No question about it – holistic therapies are “in” at addiction rehabs, particularly ones at the more elite end of the rehab spectrum. One of the ways that treatment facilities attempt to attend to the whole person and to individualize care is by providing such alternative treatments—sometimes called “complementary” or “integrative” therapies—including acupuncture, energy psychology, equine-assisted therapy, neurofeedback, psychodrama, Reiki, somatic experiencing, and massage therapy. Yet when I investigated scientifically sound approaches for helping people with addictions for my book, Inside Rehab, none of these holistic therapies surfaced.
Do these holistic interventions add to the quality of the rehab experience, increasing the chances of recovery from addiction? Could their benefit be in the user’s head—that is, just a placebo effect? Are they worth the added expense? Or could some of them pose harm?
Where’s the evidence? Some experts said that, in general, there’s no evidence that such holistic approaches are beneficial for addiction, nor that they’ll improve the odds of getting and staying sober, as suggested by a claim at a famous rehab’s website that holistic treatments have “proven” to be highly effective in improving recovery rates and preventing relapse. I asked Yale University psychologist Kathleen Carroll, PhD, whose career is devoted to studying approaches most likely to help people with substance problems, to take a look at some of the testimonials I’d heard, as well as the “experiential/integrative” offerings of some high-end rehabs. Her reaction was, “There is no evidence base for experiential therapy—no randomized clinical trial, no evidence of help with addictions. It may feel great to get a massage or to let oneself cry, but none of that appears to lead to sustainable change. Although sometimes very important, simple expression of emotion alone has not been shown to be an effective ingredient in improving addictions or mood disorders, such as depression.” She added, “The other problem with these alternative therapies is that the providers are, essentially, making claims about effectiveness of unproved interventions and may be charging an insurance company or using public funds to do things like whack around nerf balls. Finally, time spent in alternative therapies is time not spent providing good quality, evidence-based treatment.”
What’s the cost? Costs for holistic-type treatments can add up. At a high-end outpatient program, rates for massage therapy/body work were $150–$165/hour; acupuncture, $100 to $110/hour; and energy healing, about $200 for ninety minutes. A ritzy rehab included one “ionic foot bath” with the price of treatment, while additional sessions cost $125. Some programs didn’t charge separately for holistic offerings, instead building them into the overall cost of the program. One businesswoman whose daughter went to several high-end residential programs said she felt that offering holistic therapies is a marketing strategy more than anything else for treatment facilities competing for attention. “When there are more than ten thousand treatment centers out there, you need something that makes you stand out,” she said. “Having things that make you look trendy and differentiate you from the other places might make someone think, ‘Maybe that’s the one thing that will make a difference for my loved one this time.’ It’s about how you sell yourself when some desperate family needs help.”
An “in” for helping someone? Several rehab directors argued that holistic approaches can provide an “in” for helping someone that isn’t always there with conventional therapies. One said that clients might come back from an acupuncture or massage session and can then process issues in a different way or is more receptive. He added, “Our core program includes evidence-based psychotherapies such as cognitive-behavioral therapy, motivational interviewing, and medications shown to be effective for addictions. If in addition to these services someone wants holistic treatments, why not?” Another argument that could be made in support of alternative approaches is that, even if they offer nothing more than a placebo effect, they may be valuable by virtue of the fact that they attract certain people and keep them in treatment. In so doing, clients may be exposed to other therapies that have been shown to be effective. When asked for an official position on this issue, Westley Clark, MD, JD, MPH, director of the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration said, “SAMHSA endorses the use of evidenced-based practices in substance abuse treatment—treatments scientifically shown to be effective. Many evidenced-based programs which take a holistic approach to treatment may incorporate aspects of alternative or spiritual healing. These approaches may also be helpful so long as they are used as adjuncts to evidenced-based practices.”
The burden of proof? Still, before using an intervention in a treatment setting, the accepted standard—be it with the medical or psychology community or according to government agencies that protect us—is that the burden of proof is on the purveyor of a treatment to show that it is effective. In other words, the way it’s supposed to work is that helping professionals are supposed to use interventions shown first to be beneficial (and safe) according to scientific standards before adopting them as regular practice. Dr. Carroll notes that one of the benefits of thoroughly studying such therapies is that it enables us to better understand who is helped by what therapies in which settings, and who is harmed. Indeed, several people described disturbing situations at rehabs using unconventional therapies.
Informed consent. In the end, I would argue that consumers have a right to know whether therapies are science-based and that those that aren’t should not be presented as such. Addiction treatment participants are also entitled to know about the credentials of providers of any holistic therapies. Adam Brooks, Ph.D., a researcher at Treatment Research Institute in Philadelphia, said, “The crux of the matter is ‘informed consent,’ and patients in any form of addiction treatment are usually not well-informed about what it is that they’re getting, what the evidence is behind the approach, or what steps the facility takes to assure quality of care. Handling alternative treatments should be within this context—clients have a right to know, ‘How well does what we do work and what are the risks?’” Once fully informed, it’s up to the consumer to decide whether to take part. Unfortunately, people with addictions are not always in the best state of mind to think critically, plus they’re not always given accurate information. Finally, when in doubt about any intervention, don’t hesitate to check it out with your personal physician and/or your mental-health professional, outside of rehab.
Author: Anne M. Fletcher, M.S., R.D. in Inside Rehab
Date: April 2, 2013
Holistic Rehab Therapies: Do They Work for Addiction?