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How to Choose The Best Rehab - Page 3

By Constance Scharff PhD 04/08/14

What you need to know when choosing an addiction treatment center.


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Why do treatment centers use medical detox? Not only is it humane, but it also gets and keeps addicts in treatment. Why would an addict come to treatment and stay if s/he had to experience horrifying withdrawal symptoms? That’s exactly the kind of experience that would send an addict back to using. Few can go through unassisted withdrawal without breaking and in some cases, such as from alcohol, withdrawal can be deadly if not medically supervised. Rehabs want addicts to succeed. In order to get to the heart of the addict’s problem, the treatment center must get the addict through withdrawal as comfortably as possible, to give him/her the strength and courage to make the changes necessary to lead a sober, meaningful life. The physicians who specialize in detoxification know the latest medications and therapies available to help addicts through withdrawal. You or your loved one will be in good hands with an experienced medical detox specialist. 

Also, please note that detox is commonly covered by many medical insurance policies. Be sure to look into this when you’re asking questions of your rehab facility.

The Various Types of Rehab

Addiction treatment facilities are not all the same, and each type of rehab has a different idea about what constitutes quality treatment. Each facility’s treatment protocol will be based on its particular philosophy. These categories are not mutually exclusive. For example, you can have a faith-based facility that uses some evidence-based therapies. However, a single philosophy underlies or is emphasized in each treatment center; that is how they are categorized. Here are descriptions of the six most common types of addiction treatment centers:

Evidence-based: Evidence-based treatment facilities underpin their treatment protocols on the science of addiction recovery. They offer treatment, usually psychologically-based with adjunctive therapies, based on scientific research into what works for addicts. Their treatment protocols change consistently, depending on the results of the latest research. Abstinence from mind-altering substances is the goal.

Faith-based: Faith-based rehabs focus their attention on the spiritual aspect of recovery. Most will use 12-step programs in conjunction with religious ritual and practice. Their underlying belief is that God is the one who grants recovery. Most faith-based treatment programs in the USA are Christian, though there are a handful of recovery centers for individuals of other religions. Organizational treatment programs funded by religious groups, such as the Salvation Army’s recovery programs, often fall into this category. These are abstinence based programs.

12-step-based: 12-step-based programs base their therapies on the 12-step philosophy and literature of Alcoholics Anonymous and its offshoots. Through group work, attendance at meetings on and off site, work with a sponsor, and “working the steps,” individuals will look at their addiction through a 12-step perspective. Again, 12-step based programs will include other treatment modalities, such as one-on-one psychotherapy and complementary therapeutic practices, but the foundation of the recovery program is 12-step-based. These programs are abstinence programs.

Medicine-based: These treatment centers view addiction as a disease that needs to be medically managed, similarly to diabetes. The long-term use of medication such as methadone or Suboxone is prescribed to manage addiction. Many classify these types of programs as harm-reduction programs, because they are transferring the addict’s drug dependence from one drug to another. Medicines like methadone or Suboxone replace heroin or other opioids. 

There are some medicines that deter drug use. For example, Antabuse is a drug that makes alcoholics ill if they drink. These kinds of medicine-based treatments are used to help prevent relapse. These are harm-reduction or addiction management programs; they do not require drug abstinence. 

Other (non-12-step-based): There are some treatment centers that do not fit into any of the previous categories. These treatment programs offer “cures” without using evidence-based treatment protocols. They are generally anti-12-step and non-religious. These centers suggest that they have worked out their own way of treating addiction unlike anywhere else. The problem is that they may not have the proof of success to back up their claims. These may or may not be abstinence based.

Harm-reduction based: These treatment centers believe that addicts may not be capable of complete abstinence or may not want to stop using entirely. They work from the philosophy that an addict may be able to lessen the amount of a substance s/he takes. From this point of view, it’s okay to have a glass of wine with dinner and they work to teach you or the one you love how to do just that – keep a lid on the addiction, but allow some substance use. These types of programs, for example, will suggest that smoking marijuana now and again is fine so long as it isn’t leading to other problems. 

Some harm reduction programs are found outside treatment centers. An example would be needle exchange programs. The idea in this scenario is understanding that not all addicts want or are ready for help, so to try to stop the spread of life-threatening diseases such as HIV and hepatitis, communities will provide free, clean needles to IV drug users. The risk of disease transmission is reduced, even though the addict continues using. 

Does Evidence Support Rehab?

The answer to this question is both yes and no and depends on the quality of the care and the length of stay in rehab. Poor quality care or insufficient time in treatment will result in failure. Willingness also plays a role. Is the addict willing to do what is asked of him/her? Getting sober means facing the pain that holds a person back from being his/her best self. Even reluctantly, the addict must be willing to address those issues in order for treatment to work. 

What does the scientific evidence say about treatment? Several things: 

1. The most effective type of treatment is evidence-based. Evidence-based treatment centers are the most likely to track and share their long-term success rates. This may be because they are consistently looking for best practices and cutting-edge therapies that will improve their treatment outcomes. Evidence-based treatment does not adhere to a specific philosophy about what works. Rather, its goal is to consistently improve outcomes. These improved outcomes will fill beds, so there is no fear of changing protocols. However, these treatment centers tend to be more expensive, because providing top-quality treatment providers for all the different treatment modalities and complementary therapies is a relatively expensive endeavor. 

2. The evidence suggests that highly individualized programs are superior to managed-care therapies. Imagine if your loved one had cancer and was in a cancer treatment facility. What if all the people with cancer – with no concern at all for type, advanced stage, or anything else – were given the exact same treatment? You would remove your loved one immediately from this hospital and seek out a treatment facility that helped your loved one based on the exact nature of his/her problem! Expect no less from an addiction treatment center. Managed care keeps costs down and profits up, but does little to help the addict long-term. 

3. The research is very clear that longer term care is superior to shorter term care. The idea that quality treatment can be completed in 28-30 days has no basis in science. In fact, the 28 day treatment model was developed because that is what insurance would pay for, not because it works. Most addicts, to get a firm foundation in recovery, require 90-120 days of residential treatment and a solid aftercare plan that continues post-treatment support for the first year of recovery. Addicts are broken when they enter treatment and fragile when they leave residential care. They need a supportive plan to keep them on the path of recovery. 

4. After residential treatment, a quality aftercare plan is critical to long-term success. Who hasn’t heard about a person who went to rehab and then immediately returned to using? Others relapse a little later on, after slowly slipping back into their old lifestyle. An aftercare plan, which most treatment centers provide in one form or another, suggests exactly what an addict needs to do outside the treatment center to continue his/her lifestyle of recovery. Some treatment plans are simple or generic, suggesting attendance at 12-step meetings and perhaps some psychotherapy. Others are detailed and individualized, expecting that the individual will continue with most of the activities begun in the treatment center, including intensive individual psychotherapy, group therapy, acupuncture, exercise, proper nutrition, attendance at 12-step meetings and other activities. For many people, moving to a sober living situation is also suggested. It isn’t the number of activities that is important in the aftercare plan, but the creation of a quality plan that outlines activities that are designed to give the addict enough support and guidance to maintain recovery outside the safety of the treatment center.

5. More than anything else, support is key to an addict’s success outside a residential treatment setting. For some individuals, this support comes from family and friends. For others, they will find the support they need in 12-step meetings. Still others will find a team of professionals – psychotherapists, physicians, clergy, etc. – to guide them. Most will depend on a combination of these people. In all cases, addicts require people they can turn to in times of trouble. All addicts will experience troubling moments after treatment. That’s the nature of life. There will be times when situations arise that the addict does not know how to handle. A healthy support network can cocoon the addict and help keep him/her from harm, many times simply by being available to talk. When cravings or fears are put out in the open and discussed, they are much harder to act upon than when they are kept secret. 

Are All Rehabs the Same?

As you’ve noted by this point, all rehabs are not created equally. They have different guiding philosophies and different treatment protocols. They also vary with regard to expected length of stay and price. Further, some treatment centers will treat addicts punitively, by taking their phones and forcing them to do chores while others will focus entirely on recovery, not on domestic competence. 

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Constance Scharff has a PhD in Transformative Studies, specializing in addiction recovery. She is the Senior Addiction Research Fellow and Director of Addiction Research with a private treatment center and coauthor of the bestselling book, Ending Addiction for Good You can find Constance on Twitter and Linkedin.

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