Today's question is on how to deal with the incredible costs of rehab treatment.
Why is treatment in rehab so expensive? Is there any way to get results without mortgaging my home?
Lance Dodes: To begin, it's important to understand that the rehabilitation industry in this country is basically unregulated, so facilities can staff themselves any way they like and claim fabulous results without having to produce any proof. Indeed, rehabs are mostly staffed by counselors with negligible training that would not qualify them to be therapists in a more professional setting.
Hazelden Treatment Center (one of the most famous rehabs) for example, advertises that you can become an addiction counselor in just a year, while training to be a social worker, psychologist or psychiatrist requires from three to eight years plus more years of practical experience in the field.
Even saving the cost of better therapists, these programs charge from $30,000 to $90,000/month.
Many justify these charges by adding expensive "extras" that have no relevance to addiction such as equine therapy (spending time with a horse), "ocean therapy" (taking a ride on a yacht), educational lectures, fitness training, aquatic aerobics, work assignments, leisure skills group, and others. In my new book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, I published the complete daily schedules from the Betty Ford Center and Hazelden which list many of these irrelevant and unproven "treatments."
The most famous and expensive rehabs compete with each other to offer beautiful settings with spacious rooms and gourmet cuisine, none of which has anything to do with treating addiction. In many if not most, there is a specific de-emphasis on individual sessions, making these programs unable to address the specific issues within each person. There are, instead, multiple groups but unlike true group therapy, these are lectures and discussions about assigned topics.
Is it possible to find less expensive and better alternatives? Look for programs that do not have a rigidly fixed length of stay. There is absolutely no medical or psychological justification for staying in a facility for exactly 30 days. Length of treatment for addiction should be individualized just as it is for every other medical or psychological hospitalization. There are programs that average shorter, two-week stays, and are able to charge less because they are not as long and don't have horses or yachts or ocean views.
Besides emphasizing individual treatment with well-trained counselors, a competent rehab must offer a variety of modalities without insisting you fit into their favorite one. A program may offer 12-step meetings, for example, but to be adequate it must offer non-12-step approaches for those who cannot benefit from a 12-step approach. A rehab must never be a boot camp to whip you into accepting their belief system.
Mortgaging your home is not actually the worst consequence of bad treatment. The worst is spending all that money thinking that these incredibly expensive facilities will live up to their promise of changing your life, then suffering a sense of failure and despair if the treatment fails you. Save yourself the heartache and financial loss and make a careful search for rehabs that offer professional, individual treatment without trying to push you into one particular approach, and without costly and useless frills.
Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of Addiction, Breaking Addiction: A 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work. Full Bio.