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Editor's note: This story is part of a series, Hooked: America's Heroin Epidemic, that will be featured on NBC News from April 7-9.
When they were little, Ben and Ryan used to ride their bikes together on the quiet streets of their suburban St. Louis neighborhood. But by their twenties, the brothers had found a new hobby to share -- heroin.
“We used to plot and plan to get high together,” said Ryan. The family asked that we use only first names to protect their identities.
Both brothers are still living in their childhood bedrooms. But their mom Denise will tell you there is one key difference between her boys now. Ben has been sober for two months. Ryan is still struggling with addiction.
Their story illustrates the challenges facing many who struggle with heroin addiction — lack of insurance coverage for treatment, difficulties accessing services, and short-term fixes that don’t seem to make a dent in a disease that is often a life-long battle.
Last year, Denise sent both sons away to separate private rehabilitation facilities in Florida so they wouldn't influence each other’s recovery. They both entered halfway houses and were successful for a time. But then they returned to Missouri.
“As soon as they got back it started again,” Denise said. “As soon as I saw the signs I was like, please God, no.”
At 24, Ben is still covered by his father’s insurance plan. So as soon as Denise saw Ben using heroin again, she enrolled him in a treatment program covered by that health plan, which provides Ben with Suboxone — a stabilizing medicine similar to methadone that allows recovering addicts to function normally without feeling high.
In the video below, Ben talks about getting clean after using heroin for four years. He says it was a “better high” than anything he’s ever done.
“I take it three times a day. Once in the morning, once in the afternoon and then once at night,” Ben said. “There's no withdrawal symptoms. I don't have urges. I don't have cravings. I don't ever think about it anymore.”
Ben has been clean for two months.
But when Ryan returned from rehab, his mother did not enroll him in the treatment program. At 26, he had aged out of his parents’ medical coverage. He has no insurance of his own and has no savings. Ryan says he’d have no way to pay $800 per month for Suboxone and does not want to enter a state-run program.
“It's really hard,” said Ryan. “If you don't have insurance you can't go to a nice place. And state-runs take months to get into -- by that time you could be dead.”
Michael Botticelli, the acting director for the White House Office of National Drug Control Policy, says there is a “treatment gap” in America -- a gap between those who want treatment for substance abuse and those who actually enroll in treatment programs.
"Only one in 10 people who need treatment actually get it,” Botticelli said, citing the National Survey on Drug Use and Health.
Barriers include lack of insurance and under-insurance. In addition, historically many areas didn't approve of treatment facilities being in their communities. That means there are fewer clinics to serve the demand for treatment in many parts of the country. In Vermont, clinics report long waiting lists. In rural Maine, people drive for hours to get to the nearest methadone clinic.
Hear how the drug’s powerful grip has taken hold of Denise's family.
But Botticelli sees promising changes coming with the implementation of the Affordable Care Act. The new health care law requires insurance companies to cover substance abuse treatment just as they would cover any other chronic medical condition, such as diabetes.
If insurance companies are not doing so, Americans can file a complaint through their state. Parents and others have an appeals process available to them if they feel an insurance company is violating the law, Botticelli says.
Perhaps the most difficult problem to solve when it comes to treatment are the people who clearly meet the criteria and need help, but don’t seek care.
Denise believes Ryan may fall into that category.
During our visit, Ryan at times said he would seek treatment if it weren’t so expensive. But he also indicated that he wasn’t ready to enter a program like the one his brother is in.
Ben, however, says he’s committed to staying off heroin. He thinks every day about what he’s putting his mom through.
“It's just horrible to think of the things I've done," he said. "But, you know, it'll only get better. Once you hit the bottom you can only go up.”
Chad Sabora of the Missouri Network for Opiate Reform and Recovery explains why he breaks the law to distribute Narcan, a drug that can reverse overdoses.