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A fifth of the private rehab centers that volunteered to participate in a national study have shut down since the summer of 1995.

With help from recovering alcoholic Charlie Sheen, actor Ben Affleck voluntarily checked himself into a private residential alcohol rehab center in Malibu, Calif. last summer.

When the average Joe decides to check into a private alcohol treatment center these days, though, chances are the best he’ll get is outpatient services.

Changes in health insurance coverage have put the time-honored residential programs, which may last as long as six months, out of reach for all but the privileged few – if patients can even find a private rehab center at all.

Hard hit by the trend toward “managed care,” a startling number of private rehab centers have gone belly up. Of the 450 private alcohol treatment centers that volunteered to participate in a national study led by the University of Georgia’s Paul M. Roman, one-fifth have shut down since the summer of 1995.

The ongoing, nationwide treatment center study also shows that the surviving private centers have made fundamental changes. For example, they have dumped long-term residential programs, compressed 28-day inpatient programs to a week and beefed up their lower-cost outpatient programs.

“Those that still offer the 28-day in-patient program tend to be the larger, more nationally recognized centers, and they largely rely on self-paid patients because essentially anyone covered by any sort of managed care insurance won’t qualify,” said J. Aaron Johnson, a UGA assistant research scientist who is part of Roman’s research team.

The study is providing a checkup of sorts for the nation’s private substance abuse treatment centers. Findings could help private centers avoid risky practices, increase quality and improve their chances for survival. The study also provides hard data for center managers as well as people in government and the private sector who help steer healthcare policy.

While other studies have looked into such facilities as rural hospitals — focusing on organization, adaptability and closure rates — Roman said this is the first to examine similar aspects of private substance abuse treatment centers.

“We are exploring how well their strategies are working in the volatile environment of managed care,” said Roman, a distinguished research professor of sociology who has studied issues surrounding alcohol treatment for more than three decades. “We want to see whether their management practices and organizational features are providing a competitive advantage or at least buffering them from organizational death.”

The findings are timely for the estimated 14 million Americans, or one in 13 adults, who abuse or are addicted to alcohol. Statistics from the NIH’s National Institute on Alcohol Abuse and Alcoholism, which has provided more than $3.4 million for the study’s first six years, show alcohol abuse affects more men than women and is highest among people ages 18 to 29.

Effective substance abuse treatment programs are vital to the American healthcare system, said Rex Forehand, director of the UGA Institute for Behavioral Health.

“It’s frightening where we’ve gotten ourselves in this country in terms of alcohol and drug abuse,” Forehand said. “Good treatment options are clearly important for productivity in the workplace, for family functioning and for an individual's adjustment.”

Forehand describes Roman’s work as “critical” in combining research with treatment practices. “Having research and treatment work together from the get-go will help develop and evaluate better, more effective treatment practices,” he said.

Roman also directs a graduate training program that prepares doctoral students for employee alcoholism program research. The program, now in its 14th year, has received $1.7 million in NIH grants.

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