What Is Working in Addiction Treatment: Part 1
When I interviewed more than 100 people who had been to addiction rehab, asking how they chose their place of treatment, I found that many didn’t go about it very thoughtfully. It’s often a decision made in panic mode. We turn to friends and family members – or often just go by a facility’s “reputation” when, in fact, these are not necessarily the best ways to find good treatment.
Often, cost is a factor, but there’s not a correlation between quality treatment and how much you spend. (There are great programs and not-so-good ones at both ends of the cost spectrum.) A number of people said they turned to professionals for advice, but the truth is that, unless they’ve received special training, physicians and mental health professionals often have little expertise with addiction and often don’t know what’s best.
The most common way people told me they found their way to a rehab was to use the Web. However, one woman captured this method’s results well with, “Unfortunately I don’t think you can get an ‘authentic’ idea of a place from the Internet because they make themselves look better [than they are], like an advertisement for a Big Mac.”
The Right Questions to Ask Your Rehab
- Certain science-based therapies such as “cognitive-behavioral therapy” (teaches skills for coping more effectively with triggers for using drugs and alcohol) and “motivational interviewing” (applies counseling techniques that help people resolve their ambivalence about quitting drugs or alcohol) have been shown to increase the odds of success. The problem is that most rehabs say they provide such science-based approaches for addiction, but research conducted by experts who study what goes on in treatment programs show that things often aren’t done according to the proper protocol. In short, there’s a big gap between what science shows to be effective addiction treatment and what goes on in many facilities. Still, it’s important to find out whether these approaches are used and if staff is trained in them, even though they may not be used the ideal way.
- Having a counselor you connect with is probably at least as important as having one who’s trained in the latest skills. A number of studies show that clients with addictions do better with counselors whose style is empathic, accepting, flexible, and open than with those whose style is less that way. Thus, it’s important to ask, “Who will be my primary care giver be in rehab?” and “Can I change if we don’t connect?” At most addiction treatment facilities, the primary caregiver is an addiction counselor, and it’s also important to ask what their education and training is. Although most experts I consulted felt the minimum degree should be a master’s degree, many states don’t even require a minimum of a bachelor’s degree to become licensed or certified as a drug and alcohol counselor. Standards for becoming a credentialed addiction counselor vary state-by-state. To determine them for your state, you can contact your state substance abuse agency, found at samhsa.gov.
- Choice and flexibility matter because clients are more motivated and engaged when they have a say in what their goals are and what goes on in treatment – not when they’re told what to do. Confrontational, “we-know-what-works” approaches are “out,” and meeting clients more “where they’re at” is “in” when it comes to effective treatment. It’s important to know that most U.S. rehabs involve the 12 steps of Alcoholics Anonymous in some way, and studies do show that people who get involved in such support groups are more likely to remain abstinent. However, many people don’t connect with AA’s philosophy, most drop out with time, and it’s well documented that there are many different routes to recovery. So up-front, ask, “What if what we’re doing doesn’t seem to be working?” If you want something other than the 12 steps, ask about that, too. And find out if you can get at least part of your money back if you decide to leave rehab early.
Anne M. Fletcher, M.S., R.D. is the author of Inside Rehab: The Surprising Truth About Addiction Treatment – And How to Get Help that Works (Viking/Penguin).