Sheryl Santiago's son, Erik, was addicted to pills he'd been prescribed for anxiety and depression.
But when he finally decided to quit, he learned that asking for help and getting it can be two very different things.
"As soon as he contacted [a treatment facility], he thought he could go that night,” Santiago recalled. “He was ready to go and then he just got more and more discouraged."
Erik didn't have health insurance, and neither he nor his parents could afford the private facilities, where a month of treatment can cost as much as $30,000. So the first step for the family was to purchase insurance for Erik.
"When we got the insurance, they only covered a couple places, and they had waiting lists," she said.
A few weeks later, Erik was moved off the waitlist at a local treatment facility in Ocean County, N.J. However, he had been trying to stop using drugs on his own while he waited for help, and the program he was accepted into was the kind of place that helps patients detox with the assistance of medication. Like many facilities of this type, it required potential patients to be active drug users to get treatment -- to actually fail a drug test.
"He told me, he goes, 'Don't be mad at me if I use something because I have to test dirty in order to go into their program,'” said Santiago. “And he did, he must have used whatever he was using prior — the dosage — and it was too much."
Santiago said Erik had been clean for four weeks before he overdosed and died. In that time, his body may have lost some of its tolerance for the drug.
He had just turned 31 when he died, so it's hard not to play a game of “what-ifs?” but Santiago believes her son would still be here today if he'd gotten into a program right away.
"There's not enough beds, there's not enough providers,” confirmed Bruno Silie, a health educator who helps place addicts in treatment facilities at a drop-in center run by the South Jersey AIDS Alliance in Atlantic City, N.J.
"There's options, but the waiting period is ridiculous,” he added. “I've had clients wait for 60-plus days, and by that time they've given up."
"You really have to strike when the iron's hot," said Kimberly Reilly, the alcohol and drug coordinator in Ocean County, N.J. "So if someone comes to us and says I'm motivated for treatment, you really want to get them in, really, within that hour, because the next hour they could be off looking for their next hit of heroin."
There are simply not enough beds to meet New Jersey’s growing demand for substance abuse treatment. Statewide, admissions are up nearly 40 percent since 2006. As the state diverts more nonviolent drug users to treatment over prison, the waiting lists are even more of an issue.
Increasingly, people are seeking treatment for heroin and opiate additions. In Ocean County, half the admissions last year were for heroin. It's cheap and easily accessible, so many users turn to the drug after getting addicted to prescription pills, such as OxyContin.
The situation in New Jersey is mirrored across the country, according to Roseanne Scotti, director of the Drug Policy Alliance in New Jersey.
Scotti noted the Affordable Care Act will eventually add coverage for many people with mental health and substance abuse issues. The Substance Abuse and Mental Health Services Administration estimates that the ACA will eventually extend coverage to approximately 11 million people with behavioral health conditions, which include mental health and substance use issues.
Without significant expansion of treatment options, that expansion may create additional backlogs.
“In some states, like New Jersey, there just isn’t the infrastructure, at this point,” said Scotti. “There’s going to have to be new facilities, new providers, new licensed addiction counselors, and that’s going to take a while to ramp up.”
In addition to expanded access to insurance, other factors – like the aging population, the high turnover of substance abuse counselors, and better medical screening for addition – affect the availability of treatment options, according to Andrea Kopstein, a division director in SAMHSA’s Center for Substance Abuse Treatment.
Kopstein says the Obama administration is making a “significant investment” in both the number of treatments slots and to expand the number of professionals working in the field, SAMHSA was unable to specify how much. The most recent figure available on U.S. spending for substance abuse was $24 billion in 2009.