People who want to end their dependence on alcohol or any drug have few places to turn in the state.
The number of treatment facilities has actually declined over the years.
But the number of people seeking help hasn't. Our series on substance abuse continues with our report from New Hampshire Public Radio's David Darman on the state's treatment gap.
Mary Bock meets many substance abusers in her work as Nashua coordinator for Friends of Recovery New Hampshire.
She says there's not much she can do for them when they ask for help.
its very frustrating right now because there's so few treatment facilities. i believe that its fourteen facilities that have closed in the last 10 years. and so there are many waiting lists. and that can be very difficult for someone...its hard enough to get into recovery to find that moment when you can make that change. then when you're asked to wait a long period of time, its a real challenge for folks.
Federal and state data explain why people need to wait. The U.S. Department of Health and Human Services estimates that of those who need help, 10% can't find it.
State data paint a picture that is much more grim. About 90 thousand people need treatment. But only about one out of ten actually get any.
Ray McGarty runs the Southeastern New Hampshire Alcohol and Drug Abuse Services Center in Dover.
It's a publicly funded residence program that was established to treat the uninsured.
He says the shortage of treatment has caused officials at the center to revise the rules for who gets accepted.
... we've started admitting people here who have insurance, um, because they can't get care anywhere else. i fought that for a while. i was fundamentally opposed to people paying insurance premiums and having to use public beds, which are for people that don't have insurance, but from a humane perspective, we simply couldn't turn these people away.
The treatment centers that closed offered the most expensive type of care, where people came and stayed for about a month.
They relied on payments from insurance companies.
But heavy use of the centers drove up costs for insurers.
So after several years, they began looking for less expensive options.
Today, the companies encourage outpatient counseling, and will pay for up to 20 visits.
But even with outpatient programs, insurers expect results.
Dr. Todd Mandell is the associate medical director for Behavioral Health Services, the firm that handles substance abuse for Blue Cross Blue Shield.
Mandell says approval for a person seeking treatment for a second or third time is not automatic.
to me, its ok, what are they going to do differently this time? lets see what happened. what worked? what didn't work? that's what i ask the providers to tell us.
The role of insurance companies in treatment is certainly smaller than a decade ago.
Anthem records few claims for substance abuse services, well under 1% of its clients make use of these benefits.
And there is some evidence that insurers don't see formal treatment as the first step for all clients.
A spokesperson for Cigna Insurance says research has found Alcoholics Anonymous can be just as effective.
AA is something anyone can attend, for free.
John Maher believes that is a sound approach.
Maher is the founder of a support group for attorneys in the state, called "Lawyers Concerned for Lawyers ".
you know, statistically, 90 percent or 95 percent of the people in this country can't afford a 28 day program. and so, what's the next best thing, what's helping out, happens to be AA that works the best.
There are several cheaper options that lie between AA and the 28-day residential approach.
While substance abuse counselors encourage many clients to use AA, they also say that some people need a more structured approach to get their abuse under control.
They say that both insurance companies and the state could play a larger role.
State spending for treatment has fallen 17% over the last two years.
Senator Dick Green is chairman of the Senate Finance Committee.
He says he knows there isn't enough money for treatment.
in a perfect world, there would be no question that we should be putting more money into substance abuse. but based on the limited resources that we have we have to make some hard choices. and i do know that the people who are in the treatment end of things that they really are feeling that they're being shortchanged in terms of the money we're raising and the money being spent to offset their cost for treating.
People in the treatment community say they aren't the ones shortchanged by state budget priorities.
They say it's those seeking help who suffer.
People with addictions miss many days of work.
Their health care costs are higher.
They fill the courts and populate the prisons.
Treatment advocates say, when treatment isn't available, everyone is affected.
It's not easy to measure the shortfall in treatment resources in the state but there's little question that it exists. You can read our report here, but briefly, the facts we gathered suggest that there are about one-tenth as many treatment slots as needed.
In 1999, the state commission a Gallup poll which pegged the number of substance abusers at 90,000. In 2001, the state funded treatment centers served about 4,000 patients. On the private side, we learned from Anthem that the number of clients receiving substance abuse services in 2003 was "well under 1% of the total client base." That means it was well under 3,500 people.
Put it all together, you've got about 90,000 people who could use treatment (by a pretty tough clinical standard) and maybe abour 8,000 who got treated.
One other factoid stands out. If it wasn't for federal money, New Hampshire would have very little public support of treatment. Washington paid for more than 75% of the treatment in the state in FY 2004.