The State of the Rehab Union
Results of an exclusive new survey conducted by The Fix reveal why people check into rehab today, why they choose where they go, how long they stay—and the recent and troubling rise of poly-substance abuse.
For the past six months, The Fix has been amassing and analyzing a wealth of information volunteered by people who have been through all manner of residential addiction treatment centers across the country. As part of its unique-in-the-industry Rehab Review, The Fix asked 20 questions about what is most important to people who went to rehabs, and patients sounded off on everything from how they liked the food or their sleeping situation, to whether or not their treatment was 12-step-based, to how well staff handled rule-breakers.
A few of these questions covered some basic and important info about what factors were most important to people when choosing a rehab; what addictions, issues or crises led them to check into a treatment center; and for how long they were in residence at the facility in question.
The No. 1 factor affecting rehab choice was treatment quality, selected by 24% of respondents. No. 2 on the factors list was location, selected by 14% of respondents, followed by accommodations quality (10%).
The biggest new and growing trend in the rehab world, according to experts who spoke to The Fix for this story, is people checking into treatment for poly-substance abuse. Especially over the last five to 10 years, people admitted to rehab “just don’t seem to have straight-out one drug of choice anymore,” said Austin Recovery President and CEO Jonathan Ross. He speculated that this could have something to do with the mobility of modern American society, or perhaps instant gratification, with younger drug addicts being somewhat less discriminating with respect to what they use to get high. He imagined their rationale: “If it’s accessible and easy, I want it and I want it now. If it’s not my drug of choice, that’s fine.”
Our survey supports evidence of this trend, with 17% of respondents reporting seeking treatment for more than one substance. Yet this is even lower than the nearly 56% who said the same to CASAColumbia, the National Center on Addiction and Substance Abuse at Columbia University, as part of a five-year study, the controversial results of which were made public in June.
This discrepancy in percentages reporting poly-substance abuse could be a result of the way The Fix's question was worded, or it could have something to do with one hallmark of addicts entering treatment that Ross has noticed: Namely, “that they won’t often admit that prescription drugs are an issue until they get here, and they fully disclose or are drug-tested and we find out all the different things that they’re on.” So the person who went to rehab thinking they were just an alcoholic could come out realizing that they were in fact addicted to, say, alcohol, benzos and marijuana.
The Fix did not, however, ask about poly-substance abuse directly. Rather, the first set of data (see the chart, above) concerns what mattered most to people when choosing a treatment facility. Three hundred and thirty-three respondents selected one or more factors from a list of 13, including price, location, insurance, co-ed or single-sex, gay-friendly, food quality, accommodations quality, treatment quality, religious affiliation (or lack thereof), amenities and recreation opportunities, whether smoking was allowed, privacy and “other” (with an attendant fill-in-the-blank field). Collectively, these 333 respondents chose 1,066 factors that were important to them in choosing where to go to rehab, for an average of 3.2 factors per person.
The No. 1 factor was—as many rehab execs who spoke to The Fix for this story said they were happy to see—treatment quality, selected by 24% of respondents. “I believe that’s really the core of the issue,” said Ross, who noted that what constitutes good-quality treatment is changing. “It used to be that if you had a solid program and you were covering the basics of addiction … that was fine,” he said. But no longer. Now the disease is acknowledged to be more complex, encompassing process addictions and co-occurring psychiatric issues, and with the family component more important than in the past.
Although treatment quality was the most commonly chosen factor, the fact that only a quarter of respondents chose it struck Susan Foster, MSW, VP and director of policy research and analysis for CASAColumbia, as “not surprising—but disturbing.” CASAColumbia's recent study concluded that “addiction treatment is largely disconnected from mainstream medical practice,” and that “of those who do receive treatment, most do not receive anything that approximates evidence-based care.” Foster said that a quarter of respondents citing treatment quality as an important factor was, sadly, consistent with what CASAColumbia found in its report.
Foster noted that there are “enormous misperceptions” about addiction treatment among the general public—at least one reason for which is that most people don’t have much experience with it, and therefore don’t have much knowledge as to what constitutes quality treatment. So it’s unsurprising, then, that “quality of treatment” was only cited by a quarter of respondents.