Drug Rehab Treatment: America's Broken System
When Charlie Sheen finally entered rehab, it wasn't terribly shocking news. But what most people did find surprising was that instead of checking into a swanky Malibu treatment center as he has done in the past, Sheen opted to receive in-home rehab. Immediately the media began criticizing his choice and questioning his commitment to getting sober.
There are undoubtedly certain challenges related to in-home rehab, but are you really guaranteed better care if you check into a treatment center?
Absolutely not, thanks to the lack of standardization in our current rehab system.
Each year, about three million Americans seek help from a seemingly endless list of treatment facilities. But who is ensuring these treatment centers are qualified to effectively treat them?
With a lax application process for state licensure and certification, there is little accountability placed on facilities, or their ownership, to ensure proper treatment is being offered. With more than 12,000 rehab centers in the country, the odds of finding the one that best fits your needs are next to impossible.
When treatment fails, which it often does, it is then assumed to be the addict who failed, when in reality it was often the addict who was failed by a flawed system.
This leads to a vicious cycle of relapse -- a story all too familiar to families struggling with addiction, not to mention one we've seen repeatedly played out by Hollywood stars.
It is true that some don't take advantage of their treatment and fail at sobriety on their own, but others simply weren't given a chance to succeed.
This is made worse by the fact that most rehab clinics market themselves as "all inclusive" -- able to treat any type of addiction disorder -- which most are certainly not. Addicts and their families are often so desperate to get help that they select a rehab clinic based on cost and availability, without understanding whether or not the care providers are properly certified in the type of addiction that affects them or are qualified to fulfill any additional needs they might have (including mental health needs).
This is especially true of first-timers (over 60 percent of those seeking addiction treatment are first-timers). They don't know what questions to ask or even what they are looking for out of a treatment center, making it nearly impossible to find the right option for their individual needs.
We need to try and get some measure of standardization into the system so that we are able to match those looking for treatment with providers that fit their needs. Currently, there is essentially no oversight regarding the services addiction treatment providers report and their actual capabilities for providing those services.
In the place of a centralized federal or state-level vetting system, there are some private groups that provide directories. But it is not easy to tell how well these directories actually vet the treatment centers listed. It is critical for treatment candidates to know exactly what type of credentialed treatment services are provided. This should be provided by the public health departments, but until that happens, it's basically "every man for himself." (At my site All About Addiction, we recently launched our own "rehab finder," to provide a vetting system in the meantime.)
We believe this is a crucial element for successful treatment; especially when you consider that more than 50 percent of addicts suffer from mental health issues, meaning they need special care by a trained professional. And while some may promise this, there is no verification process to ensure they are able to deliver on their promise.
In fact, a huge survey of the addiction treatment industry found that more than 20 percent of addicts entering treatment were missing crucial mental health services that they needed. (About 50 percent were missing other necessary medical services.)
Rehab is a business -- a booming one, at that -- and right now it is too easy to sell the idea of recovery. Because there is no model of care to follow, the system is compromised with clinics that don't know how to do things better, some that limit their treatment due to dogma and other centers that are actually trying to "game" the system.
The bottom line is, without some level of standardization, treatment becomes nothing more than a crapshoot. You are left at the mercy of a broken system and never know what kind of treatment you are going to receive until it is too late.
Right now, you could easily check into rehab facility and find they offer nothing more than an expensive 12-step program. This is unacceptable. We have tools, like cognitive behavioral therapy and motivational enhancement therapy, which we know are effective, we just need to ensure they are part of the treatment model being offered to patients.
Add to that some very effective, if poorly utilized, medications and it's clear we're handicapping our patients, pun and all.
However, there is hope, and a better way of doing things, but it will require us to adopt a more progressive model of treatment.
Our society has too readily accepted the supposed "fact" that recidivism rates are high, and will always be high, for addicts. The fact of the matter is that the treatment process itself is deeply flawed and until we fix the model of care for recovering addicts, we will never be able to truthfully tell how many of them can recover. Addiction isn't a death sentence. It is a treatable disease; we need to acknowledge that the way we are doing things doesn't work and do something to change it.
After many years of trial and error, researchers and doctors have finally begun to grasp what works and what doesn't in terms of treating addiction.
It is now our job and our responsibility to start developing a system that gets the proper treatment to the people who need it.
Any doctor will tell you, there are no guarantees with addiction. All we can do is give people the best shot at treatment, and sadly, right now, our system is failing at that.
February 11, 2011
Adi Jaffe, Ph.D. is a Los Angeles addiction psychologist and researcher. Himself a former drug addict and convicted drug dealer, Dr. Jaffe is an expert on substance abuse, especially on the neuroscience and policy issues involved. Today, he is a UCLA-affiliated researcher on addictions, founder of AllAboutAddiction.com and a columnist for Psychology Today.
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