For nearly 20 years, William C. Moyers led two lives. There was the successful journalist, dedicated family man and churchgoer. And there was the alcoholic and cocaine addict. He’d struggled with substance abuse since he was a teenager. He’d walked away from a couple jobs when the drinking got too bad.
He’d seek treatment, stay sober for a while and then, like many alcoholics, falter. In 1994, he suffered a near-fatal relapse, failing to show up for his job as a writer and producer at CNN for four days.
Instead of firing him, his CNN supervisors, who were aware of his past drinking problems, told him: Go get treatment and you can keep your job.
“CNN stood right with me,” says Moyers, the son of broadcast journalist Bill Moyers. “They held me accountable by saying, ‘Moyers, you better go to treatment; you better stay sober when you get back here.’ ”
After a nearly four-month stay at a rehabilitation center in suburban Atlanta, Moyers returned to his job. Eleven years later, he has remained sober and now works as a vice president for the Hazelden Foundation, a substance-abuse treatment center in Minnesota. He credits his former employer with saving his life and career.
But success stories like Moyers’ are surprisingly uncommon in America today.
Even as scientists have gained a better understanding of the nature of alcoholism and more effective treatments have become available, fewer people are getting help. Fewer than one in 10 of the more than 20 million alcoholics in the United States are diagnosed each year, according to a recent study by researchers at George Washington University Medical Center.
Of those who are diagnosed, fewer than half receive any type of treatment. The number of Americans entering alcoholism treatment programs has been declining steadily, dropping by more than 23% between 1993 and 2003, the latest year for which federal statistics are available.
The costs of underdiagnosis and lack of treatment are staggering. Beyond the incalculable toll on the personal lives of alcoholics and their families, there is the hefty tab for U.S. employers: an estimated $40 billion a year from absenteeism, lower productivity, healthcare and other costs, according to an analysis of federal data by Ensuring Solutions to Alcohol Problems, a research group at George Washington University.
Yet, recent research shows that roughly half of alcoholics who undergo treatment will remain sober one year later -- a success rate that compares favorably with treatments for such common chronic conditions as asthma, diabetes and high blood pressure. Based on genetic and neural imaging studies, scientists believe they understand the causes and mechanisms of alcoholism better than ever.
Research has shown alcoholism to be linked to several genes, which interact with the environment in complex ways, according to Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism.
The disease is thought to be caused by roughly 60% genetic factors and 40% environmental ones. Researchers also have begun to document changes that occur in an alcoholic’s brain, especially in parts of the brain that govern motivation and emotion.
With this knowledge, some scientists, including Willenbring, believe that treatment for alcoholism could improve dramatically during the next 10 years.
For decades, the only drug available to help alcoholics was Antabuse, which produces unpleasant side effects, including headache, vomiting and chest pain, when patients drink alcohol. But two newer drugs are helping many alcoholics. Both act on the mechanisms of addiction, rather than simply deterring people from drinking, as Antabuse does. Naltrexone, approved by the Food and Drug Administration in 1994, reduces the craving for alcohol and the desire to drink more if an alcoholic has a relapse. Acamprosate, approved in 2004, is thought to normalize some of the chemical imbalances in the brain caused by prolonged alcohol abuse.
And researchers are investigating the drug topiramate, an anti-seizure medication, for the treatment of alcoholism. In preliminary research, scientists at the University of Texas in San Antonio have found that topiramate reduced the amount of drinking among recovering alcoholics and increased the number of days of total abstinence from alcohol by 26.2%, as compared with a placebo group. The National Institute on Alcohol Abuse and Alcoholism is also conducting clinical trials on topiramate for alcoholism.
As new drugs are developed and treatment improves, why are fewer people getting help?
The answer to that question is complex. Certainly, the social stigma of alcoholism and patients’ unwillingness, or denial, to acknowledge their drinking as a serious problem remain issues. But some more immediate factors are exacerbating the problem, experts said.
According to a 2004 federal report, the average cost of outpatient substance abuse treatment was $1,433 in 2002, while inpatient treatment averaged $3,840. But some private inpatient treatment programs are much more costly. At Hazelden, for example, a 30-day inpatient stay can cost $20,000, notes Moyers.
Groups such as Alcoholics Anonymous are free or inexpensive, but behavioral therapy is only one part of treating an alcoholic’s addiction, and the groups cannot provide professional therapy, help with the acute effects of withdrawal or prescribe drugs to manage recovery. Many people simply can’t get access to treatment programs if they are unable to afford them.
“There is no other health condition in which health insurance puts up more barriers to care,” said Eric Goplerud, a professor of health policy at George Washington University.
Private medical insurers steadily reduced payments for alcohol treatment during the 10-year period that ended in 2001 by a total of 11%, according to a report published by the federal Substance Abuse and Mental Health Services Administration.
And many employers are cutting substance-abuse benefits to help contain rapidly rising medical costs. It’s easy to cut benefits for substance abuse, Moyers said, because there is a misperception that alcoholics never work. Also, employers pay a smaller “public relations penalty” when they choose not to cover benefits for alcoholism, Willenbring said, because the stigma and moral condemnation associated with it is so common.
Also, some employers are skeptical of paying for treatment because alcoholics often relapse and require multiple treatment attempts before recovering, said Denise Podeschi, a substance-abuse and mental health manager at Mercer Human Resources Consulting.
Employer-sponsored health insurance often has significantly lower benefits and coverage limitations for substance-abuse treatment than for other medical care, according to the Mercer/Marsh Survey of Employer-Sponsored Health Plans for 2004. The limitations include higher co-payments and separate deductibles.
“Health insurance, as a general rule, does not encourage treatment and may discourage treatment,” Willenbring said.
Dealing with denial
The number of alcoholics who seek treatment is small compared with the overwhelming majority who won’t admit that they need help. Indeed, the accepted medical definition of alcoholism includes a mention of “disorders of thinking, most notably denial.” When alcoholics refuse to admit a problem or seek treatment, it makes society less willing to want to help them, said Dr. H. Westley Clark, director of the substance-abuse treatment center at the Substance Abuse and Mental Health Services Administration.
Then again, people who publicly acknowledge being an alcoholic can face scorn and shame in their personal and professional lives. “The stigma is a huge barrier,” Willenbring said.
The workplace is hit hard by alcoholism, but it also has potential to help. More than 80% of heavy drinkers are employed or are family members of someone who is employed full time, according to government figures. Work is one of the first places that a person’s alcoholism can be noticed.
Candy Cargill-Fuller was 15 when she had her first drink. It wasn’t long before the Southern California woman was drunk every day. She abused alcohol and drugs until she was 23, when a close friend helped stage an intervention. The friend contacted Cargill-Fuller’s employer, the Southland Corp., and made arrangements with the firm’s employee assistance program, a free, confidential counseling program offered by many employers.
The next day, Cargill-Fuller entered a 30-day inpatient recovery program, covered by her employer’s health insurance plan. She was able to get sober, return to work, and has remained sober for 19 years. Cargill-Fuller is now an administrator at Behavioral Health Services, a treatment program in Gardena.
The benefits she enjoyed in the 1986 are rare today, Cargill-Fuller said, noting the benefit cutbacks at many companies. Based on her experience as a substance-abuse counselor, Cargill-Fuller said, employers are more likely to fire an employee with a drinking problem than help them seek treatment.
Though many employers limit addiction treatment benefits, Musco Lighting, an Iowa lighting construction firm, offers full coverage for addiction treatment with no additional limitations, deductibles or co-payments. Musco’s substance-abuse coverage makes good business sense, said Diane Crookham-Johnson, the company’s vice president of administration. She said the benefits help reduce turnover, increase productivity, attract more qualified applicants and increase employees’ dedication to the company.
Indeed, a study released last week and reported in the British Medical Journal found that two nonresidential programs for alcohol treatment in Britain were not only highly effective, but also produced five times the savings in health and social services than the cost of the programs themselves.
Employees who get treatment for alcoholism incur smaller medical costs overall, according to a 2001 study published in the Journal of Studies on Alcohol. Helping employees get treatment rather than firing them can also help an employer avoid the costs of turnover and training for new employees to replace unproductive addicts.
Moyers acknowledges that his struggle with addiction is hardly typical: He and his family could afford treatment, and his employer was dedicated to seeing him through recovery.
“I’m the exception rather than the rule,” he says. “I got access to treatment, no questions asked.”