Traveling for Addiction Treatment

Going away for treatment can be the right call, and the reason is usually about the place you are leaving rather than the place you are going to. What almost nobody plans for is the journey itself, which is the most dangerous part of the whole arrangement and the part that gets booked last.

This page covers when distance is clinically useful, what makes traveling while in withdrawal risky and how to sequence around it, how transport and arrival timing are usually arranged, what happens to coverage across state lines, the work, pets and dependents problem, how families visit over a distance, why aftercare has to be planned for the state you go home to, and what to book first. Our guide to how to get into rehab covers the admissions side.

When distance is genuinely useful

There are two good clinical reasons and one bad one, and telling them apart saves money and time.

The first good reason is the home environment. Federal reporting describes residential programs as appropriate for physically and emotionally stabilized individuals who may not have a living situation that supports recovery, may have a history of relapse, or have co-occurring physical or mental illnesses [5]. If the substance is in the house, or the people in it are using, distance is not indulgence. It is the treatment plan.

The second is availability. The level of care an assessment recommends may simply not be running near you at the point you need it, and waiting for a local bed at the right level is worse than traveling to an available one.

The bad reason is anonymity for its own sake. Going a long way to avoid anyone knowing is understandable, but it usually means the aftercare plan is built in the wrong state, and aftercare is where most of the work happens. Our levels of care page explains what each recommendation means.

Traveling while in withdrawal: the safety problem

This is the section to plan around, because the sequence people choose by default is the risky one.

Withdrawal does not wait for a flight. Federal guidance states that for alcohol, sedative-hypnotic and opioid withdrawal, hospitalization or some form of 24-hour medical care is generally the preferred setting for detoxification [3]. A pressurized cabin at 30,000 feet, or a car on an interstate, is the opposite of that.

For alcohol and sedatives the risk is serious in kind. In severe alcohol dependence, seizures, delirium tremens, and dysregulation of body temperature, pulse and blood pressure are outcomes that can lead to fatal consequences [3].

Opioid withdrawal is different but not harmless in transit. Unlike alcohol and sedative withdrawal, uncomplicated opioid withdrawal is not life-threatening [3], though severe gastrointestinal symptoms such as vomiting or diarrhea can rarely lead to dehydration or electrolyte imbalance [3]. Vomiting carries its own hazard: material can be breathed into the lungs, which is called aspiration and can cause lung infection, and vomiting and diarrhea can cause dehydration and disturbances of body chemicals and minerals [4].

If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988.

So the question to put to the admissions team is not “can we fly” but “when in the sequence should we travel”. Sometimes the answer is to stabilize locally first and travel afterward. Our medical detox page covers what stabilization involves.

Transport, escorts and arrival timing

Sort three things in this order: who is traveling with them, what the program’s arrival window is, and what happens if the journey goes wrong.

Ask the program directly what it can arrange. Orlando Recovery Center, for instance, publishes in its own words that it does not pay for travel to or from the facility, and that its representatives can help coordinate travel arrangements [1]. Those are two different things and it is worth knowing which you are being offered. Its what-to-expect page names one thing it does arrange: if you are traveling by air, you will be picked up from the airport and transported to the center [2].

An escort matters more than people expect. Someone traveling alone in early withdrawal has every opportunity to change their mind at an airport bar, and a companion removes most of those opportunities without anyone having to police anybody.

On timing, ask for the admission window in hours rather than as a date, ask what happens if a flight is delayed past it, and get a phone number that is answered at the hour you will actually land. Our page on the rehab intake process covers what happens once you arrive.

Insurance across state lines

Crossing a state border does not change the benefits your plan has, but it can change whether a program is in network. And on some plans there is no out-of-network benefit at all, so an out-of-state admission may not be covered. That is where out-of-state admissions go wrong.

Two questions settle most of it. Is this program in network for my plan, and if not, does my plan have out-of-network benefits for this level of care? Ask the program’s admissions team to verify both with the plan before anyone books a flight, and ask them to say what the answer means in dollars rather than in percentages.

What does not change is the floor. All Marketplace plans cover mental health and substance use services as essential health benefits, including behavioral health treatment such as psychotherapy and counseling, mental and behavioral health inpatient services, and substance use disorder treatment [8]. Plans cannot deny coverage or charge more for a pre-existing condition including a substance use disorder, and cannot apply yearly or lifetime dollar limits to an essential health benefit [8].

Parity sets the other boundary. Under the Mental Health Parity and Addiction Equity Act, a plan covering mental health and substance use care may not apply harsher financial requirements or treatment limits to it than it applies to substantially all medical and surgical care in the same class, and that reaches prior authorization and step therapy as well as visit and day caps [7]. Its scope is narrower than most people assume: non-federal governmental plans with more than 50 employees, group health plans of private employers with more than 50 employees, and the individual market [7]. Small-employer plans are not covered directly and get comparable protection through the Affordable Care Act’s essential health benefits requirement [7]. Our page on whether insurance covers rehab sets out the mechanics, and what rehab costs covers the arithmetic.

Work, pets and dependents

These are the objections that actually cancel admissions, and they are solvable if you name them out loud rather than carrying them silently.

Work comes first because it has deadlines. Establish what leave is available and what certification the employer needs before the travel date, not from a departure lounge. Our page on going to rehab and keeping your job covers that ground.

Dependents need a named person and a written arrangement, including who can collect a child from school and who holds a key. Pets need boarding booked and paid, because an unresolved animal is a real reason people leave treatment early.

Then there is the mail and money layer: direct debits, rent, a car that will be towed, a prescription that runs out. Write the list before you go and hand it to one person. Our page on the most common barriers to treatment covers the rest of this category.

How families visit over a distance

Ask about visiting before you choose a campus, because the answer differs by program and by level of care and it is easier to plan around than to argue with afterward.

Three questions are worth asking in the same call. When do visits typically start, given the level of care being recommended? Are video visits available, and on what schedule? And does the program run family programming that a relative can join remotely?

Expect the early days to be quieter than you want. Programs commonly restrict contact at the start of a residential stay and open it up in stages, and that is a clinical decision rather than an obstruction. Plan around one good visit rather than several thin ones, and book travel once you know the schedule rather than hoping.

For the person in treatment, the useful framing is that distance ends. Our page on what the rehab process is like sets out the shape of a stay from admission to discharge.

Aftercare in the state you go home to

This is where traveling for treatment most often fails, and it fails quietly.

Federal protocol treats the handover as part of the work rather than as an afterthought. Fostering a patient’s entry into treatment means preparing them for it by stressing the importance of following through with the complete continuum of care, and where someone has a pattern of completing detoxification and then not engaging in treatment, a written treatment contract may encourage entrance into that continuum [6]. Such a contract is not legally binding, is signed voluntarily when the patient is stable enough to do so, and commits them to a continuing care plan with details and contacts established before detoxification finishes [6].

Read that last clause again if you are traveling: details and contacts, established before the end. If you flew 1,200 miles for treatment, those contacts have to be in the state you are flying back to, and someone has to build that list while you are still on the campus.

So ask, in week one rather than week four, who at the program does out-of-state discharge planning, what they will have arranged by discharge day, and what happens with prescriptions across a state line. Our medication assisted treatment page covers why that last question matters for some people.

Booking the logistics straight away

If the decision is made, this is the order that wastes the least time.

Get the clinical assessment and the benefits verification done first, because both can change the plan. Ask what each one costs on the first call rather than assuming. Then confirm the admission window in hours, the campus address and the name of who to ask for on arrival.

Then travel: tickets, an escort, and a fallback if the journey slips. Then home: leave request lodged, dependents and pets arranged, direct debits and prescriptions handled, and the bag packed to the program’s own rules. Orlando Recovery Center, for example, states that new residents pack into one suitcase, that additional luggage may be turned away during admission, and that arrivals are asked to consent to a search of their belongings [2].

Finally, tell one person at home the whole plan, including the arrival window and the number to call. Our facility directory lists the campuses we operate, grouped by state.

Frequently Asked Questions

Sources

1. Orlando Recovery Center. Drug, Alcohol and Mental Health Rehab in Orlando. The Recovery Village. https://www.therecoveryvillage.com/locations/orlando/
2. Orlando Recovery Center. What to Expect at Orlando Recovery Center. The Recovery Village. https://www.therecoveryvillage.com/locations/orlando/what-to-expect-orc/
3. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances. Treatment Improvement Protocol (TIP) Series, No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
4. U.S. National Library of Medicine. Opiate and Opioid Withdrawal. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000949.htm
5. Office of the Surgeon General. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health — Chapter 4: Early Intervention, Treatment, and Management of Substance Use Disorders. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK424859/
6. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. Treatment Improvement Protocol (TIP) Series, No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64119/
7. Centers for Medicare & Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA). CMS.gov. https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
8. Centers for Medicare & Medicaid Services. Mental Health and Substance Abuse Coverage. HealthCare.gov. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.

Author

Kevin Wandler, MD

Chief Medical Officer, The Recovery Village