DRUG, ALCOHOL TREATMENT OPTIONS DWINDLING

For the thousands of Greenville County residents who need treatment for drug
or alcohol addiction, the past six months have brought a disturbing trend.

In October, the Greenville Hospital System closed the inpatient part of its
addiction treatment program, blaming declining reimbursements from the
federal Medicare and Medicaid programs.

Last month, Charter Behavioral Health Systems one of the nation's biggest
operators of treatment centers, which runs a 66-bed hospital in Greer filed
for Chapter 11 bankruptcy protection from creditors, citing cutbacks by
insurers on treatment payments.

Now a task force is looking at ways to save the county's ailing
detoxification center, which came within days of closing last month when
officials said they couldn't afford to keep the 16-bed facility running.

An increasing number of drug-treatment centers across the country are
struggling to stay afloat not because of skyrocketing costs, experts say,
but because of a brewing battle over who should pay for addiction services.

Caught in the middle: about one in 10 who need treatment but may not have
access to it.

"We as a society create the problem we sell alcohol and drugs," said Winston
Woodward, a recovering alcoholic who now runs two transitional houses in
Greenville for former addicts as director of Sharetime Ministries for
Upstate Carolina. "We have a responsibility to clean up the people we've
made a mess of."

In the Upstate, outpatient treatment at a private center starts at about
$150 a day, while inpatient care can cost $1,000 a day or more.

Those costs are rising about 7 percent each year slightly less than the
annual increase in overall health-care costs, according to the federal
Substance Abuse and Mental Health Services Administration.

Since the arrival of managed care in the early 1990s, though, less money has
been available for drug treatment, said Joe Feleppa, director of AnMed
Wellspring, a private treatment program affiliated with the Anderson Area
Medical Center.

Health plans offered by employers typically provide less coverage for
substance-abuse treatment than for other medical care, and Medicaid and
Medicare have lowered their reimbursements for those patients.

As a result, Feleppa sees an increasing number of patients who are forced to
drain their personal savings after their insurance benefits run out.

"A lot of folks are paying on credit cards or getting their families to put
money together," Feleppa said.

When that money runs out, he refers patients to public facilities like
Holmesview Alcoholic Center operated by the state Vocational Rehabilitation
Department. That center charges less for inpatient care about $150 a day but
typically has a two-to three-week waiting list, said director Bob Opperman.

South Carolina doesn't track the numbers of patients who shift from private
treatment to public, but officials know "it is increasingly becoming a
problem," said Jack Claypoole, spokesman for the state Department of Alcohol
and Other Drug Abuse Services.

Experts say the public system can't bear that increased burden forever.

In response, five states have passed laws that require equal coverage or
parity for substance-abuse treatment, and the federal government's employee
health plan will offer that parity starting in 2001. With parity, caps on
lifetime benefits and number of visits for substance-abuse treatment would
match what's covered for other health conditions.

A key concern: Many patients denied substance-abuse services seek and
receive more expensive treatment elsewhere in the health care system, said
Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment,
part of the U.S. Department of Health and Human Services.

Clark uses this analogy to explain: "If I'm drunk and I break my leg, you'll
pay to fix my leg, but you won't allow me to get care for my alcoholism.
Well, it costs more to fix my leg."

In South Carolina, a bill pending before the state Senate would implement
parity in the state employees' health plan and track the costs over three
years.

National studies show that adding equal substance-abuse treatment coverage
raises premiums by less than 1 percent.

In the meantime, though, advocates worry that as long as treatment isn't
readily accessible, those struggling with substance abuse will continue
their destructive pattern and the more subtle costs of addiction will
escalate.

Feleppa said he's already noticed fewer people seeking treatment not because
the Upstate has solved its drug problem, but because the problem has gone
underground.

"Where you'll see it surface is the prison system," said Feleppa, who worked
in addiction counseling at two South Carolina prisons. Studies show that at
least three-quarters of inmates were under the influence of drugs or alcohol
when they committed the crime that sent them to jail, he said.

Greenville's ongoing discussion about the future of its detox center is a
clear illustration of a national issue with serious consequences, experts
say. Communities can accept substance abuse as a chronic disease or condemn
it as a moral failure, but either way, they can't afford to ignore the
problem, Clark said.

Failing to provide treatment for addiction will lead to higher crime rates,
more traffic accidents, more expensive health care and higher taxes, he and
others said.

"You may believe there's a moral component," Clark said, "but you're going
to pay one way or another as a community."