company might pay $30 for an hour of group therapy, Medical Assistance pays $8,” he said.

Those who cannot afford treatment at a private facility have options in the public sector, accessing providers and services through their county government, said Tom Swenson, behavioral health manager for Calumet County.

“But I’m not sure we can continue without more federal and state dollars,” he said. “We’re finding ourselves with less money for support and more people needing it. That is certain to get worse in the current economy.”

As an alcohol and other drug abuse counselor with the Health Center and Fox Valley Psychiatric Associates, Kerrie Jo Larsen has a foot in public and private sectors.

“Most people I see have no insurance coverage,” she said. “They’ve often been through the whole gamut with their disease, progressing from leading a stable professional life with health insurance coverage to no insurance and homeless or living in a shelter — all directly related to their alcoholism.”

Some treatment providers doubt insurance firms have the client’s best interest in mind when monitoring costs.

NOVA’s Marcia Larson said that even though her 50-bed program, one of Wisconsin’s few inpatient rehabilitation centers, is relatively inexpensive, health care management companies prefer less costly outpatient care.

“The biggest single paradox in the insurance industry is that employers purchase policies and have what they believe is a reasonable benefit for their employees,” she said, “and what is not said in these policies typically is that said benefit will be managed in such a way you can’t access it.”
Insurance challenges

Parity may not be the answer if it means even more layers of management, she said.

“Clients practically have to be poised on the edge of a building preparing to leap before the insurance companies say they need to be served in anything other than an outpatient setting,” Larson said.

“We need a more enlightened insurance industry. There are people doing case management who don’t know anything about chemical dependency. They try to cut costs. We try to save lives. Sometimes those agendas are at odds.”

Karrie Jo Larsen, the alcohol and drug abuse counselor, said she thinks it has become tougher to get treatment in Wisconsin.

“It’s very frustrating that insurance companies really dictate treatment,” she said. “Our hands are often tied by how often, how many times and the level of care insurance will pay. An incredible amount of work goes into justifying how much care is needed.”

Insurance companies are not the bad guys, said Greg Thousand, manager of behavioral health for Network Health Plan, Menasha.

He said his role is part gatekeeper with employers’ interests in mind and “part trying to make the best match so people aren’t out in the cold looking for resources in the Yellow Pages.”

Such determinations are based on “medical necessity,” he said, “so people don’t go into more costly residential programs when there might be a more effective treatment match based on their symptoms, such as outpatient treatment or group therapy.”

Thousand is glad to see efforts to bring about insurance parity in Wisconsin, but he said: “I wish they would look more incrementally without shooting for the moon. We’re all trying to keep costs down.”

Webb said the Fox Valley enjoys better treatment options and greater access than other parts of the state, largely because local county boards support alternatives to license revocation and jail that hold people accountable yet help them get well.

Insurance companies and families need to understand it may take more than one stab at treatment to succeed, Brown said.

“The vast majority who get treatment will drink again, just like people who get treated for high blood pressure, diabetes will see their blood pressure or blood sugar get out of control at times,” he said.

“So, often we conclude (treatment is) not effective when we say he got treatment and is drinking again. The better question to ask is do people who get treatment do better than people who don’t? … The answer is yes.”
‘Finally figured it out’

Krueger has gone through 10 treatments, most of which were court ordered. They range from drunken driving education programs and counseling to outpatient treatment and group home rehabilitation.

“I’ve been in so many treatments they all run together,” he said.

“You don’t know which treatment will stick, but you don’t stop getting it, and you hope nobody gives up on you.”

Treatment gave him the foundation he needed to overcome his addictions, he said; it was up to him to build on that.

“They showed me everything I needed to know. It was up to me to use it to my advantage.”

I had to realize I can't stay sober for anybody but me.”

Some court-ordered treatment he didn’t have to pay for, some he did.

His longest treatment was 90 days in a Mooring House and 60 days in a three-quarter house following prison.

He attends Narcotics Anonymous meetings once a week and checks in at Mooring, a halfway house for men in recovery from substance abuse, every weekday — to “stay connected,” he said.

“I do that just for me.”

Krueger said he has been sober for 19 years and has managed to stay away from cocaine for the past three years. “It took me (a lifetime), but I think I have finally figured it out.”

Life isn’t easy. Unemployed and uninsured, he lives with his mother. His health is shaky; he has diabetes, severe osteoarthritis and arthritis.

But before all is said and done, there might be something like an element of redemption in his story.

He has enrolled to start taking classes at Fox Valley Technical College to become an alcohol and drug counselor.

Appleton Post-Crescent