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How is ED treated?

Most doctors suggest that treatments proceed from least to most invasive. Making a few healthy lifestyle changes may solve the problem. Quitting smoking, reducing alcohol consumption, losing excess weight, and increasing physical activity may help some men regain sexual function.

Cutting back on or replacing medicines that could be causing ED is considered next. For example, if a patient thinks a particular blood pressure medicine is causing problems with erection, he should tell his doctor and ask whether he can try a different class of blood pressure medicine.

Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

Psychotherapy

Experts often treat psychologically based ED using techniques that decrease the anxiety associated with intercourse. The patient's partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety during treatment for ED from physical causes.

Drug Therapy

Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis.

Oral Medications
In March 1998, the U.S. Food and Drug Administration (FDA) approved sildenafil (Viagra), the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested for safety and effectiveness.

Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

The recommended dose for Viagra is 50 milligrams (mg), and the doctor may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the doctor may adjust this dose to 20 mg if 10 mg is insufficient. Lower doses of 5 mg and 2.5 mg are available for patients who take other medicines or have conditions that may decrease the body's ability to use the drug. The 5 mg and 2.5 mg doses of Cialis are FDA-approved for daily use.

None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin pills for heart problems should not use any of the three drugs because the combination can cause a sudden drop in blood pressure. Also, men should tell their doctor if they take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. The doctor may need to adjust the ED prescription. Taking a PDE inhibitor and an alpha-blocker within 4 hours of each other can cause a sudden drop in blood pressure. A small number of men have experienced vision or hearing loss after taking a PDE inhibitor. Men who experience vision or hearing loss should seek prompt medical attention.

Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs-including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone-are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect-that is, a change that results simply from the patient’s belief that an improvement will occur.

Injectable Medications
While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil widen blood vessels. The injectable form of alprostadil is marketed as Caverject. These drugs may create unwanted side effects, however, including scarring of the penis and persistent erection, known as priapism. Nitroglycerin ointment, a muscle relaxant, can sometimes enhance an erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra uses a prefilled applicator to deliver the pellet about an inch into the urethra. The pellet form of alprostadil is marketed as MUSE. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; a warm or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances.

Vacuum Devices

Mechanical vacuum devices cause an erection by creating a partial vacuum, which draws blood into the corpora cavernosa, engorging and expanding the penis. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic ring, which is moved from the end of the cylinder to the base of the penis as the cylinder is removed. The elastic ring maintains the erection during intercourse by preventing blood from flowing back into the body (see Figure 2). The elastic ring can remain in place up to 30 minutes. The ring should be removed after that time to restore normal circulation and to avoid skin irritation.

Couples may find that using a vacuum device requires some practice or adjustment. An erection achieved with a vacuum device may not feel like an erection achieved naturally. The penis may feel cold or numb and have a purple color. Bruising on the shaft of the penis may occur, but the bruises are usually painless and disappear in a few days. Ejaculation may be weakened because the elastic ring blocks some of the semen from traveling through the urethra, but the pleasure of orgasm is usually not affected.

Paying for Drug Treatment

Finding ways to pay for treatment to recover from dependence on alcohol or drugs takes some research. Addiction treatment can be quite costly and the wrong program can be ineffective. The severity and duration of the substance a person abuses and the type of treatment the person requires all contribute to the costs.
Some treatment for drug and alcohol dependence costs more than others. Residential treatment is more expensive than outpatient treatment. The location of the facility, amenities offered and staffing also influence treatment costs. Chronic alcoholism or drug abuse may require longer-term treatment and that can become very costly depending on the treatment facility.

Private Insurance

The most commonly used payment for drug and alcohol treatment is through private insurance. The insurance coverage may pay for some or a great portion of the drug and alcohol treatment program. The websites of some addiction treatment centers may mention specific insurance carriers, particularly if the facilities are preferred addiction treatment centers for national insurance companies such as Blue Cross, Aetna, Cigna and others. Whether or not private insurance covers any portion of drug and alcohol treatment depends on whether the facilities are ERISA or non-ERISA plans. The Employee Retirement and Income Security Act (ERISA) is a federal law that sets standards for certain health plans offered by employers. If the plan is ERISA, it may or may not cover drug and alcohol treatment, as it is not required to. Non-ERISA plans and other group health plans, are required to provide at least four inpatient detox admissions (of up to 7 days each) in a lifetime, at least 30 days per year (lifetime 90 days) of non-hospital residential treatment and at least 30 days a year of partial hospitalization or outpatient services.

Military Insurance

Members of the armed services who need alcohol or substance abuse treatment may have some or most of the costs paid for through military insurance.

Medicare, Medicaid and Medical

Many treatment facilities advertise that accepting Medicare, Medicaid and Medical. Medicare Part A covers some drug and alcohol treatment received at a hospital (including room, meals, nursing and some other services), while Part B covers some services provided by alcohol and drug professionals (inpatient or outpatient), lab tests, partial hospitalization and outpatient therapies. Be aware that Medicare does not cover the total cost of most treatment and services and patients pay deductibles and co-payments.

Self Payment

The two major things to consider when evaluating self payment for addiction treatment are that the first attempts at drug and alcohol treatments do not always work. Ongoing addiction usually has high mental and financial costs as well as increased risk for other problems.

Personal Savings

It may come down to the having to tap into personal savings to pay for rehab treatment, especially if a person has a high insurance deductible, no insurance at all, does not qualify for scholarships or does not want to take out a loan. Again, be sure to find out exactly what the cost break down is to estimate if it will exhaust a savings account.

Family Assistance in Paying

Asking family for assistance to pay for the drug and alcohol treatment can be an option. If a person is genuinely committed to quitting the abuse, family members may be willing to help. If the aunt or uncle says that rehabilitation treatment will be a loan, be sure to draw up a loan agreement and make good on the promise to pay them back.

Creative Payments

One-Time Pay Assistance

Some treatment centers offer some type of financial assistance on a one-time-only basis.

Scholarships

Several drug and alcohol treatment centers in California offer scholarships to those individuals who cannot afford to pay for treatment out of pocket or who do not have insurance. In fact, some of these treatment facilities may be required to make a certain number of beds available for scholarship recipients as part of state licensing requirements--depending on what type of license the facility has. If a person qualifies for a scholarship, it will pay for the entire cost of the treatment. Scholarships are for those individuals who really have no other option.

Self-Pay Sliding Scale

Another popular payment method for drug and alcohol treatment is one where a patient pays what he or she can, according to a sliding scale. This assures that the patient will get the necessary treatment to kick alcohol and/or drugs, but will not break the bank.

Loans

Some facilities may offer loans that patients can take out to pay for the treatment. Be sure to find out everything that the loan covers in the treatment and understand exactly what the terms of the loan are. No one wants any hidden fees or surprises. Ensure that someone explains anything there is a fee-for-service, as this would be in addition to the treatment costs.

Facility that Meets Needs and Budget

The next step seeking treatment is to locate the right treatment facility to meet the needs and budget. Whether an inpatient hospital or residential treatment center specializing in addiction treatment or outpatient treatment, determine which treatment facility can best address the particular addiction situation.

The following step is to contact each of the treatment providers on the list and ask a series of questions. Some people may visit the clinics that seem well-matched in order to see firsthand how these facilities operate and to get a better sense of the kind of care a patient will be receiving at the facility. Ask for literature and inquire about all costs associated with the treatment and various treatment options each may offer. Some residential treatment facilities, for example, offer outpatient treatment, aftercare treatment and other services.

In order to shorten a long list of possible treatment facilities it is best to examine in-depth exactly what the costs of the programs are. Some facilities require an initial assessment first, in order for professional staff to determine the best and personalized program for a patient. In fact, whichever treatment facility ultimately chooses, no treatment can begin without a comprehensive assessment. This assessment involves an interview to learn about patient background, family history, type of substance and duration of abuse and other issues important to the treatment. Some treatment centers require patient detoxification in order to be admitted to the treatment program. This will be determined at the time of the assessment. No one can enter treatment without being free of traces of drugs or alcohol.

Don’t Let an Inability to Pay Defer Treatment

Employer-Sponsored Programs: Find out if an employer has a substance abuse program. This may be a part of the employer-paid insurance coverage or it may be separate.
Federal, State, County or Local Assistance: Check with the Department of Health, county or local organizations to inquire about assistance with treatment programs or treatment at a sponsored facility. There may be citizenship, residency and income limits applicable before treatment.

The best advice anyone can give is to fully explore all the options to getting treatment to quit drugs and alcohol. Be honest and upfront about the financial and insurance situation and ask for help to get the treatment need.