What Really Goes on Inside Rehab

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It depends on how severe the problem is. First, get an assessment, ideally from an independent person who has expertise with substance-abuse disorders. They could give you some sense of what your options will be for treatment. They would not have a vested interest of where they might send you.

One of the issues with addiction treatment is that it’s all group-based. What other mental-health disorder do you know of where you all sit around in groups and talk about your problems? There is no evidence that that’s the ideal model for addiction treatment.

It’s the same thing with weight control: Groups can be great, but a lot of people don’t want to sit in Weight Watchers and talk about their problems. They want to go to a place like Jenny Craig where they have one-on-one therapy.

Whoever said that we should all sit around in groups and talk about our addictions? There is very little individual counseling in most of these treatment programs. Some of the outpatient programs have almost none, and lots of people told me that they didn't get well until they went to either an individual counselor or a non-traditional program where the treatment was predominantly one-on-one.

"One woman at one of the 12-step-based rehabs [I visited] said that it was mentioned that there were alternatives to deal with addiction and she asked what they were and was met with silence."

My friend’s dad just checked into rehab for the first time, so she's just being introduced to all of this. What advice would you offer people who are just starting to deal with these problems?

For somebody already [in rehab], continue to ask questions. You have to be the squeaky wheel, because if not, the treatment is often one-size-fits-all. One woman said to me at an expensive rehab that at night they all tended to be doing the same homework assignments.

If you know that your loved one struggles with depression or anxiety, [you should ask] how is that problem going to be addressed? How are we going to be involved as a family? What’s going to happen after he or she reappears? How can we continue this for the person?

What else struck you while researching Inside Rehab?

There are a number of rehab staff and administrators I met who were unfamiliar with things that I thought they should have been familiar with. Number one, they were not familiar with alternatives to AA at all. They had not heard of SMART Recovery, Women for Sobriety, Secular Organizations for Sobriety, or they were misinformed about them, like, “Oh, that’s a moderation group.” But no, they are all abstinence-based groups. One woman at one of the 12-step-based rehabs said to me that in a lecture it was mentioned that there were alternatives to deal with addiction and she raised her hand and asked what they were and was met with silence. And she was angry about that.

In part we are talking about informed consent here. If you have breast cancer or heart disease, you go to your doctor and he tells you about what your surgical or treatment options are. “You can have bypass surgery, you can have angioplasty, you could have a stent.” And if one thing doesn’t work, they don’t keep doing the same thing over and over again, they modify the treatment. Well, that tends not to happen in traditional rehab. You keep going back, but the treatment is not modified much at all the third, fourth, and fifth times that you go back—and you’re blamed if the treatment fails. If a 12-step-based treatment approach doesn't work for you the first time around, … then maybe you should refer a person to a completely different program.

One of the things that I found that was really sad was that the non-12-step-based programs—and there aren't that many—were very willing to do whatever worked for their client, [including] referring them to a 12-step-based program. I did not find that reciprocity at all with the 12-step-based programs.

The other thing that surprised me was that only one program was using the Community Reinforcement and Family Training approach that has been shown to be most effective in research studies.

Another thing that was really intriguing, and I did not expect to find this: I had been told a lot of those myths about treatment, that the more money you spend, the better your treatment is—but that’s not necessarily true. I was really surprised at the quality … of some of the low-income, community-based outpatient programs. [In some cases, these] provide treatment that is more state-of-the-art, science-based and comprehensive than that provided by prominent programs in this country.

Chrisanne Grise is a former staff writer for The Fix. She lives in New York City and blogs at chrisanne-grise.com.