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Recovery in the News
Denial, cost keeps treatment out of reach for many
Kathy Walsh Nufer
The Northwestern
July 19, 2008
Terry Lee Rucks credits Alcoholics Anonymous with saving his life.
Over more than a decade of heavy drinking, Rucks, 61, of Oshkosh, was in denial that he was an alcoholic.
"I drink. I get drunk. I fall off the bar stool and then I got on the bar stool," Rucks had reasoned to himself after nights of heavy drinking.
Born and raised in Oshkosh, Rucks said he grew up in an alcoholic home. His alcoholic father introduced him to beer at a very young age.
Rucks' drinking continued to get worse as he got older. He would drink five or six nights a week and then he would go home and be verbally abusive to his family, friends, and co-workers.
It wasn't until age 35 when he was about to lose his job as a bus driver for Valley Transit in Appleton that Rucks turned to treatment.
"If I continued drinking the way that I had, I would not be able to give testimony today," he said.
Rucks' story speaks to Wisconsin's alcohol-ingrained culture, which can engender problem drinking while obscuring the need for treatment. Those who do recognize they have an addiction and seek treatment often find it prohibitively expensive.
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. Only 10-12 percent of those Wisconsinites who need help actually get it, said Dr. Richard Brown of the University of Wisconsin-Madison.
Over the past five years, Wisconsin has averaged the fourth 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 third highest rate of people needing, but not receiving treatment for an alcohol problem, the same survey shows.
"We lead the nation in risky drinking and for the most part, people don't get treatment," Brown said.
Rucks, who today owns a barber shop on Evans Street, said he didn't start drinking heavily until age 18.
His drinking accelerated after he was drafted in 1966 and spent a year and a half in Berlin, Germany. Since he didn't smoke, he would trade his cigarettes for drinks.
He got used to the stronger European drinks and, when he returned home, Rucks would pour five shots of whiskey into a pitcher of beer to make it taste right.
"When I started drinking more, I needed to have more to have that 'Haha, feeling good' feeling," he said.
Eventually, his drinking affected his homelife. The slightest thing that either the kids, the wife, or the dog would do upset him, when he stumbled back home.
"I would be totally out of control with my words because at that time, I would be too drunk to care," he said.
Although he was still in denial about his problem, trouble at work ultimately led Rucks to treatment. His company referred him to the Anderson Behavioral Consultants, where he learned to recognize his alcoholism.
Denial isn't the only barrier to treatment.
An even bigger obstacle, Brown believes, is a lack of insurance parity which puts treatment out of reach of many alcoholics.
Wisconsin is one of fewer than a dozen states that do not provide for some form of insurance parity for both 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.
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 Counseling Services in Oshkosh operates one of the state's few inpatient rehab centers. It charges $4,000 for a 28-day stay. Most clients pay out of their own pockets, said executive director Marcia Larson.
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 both 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.
However, insurance parity ran into a wall in the state legislature, according to former state Sen. Carol Roessler, an Oshkosh Republican who spent years fighting for it.
"There wasn't a coming together in the minds of folks to venture in that arena," Roessler said.
Without mental health insurance parity, people run the risk of running out insurance coverage for outpatient services, even while they are still in recovery.
"Once that money is gone, it's gone," Roessler said. "The only way that the insurance companies are able to help is if the person has a crisis that ends with them going to a hospital for more expensive care and treatment."
Some treatment providers doubt insurance firms have the client's best interest in mind when monitoring costs.
As an alcohol and other drug abuse counselor with the Fox Cities Community Health Center and Fox Valley Psychiatric Associates, Kerrie Jo Larsen has a foot in both 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."
Larson said that even though NOVA's 50-bed program is relatively inexpensive – one of Wisconsin's few inpatient rehabilitation centers, NOVA charges $4,000 for a 28-day stay – healthcare 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 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."
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."
And that's what happened to Rucks, who believes a higher power aided him.
"God gave me a second chance in life and I am grateful to him for allowing me to find AA," he said.
Three months into his sobriety, Rucks was part of a bowling league when one of the guys brought out a crystal glass full of alcohol and some shot glasses. Rucks said he put his finger into the drink and tasted it. It was sweet on his tongue and he wanted a shot. Then, he prayed and suddenly felt a burning sensation from his navel to his backbone. He rushed to the bathroom and stayed there for half an hour, sweating and shaking.
And after that, Rucks was able to say no. That was the last drop of liquor that he has ever tasted,
Rucks said he now has 25 years of sobriety behind him. As he started to heal, his relationships also started to improve.
"It doesn't bother me anymore to let people know that I am a recovering alcoholic," he said. "At first, I was ashamed of my past and now, I don't mind sharing my story."
© 2008 Oshkosh Northwestern