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Denise Mariano and her husband depleted their retirement savings and two of their children’s college funds—a total of nearly $375,000—to help their eldest son, now 27, battle addiction to a range of drugs, including heroin. Credit ruined and retirement plans dashed, Mariano still says she is blessed: Her son is alive and in recovery.

It’s been a tortuous journey. At one point, the 55-year-old drove to five treatment centers in New Jersey to find one that would take her insurance—or at least take her teenage son. But he didn’t have enough drugs in his system to be admitted to one, and too much for another, and yet another wouldn’t have room for him for at least three months. She says that seemingly empathetic go-betweens turned out to be more interested in a referral fee than her struggle. “I had nowhere to turn. My support system was Google. Knowing what I know now, I would have looked differently—asked the right questions and known they were preying on me,” says Mariano, who now volunteers as a parent coach for nonprofit Partnership for Drug-Free Kids.

Nearly 19 million Americans suffer from substance-use disorder. More people died from drug overdoses than car accidents in 2017, making overdose the leading cause of accidental death. More than two-thirds of the 70,000 deaths involved opioids like heroin, as well as prescription drugs like OxyContin, Vicodin, or Percocet, as the epidemic hit neighborhoods across the country in ways past crises have not. And the mortality rate for those under age 20 tripled from 1999 to 2016, according to a recent study by Yale University’s medical school.

Overdose Deaths Opioids were involved in more than two-thirds of the 2017 deaths 70,000 50,000 30,000 10,000 ’05 ’10 ’15 2000 70,000 50,000 30,000 10,000 ’15 ’10 ’05 2000

Affluence offers no protection. It can even make things worse. Families can spend hundreds of thousands of dollars and get no closer to long-term recovery because of a largely unregulated treatment industry that often doesn’t treat addiction as the chronic disease that it is.

Gary Mendell learned this too late. When his son, Brian, developed a drug problem in high school, Gary says he thought he was dealing with a behavioral problem, not a disease. He sent Brian to a therapeutic boarding school recommended by the school psychologist. “That was the beginning of the end of his life, because it started a path of treatment programs that didn’t follow evidence-based practices,” says Mendell, who co-founded HEI Hotels & Resorts. Brian went through eight facilities in as many years, ran away from one in which people were being beaten, and lived in his car in a parking lot five miles from home because Mendell was advised to not let him return until he agreed to treatment.

After a year of sobriety, Brian committed suicide, leaving a note apologizing to his parents and telling of the poor state of the treatment system. On his last visit home to Connecticut, after a day of golfing and barbecuing, Brian told his father he hoped that, someday, people would realize he was a good person with a bad disease. Those words stuck with Mendell, who started the nonprofit Shatterproof to get addiction attention like that given to other chronic ailments, such as cancer and heart disease.

Affluent communities have been hit particularly hard: Rates of serious dependence on substances, including hard drugs, for teens from these areas are two or three times the national norms, according to 2017 research led by Suniya Luthar, an Arizona State University psychology professor. “The peer culture is built around drugs and alcohol, so it is rare that there’s a social gathering or party where there isn’t plentiful substances, from weed to harder drugs,” Luthar tells Barron’s. “There is also a pressure to accomplish and achieve.”

How to Get Help Families are often at a loss about navigating the largely unregulated treatment industry. Here are five tips from care managers and addiction experts for families evaluating treatment centers. 1. Get an assessment to see which services are needed. Addiction often coexists with ­behavioral- and mental-health issues, so make sure the center has trained professionals to deal with those issues. 2. Ask if treatment follows standardized criteria, like those used by the American Society of Addiction Medicine, to see if they follow evidence- based approaches. Look for those offering cognitive ­ behavioral therapy and ­ medication-assisted treatment. 3. Look for centers that offer a long-term plan from the beginning and those that offer ongoing support, including out-patient programs, family therapy, and someone who will check in during the year after discharge. 4. Look for facilities that are upfront about costs, including for things like drug screenings, which should be done randomly and often—and not cost a lot. 5. Find sober-living facilities with a no kickback policy, trained counselors, and plans for ­relapse, as well as programs to ease social interactions without the lubricant of drugs. 1. Get an assessment to see which services are needed. Addiction often coexists with ­behavioral- and mental-health issues, so make sure the center has trained professionals to deal with those issues. 2. Ask if treatment follows standardized criteria, like those used by the American Society of Addiction Medicine, to see if they follow evidence-based approaches. Look for those offering cognitive ­ behavioral therapy and ­medication- assisted treatment. 3. Look for centers that offer a long-term plan from the beginning and those that offer ongoing support, including out- patient programs, family therapy, and someone who will check in during the year after discharge. 4. Look for facilities that are upfront about costs, including for things like drug screenings, which should be done randomly and often—and not cost a lot. 5. Find sober-living facilities with a no kickback policy, trained counselors, and plans for ­relapse, as well as programs to ease social interactions without the lubricant of drugs.

Money can prolong addiction, funding legal teams to avoid prison terms or shielding addicts from the fallout of losing a job. “The lesson is they will be rescued, so they take increasingly significant risks,” says Arden O’Connor, who created the O’Connor Professional Group to help families with addiction and behavioral health issues. Her brother Chris died last year of a heroin and cocaine overdose after he relapsed following 4½ years of sobriety.

The O’Connors became aware of the problem while Chris attended Georgetown University. Over the next decade, he cycled through 15 long-term residential facilities and 25 medicines, and was in and out of jail in California. His family hired lawyers on both coasts on retainer at $3,000 to $4,000 a month for about three years. Relapses happened often, leaving Arden and Chris’ father, Peter, a Boston-based commercial real estate developer, fielding middle-of-the-night calls informing him that his son was missing, and then frantically trying to have him located.

“If you are in the business world, you plan out what you are going to do. In addiction with your child, you are always operating in panic—most of what you do isn’t rational,” says Peter O’Connor. In retrospect, he sees a big money grab by the treatment industry. “I bet half of the $600,000 to $700,000 we spent was wasted,” he says.

It’s a common feeling. “The treatment model doesn’t fit the disease,” says Paul Earley, an addiction medicine physician who is on the board of the American Society of Addiction Medicine, or ASAM. “The roots of addiction programs came from a grass-roots, acute-care model, like the 30-day treatment model. But we now know that addiction is a chronic condition, requiring long-term care. The science has been there, but the industry has been slow to move.”

Most treatment is short term, with little continuity or ongoing support throughout the many stages of recovery, making it easy for people to fall through the cracks. When it comes to opioid addiction, treatments tend toward abstinence; 70% of treatment centers don’t offer the three medications—methadone, buprenorphine, and naltrexone—that substantially improve outcomes.

Patients on methadone, for example, had 33% fewer positive drug tests for opioids and were four times more likely to stay in treatment, according to the National Institute on Drug Abuse, part of the federal government’s National Institutes of Health. When facilities ignore medication when treating addiction, it’s akin to helping diabetics go sugar-free and exercise for a month and then sending them off with little ongoing support and no insulin to manage their chronic condition.

Unlike other chronic diseases, addiction lacks a standard protocol. Instead, families face a series of impossible questions that can rip them apart. Do you kick your daughter out of the house if she is using again—or keep her under close watch? When do you sever ties? Peter eventually wrote Chris a heart-wrenching letter, saying he wouldn’t talk to him for six to 12 months. Mariano kept her son at home, even though people blamed her for enabling the addiction. “It was the ability to put my head on the pillow and know he was still alive,” she says.

The stigma of addiction can’t be underestimated. “If your child had cancer, the community rallies behind you and your child with cooked meals and bake sales and carpools,” Mendell says. “When a child is battling addiction, he’s just a problem kid, and people wonder what the parents did wrong.” His advice: tell your child how proud you are of them for fighting this chronic illness.

What to Do

Parents often get two pieces of advice: This is a marathon, not a sprint, and you need an advisor to help you get through the race—either someone who has navigated the process with good outcomes, or is unaffiliated, but knows the system and doesn’t accept referral fees. Arden O’Connor’s firm, for example, will do everything from assessing an individual and crafting a long-term treatment plan, to doing interventions and staying with addicts in a hotel while they detox.

Treatment can be extremely expensive, so it’s important to use resources wisely. Don’t blow the entire budget on the first round, O’Connor advises. Relapse is part of recovery—72% to 88% have a setback in the 12 to 36 months following opioid detoxification. Five years is a better marker; about 90% of those who stay sober that long remain so.

$79 billion 25% of young adults ages 18 to 25 used illicit drugs in 2017. Estimated annual economic cost of opioids. 25% of young adults ages 18 to 25 used illicit drugs in 2017. $79 billion Estimated annual economic cost of opioids.

O’Connor recommends that families budget for at least a year of sobriety, including in- and outpatient services, and ongoing support from therapists and psychologists to address mental- and behavioral issues that often coexist with addiction. The whole family could benefit from therapy and coping strategies, as well.

Private insurance covers about 18% of addiction treatment. Only two to 10 days of medical stabilization or detox might be covered. Insurance might also cover residential facilities for 15- 30 days in-network, and 20% to 80% out-of-network. But most residential treatment centers are paid out of pocket, with high-end facilities charging $50,000 to $70,000 a month, says O’Connor. Therapists and psychiatrists also might not be covered. Neither is sober or transitional housing.

The drain on accounts means that financial advisors are sometimes the first to spot the problem, which they say has parallels to elder care. “It’s a slow progression, and you can excuse a lot of things away. Then some crisis happens,” says Catherine Seeber, a financial planner at CapTrust, who grappled with addiction with her own son. Seeber recommends assembling a team, including lawyers who focus on special-needs situations and can navigate disability-insurance and guardianship issues, as well as specialists who know local programs that can be tapped. Parents should also gain access to privacy releases around college grades, medical information, and health-care proxies.

When it comes to treatment centers, price and quality aren’t synonymous, says Steve Feldman, a case manager at Feinberg Consulting in West Bloomfield, Mich. “Some people can throw $500,000 at the problem, and it’s not enough, and you can go to a church or hospital basement and have good treatment. It’s not one-size-fits-all.”

Finding the right fit isn’t easy. ASAM and the Commission on Accreditation of Rehabilitation Facilities are working on a national certification program, but there’s still a long way to go. Mendell’s nonprofit Shatterproof is piloting a treatment ratings system, similar to Leapfrog’s grading system for hospitals, with plans to make it public by mid-2020.

For now, specialists stress finding treatment centers that match standardized criteria, like those used by ASAM, for evidence-based care; offer a long-term plan beyond the first 30 days; and have full-time certified physicians, psychiatrists, and others on staff.

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Some of the best abstinence rates come from programs that treat physicians and pilots, and are run by their licensing boards. In these, treatment starts when a problem is spotted, not when someone hits rock-bottom, and monitoring is long-term, with consequences such as suspension or loss of a license for noncompliance. Families can similarly impose consequences, such as making paying a child’s rent contingent on working or sticking with a recovery plan, O’Connor observes.

Cash is dangerous. Warns Seeber: “Anything can be exchanged for drugs—anything. Instead of giving money for gas, I would drive [my son] to get the gas.” Parents should pay for rent and other needs directly. Financial-services firm True Link recently introduced a prepaid Visa card that restricts transactions. For example, it can limit purchases to just the morning hours, when someone may be less likely to use drugs, or block cash withdrawals altogether—and provide notifications if the card is used outside of the parameters.

Support is crucial. “It’s not just about eating and a 12-step program and then dinner and a 12-step program,” Mariano says. “If you have a record, you can’t even rent an Airbnb. You may be doing well, but society still says you are not one of us. Good treatment is so important because you learn coping mechanisms for when the world beats you up.”

Write to Reshma Kapadia at reshma.kapadia@barrons.com