Hannah Berkowitz is 20 years old and when she was a senior in high school her life flew off the rails.
She was abusing drugs. She was suicidal. Berkowitz moved into a therapeutic boarding school to get sober. But she could only stay sober while she was on campus during the week.
"I’d come home and try to stay sober really hard – really, really hard," says Berkowitz. "And sometimes I’d make it through the weekend and sometimes I just couldn’t make it. It was white-knuckling it, just holding on."
The transition back home always triggered a relapse for Berkowitz.
"I thought it was just my fault and there was no hope," she says.
No hope – but Berkowitz did have luck. She had private insurance and she lived in Connecticut right as a startup began treating clients in the very environment where Hannah struggled to stay sober: her home.
Treating addiction is a growing business in New Hampshire. But a lot of the treatment that’s available is expensive and patients often relapse. A Connecticut-based company is expanding in New Hampshire with the promise of helping some people pay less money for better results.
A chronic disease approach
Matt Eacott is Vice President of Aware Recovery Care, which started treating clients in New Hampshire earlier this year. Eacott says his company has figured out a cost-effective way of treating addiction with better results than most of their competitors.
"Ninety-nine percent of the industry really treats addiction as an acute problem – like a rash on your arm that you rub lotion on and you’re done," says Eacott.
Rather than a bad rash, Aware treats addiction as a chronic illness that doesn’t disappear just because symptoms are under control.
Aware comes into clients homes and connects them with a nurse, a primary care doctor, a therapist, peer support, 12-step meetings and a case manager. Clients hooked on opioids can get medication-assisted treatment. They can also submit to urine screening and GPS tracking.
Hannah’s mother, Lois Berkowitz, says the program is intense at first. But as Hannah built coping skills the supports faded into the background.
"It’s not like they’re doing the work for the addict," says Lois Berkowitz, "but they’re just basically taking them by the hand and saying, "Here are the places you need to go that will help you. And I’m going to go with you to start so it doesn’t feel that uncomfortable. And then we’re going to let you fly.'"
Before they fly, Aware clients have a pretty long runway. The treatment lasts for a full year.
An endorsement from Anthem
Aware isn’t exactly cheap. It costs $38,000. And it’s only available to private-pay clients and people insured through Anthem in New Hampshire and Connecticut.
One of Anthem’s behavioral health experts, Dr. Stephen Korn, says he’s a big skeptic of big healthcare claims. But he says Anthem was convinced to be the first insurer to pay Aware because the treatment is based on hard science that’s yielding solid results for clients.
Science and results? Korn says those are surprisingly rare in addiction treatment.
"There are old, old notions that have hung pretty tough," says Korn. "When I was young, when I was in training and as soon as substance abuse was mentioned, the response of physicians was, 'Well, go to AA. That’s not our problem. We don’t treat that.'”
For a year of treatment, Anthem says it’s paying Aware about the same as the cost of a month or two of inpatient treatment. Anthem also says 72 percent of Aware clients are either sober at the end of one year or still in active treatment.
According to Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine, that’s about twice the sobriety rate of people who check in to a facility for a month and then get no follow-up care. Gitlow says treating addiction at home makes sense because it’s the exact place where people learned all their bad habits.
"It’s all based on this concept that addiction is not about the substance use, but is about what led to the substance use in the first place. And you can’t really get there without getting to know the patient," says Gitlow.
Aware says it’s in negotiations with four more major insurers. They’re hoping to have a couple hundred clients in New Hampshire by the end of the year.