What’s the right kind of rehabilitation, after addiction?

    The concept of “rehab” tends to make us think of a place where drug addicts go away for weeks or months at a time to recover. However, residential inpatient treatment is only a small subset of addiction treatment.

     “The vast majority of people who are treated [for substance use disorder] in this country are treated in outpatient programs,” explained Anne Fletcher, author of “Inside Rehab: The Surprising Truth About Addiction Treatment–and How to Get Help That Works.”

    “Very few people actually end up going away to rehab,” she said. 

    Treatment of substance abuse disorder is, however, quite different from that of other medical and mental health conditions.

    “It’s totally separate from the whole rest of the healthcare system,” said Fletcher.

    Because addiction was not always considered to be a health issue, its treatment “kind of developed in a vacuum… it’s not treated in the same way,” she explained.

    First, many evidence-based approaches are not used consistently. Fletcher gives the example of the effective medications that are underutilized.

    “[Treatment centers] often don’t see people as being in true recovery if they’re on medications like suboxone or methadone, which we know lower recidivism, or relapse, rates. We know that they lower infection rates and even death rates. They are one of the most highly effective treatments for addiction that we have.”

    Another difference is in the training required to become a provider of addiction treatment.

    “They’re, in general, very poorly trained. They are in many states not required to have a Bachelor’s degree,” Fletcher says. “For no other mental health disorder would we allow it to be treated by anybody with less than a Master’s degree.”

    Fletcher grants that this doesn’t mean there aren’t many excellent drug addiction counselors, but she argues the standards are not high enough.

    “We have pretty much unqualified treatments being provided by unqualified people,” she said. 

    When deciding on a course of treatment for addiction, Fletcher recommended to ask providers about their staff’s qualification and training. She also suggested to ask for outcome research (which most facilities will not have) and to ask if a treatment provider offers a variety of approaches that is tailored to each individual.

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