Residential addiction treatment for U.S. teens is scarce, expensive

Despite an alarming increase in overdose deaths among young people nationwide, a new “secret shopper”-style study led by Oregon Health & Science University researchers finds that access to residential addiction treatment centers for adolescents in the United States is limited and costly.

The study, published today in the January issue of the journal Health Affairs, found that about half of the sites reported a wait time, and among those the average wait was almost a month. For those who do manage to find a placement, the average daily cost is $878 — with close to half of the facilities that provided information requiring partial or full payment upfront. For the average residential facility, the average quoted cost of a month’s stay is about $26,000.

“If you are a family in crisis and you have a kid for whom outpatient treatment is not an option, you hope to be able to call the closest residential facility to you and have access to timely, safe, affordable care for your child,” said lead author Caroline King, M.D., Ph.D., who conducted the study as a medical student at OHSU and now serves as an emergency medicine resident in the Yale School of Medicine. “This study shows that affordable, timely and effective treatment is severely lacking for the most vulnerable kids in our population.”

Researchers posed as the aunt or uncle of a 16-year-old seeking treatment after a recent non-fatal fentanyl overdose, inquiring about admission and costs. They identified a total of 160 residential treatment centers in the country primarily through a database maintained by the U.S. Substance Abuse and Mental Health Services Administration, and extracted cost information for 108 facilities.

For-profit treatment centers were more likely to have space available — but at roughly triple the cost of non-profit facilities, on average.

In the midst of an overdose epidemic supercharged by cheap, potent and readily available fentanyl, overdose rates have risen nationwide among young people in recent years. The steep cost and scarce access to residential addiction treatment leaves many kids untreated and vulnerable to overdose, or their families susceptible to significant economic hardship, study leaders said.

King noted that some sites offered loans through an outside provider, or suggested alternatives such as taking out a second mortgage on a home or putting it on a new credit card.

The situation highlights the importance of providing addiction treatment across the medical field as opposed to relying on residential inpatient centers that are scarce, expensive and often ineffective, researchers said.

“When your kid is in a crisis and needs treatment, it can be terrifying to know where to turn. Many parents or family members will look first for residential care and find the experience profoundly disheartening,” said senior author Ryan Cook, Ph.D., research and training scientist for addiction medicine at OHSU. “Systems-level changes are needed to ensure effective, affordable treatment options for adolescents.”

King agreed.

“The solution isn’t to build new treatment centers,” she said. “It’s to strengthen care for addiction in primary care settings.”

This study follows previous OHSU-led research revealing that only one in four of these centers provide buprenorphine, a proven medication to treat opioid use disorder that is approved by the Food and Drug Administration for people age 16 or older.

For more information on substance and mental health treatment programs in your area, call the free and confidential National Helpline 1-800-662-HELP (4357) or visit www.FindTreatment.gov. 

The research was supported by the National Institute on Drug Abuse of the National Institutes of Health, award K23DA045085, R01DA057566, K23DA044324 and UG1DA01581; the Agency for Healthcare Research and Quality award T32HS017589; and the Oregon Clinical and Translational Research Institute award UL1TR002369 from the National Center for Advancing Translational Sciences of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.