Sharing Information Regarding Treatment
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Sharing Information Regarding Treatment
Effective Addiction Treatment - NYTimes.com
February 4, 2013, 2:17 pm
Effective Addiction Treatment
By JANE E. BRODY
Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.
But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you're not alone. And chances are, it's not your fault.
Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.
According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.
A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that "the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care." The report added, "Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works."
The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered "a form of medical malpractice."
The failings of many treatment programs - and the comprehensive therapies that have been scientifically validated but remain vastly underused - are described in an eye-opening new book, "Inside Rehab," by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed "Sober for Good."
"There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches," A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.
Ms. Fletcher's book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.
Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher's exhaustive exploration in the first place.
In an interview, Ms. Fletcher said she wanted to inform consumers "about science-based practices that should form the basis of addiction treatment" and explode some of the myths surrounding it.
One such myth is the belief that most addicts need to go to a rehab center.
"The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually," she wrote.
Contrary to the 30-day stint typical of inpatient rehab, "people with serious substance abuse disorders commonly require care for months or even years," she wrote. "The short-term fix mentality partially explains why so many people go back to their old habits."
Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, "You don't treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it."
Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr "to serve as a model to demonstrate what comprehensive 21st century treatment should look like."
"While some people are helped by one intensive round of treatment, the majority of addicts continue to need services," Dr. Willenbring said. He cited the case of a 43-year-old woman "who has been in and out of rehab 42 times" because she never got the full range of medical and support services she needed.
Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.
"We have some pretty good drugs to help people with addiction problems, but doctors don't know how to use them," he said. "The 12-step community doesn't want to use relapse-prevention medication because they view it as a crutch."
Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.
Check on the credentials of the program's personnel, who should have "at least a master's degree," Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.
Does the facility's approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don't choose it just because it's the best known approach.
Meet with the therapist who will treat you and ask what your treatment plan will be. "It should be more than movies, lectures or three-hour classes three times a week," Ms. Fletcher said. "You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all."
Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, "To be effective, treatment must address the individual's drug abuse and any associated medical, psychological, social, vocational, and legal problems."
Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.
Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, "Get Your Loved One Sober," with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.
This is the first of two articles on addiction treatment.
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February 4, 2013, 2:17 pm
Effective Addiction Treatment
By JANE E. BRODY
Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.
But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you're not alone. And chances are, it's not your fault.
Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.
According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.
A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that "the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care." The report added, "Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works."
The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered "a form of medical malpractice."
The failings of many treatment programs - and the comprehensive therapies that have been scientifically validated but remain vastly underused - are described in an eye-opening new book, "Inside Rehab," by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed "Sober for Good."
"There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches," A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.
Ms. Fletcher's book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.
Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher's exhaustive exploration in the first place.
In an interview, Ms. Fletcher said she wanted to inform consumers "about science-based practices that should form the basis of addiction treatment" and explode some of the myths surrounding it.
One such myth is the belief that most addicts need to go to a rehab center.
"The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually," she wrote.
Contrary to the 30-day stint typical of inpatient rehab, "people with serious substance abuse disorders commonly require care for months or even years," she wrote. "The short-term fix mentality partially explains why so many people go back to their old habits."
Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, "You don't treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it."
Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr "to serve as a model to demonstrate what comprehensive 21st century treatment should look like."
"While some people are helped by one intensive round of treatment, the majority of addicts continue to need services," Dr. Willenbring said. He cited the case of a 43-year-old woman "who has been in and out of rehab 42 times" because she never got the full range of medical and support services she needed.
Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.
"We have some pretty good drugs to help people with addiction problems, but doctors don't know how to use them," he said. "The 12-step community doesn't want to use relapse-prevention medication because they view it as a crutch."
Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.
Check on the credentials of the program's personnel, who should have "at least a master's degree," Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.
Does the facility's approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don't choose it just because it's the best known approach.
Meet with the therapist who will treat you and ask what your treatment plan will be. "It should be more than movies, lectures or three-hour classes three times a week," Ms. Fletcher said. "You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all."
Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, "To be effective, treatment must address the individual's drug abuse and any associated medical, psychological, social, vocational, and legal problems."
Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.
Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, "Get Your Loved One Sober," with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.
This is the first of two articles on addiction treatment.
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Thanks, L2L--somebody posted a link to that over at the Alcoholism forum, too.
I think there are instances where rehab can be particularly helpful for a particular person, but the vast majority of alcoholics don't NEED it for recovery. I had rehab in the back of my mind as "Plan B" in case I didn't stay sober after 90 meetings in 90 days--I was hoping to avoid having to take the time off from work. But I would have done it if I'd felt a more concentrated dose of recovery was needed.
I think there are instances where rehab can be particularly helpful for a particular person, but the vast majority of alcoholics don't NEED it for recovery. I had rehab in the back of my mind as "Plan B" in case I didn't stay sober after 90 meetings in 90 days--I was hoping to avoid having to take the time off from work. But I would have done it if I'd felt a more concentrated dose of recovery was needed.
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Location: Midwest USA
Posts: 2,284
Thank you for posting a great article. I know folks who have done 20+ treatments & still continue to drink & use. A traditional 28 in-patient program is like putting a band-aid on a bleeding out knife wound. I think addiction treatment needs to focus on the insanity of the alcoholic and drug addict. Alcoholism is a very complex brain disorder that usually will not respond to therapy type approaches alone.
To thine own self be true.
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Join Date: May 2009
Location: U.S.A.
Posts: 5,924
I was lucky. I saw and admitted my alcoholism relatively early, that is, at 29 years of age, and immediately stopped. I think that alcoholism (and especially the alcoholic/addictive thinking) is just like pretty much any other disease, injury, or illness: The longer it is let go, the worse it gets, and the more difficult it is to successfully treat it.
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Join Date: May 2012
Posts: 585
I'm both encouraged and discouraged by this article. My AH is in a 30 day inpatient rehab right now. He seems to be "getting it" but I am fearful of what happens when he comes home. He seems to be doing well and learning a lot. They are encouraging him to find a sponsor before he gets out. They're also encouraging him to find a psychologist who will do more than throw drugs at him. But I also hope they encourage him to take advantage of medications that are appropriate for him to handle his depression, anxiety, and maybe also his cravings. There are mixed messages out there for "alcoholism medications" - some swear by them, some say the A will find a way to drink even while on meds.
I had to laugh a little at the part of the article where it mentioned that movies & meetings a couple times a week doesn't a recovery program make...his last IOP was pretty much just that. Intensive in time, but not intensive in the program - counselor would often put on a movie & just pop in & check her phone, do paperwork, etc. Sometimes they'd play a game. Granted, he only went a few times, but this didn't seem like a very intensive program at all.
We discussed this lack of intensity with his current counselors at the rehab center, and they agreed it was not kosher...even though it was a separate location of the same company (I appreciate their honesty here). Seems that folks in his current location are a bit more dedicated and serious, and they assure him that the IOP at their location is actually intensive. So the plan is that he will likely return there for IOP & will attend AA meetings on the non-IOP days. At this point, he has just 9 more days before he comes home. I feel like it will be both the longest & shortest 9 days of my life! I'm fearful, but I'm also looking forward to having him home again. If nothing else, it definitely will be nice to not be the only dog walker in the house!
I had to laugh a little at the part of the article where it mentioned that movies & meetings a couple times a week doesn't a recovery program make...his last IOP was pretty much just that. Intensive in time, but not intensive in the program - counselor would often put on a movie & just pop in & check her phone, do paperwork, etc. Sometimes they'd play a game. Granted, he only went a few times, but this didn't seem like a very intensive program at all.
We discussed this lack of intensity with his current counselors at the rehab center, and they agreed it was not kosher...even though it was a separate location of the same company (I appreciate their honesty here). Seems that folks in his current location are a bit more dedicated and serious, and they assure him that the IOP at their location is actually intensive. So the plan is that he will likely return there for IOP & will attend AA meetings on the non-IOP days. At this point, he has just 9 more days before he comes home. I feel like it will be both the longest & shortest 9 days of my life! I'm fearful, but I'm also looking forward to having him home again. If nothing else, it definitely will be nice to not be the only dog walker in the house!
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Join Date: Jan 2013
Posts: 458
I am torn about my thoughts on inpatient vs outpatient recovery. I watched EXAG do 30 days in a lockdown facility 13 years ago. Librium detox (scary), etc... Did the 90 meetings in 90 days, etc. Relapsed within 3 months. Was in and out for a year or two, then managed a few years of solid sobriety. Then started drinking again (not constantly) in 2007. Early in 2012 she did 40 days inpatient at a women's facility. Then 90 days in halfway house. She relapsed hard about 4 months out, resulting in a full downward spiral.
As her therapist told her, the inpatient and halfway house seemed to be easy for her, because she was under constant supervision (urine tests, etc). It is when she gets out that the problems arise.
She is now in an IOP program. It is both men and women, and from what she told me is pretty intense. 3 nights per week, 3 hours per night, and urine tested. I believe it is for 18 weeks. The other nights are AA. And she also has her own therapist she meets with during the week. Perhaps this time will take hold and help keep her sober.
Something I also heard is that when alcoholics relapse after treatment, look out... They generally relapse hard. For my EXAG this has been proven to be true. Others experiences may be different.
As her therapist told her, the inpatient and halfway house seemed to be easy for her, because she was under constant supervision (urine tests, etc). It is when she gets out that the problems arise.
She is now in an IOP program. It is both men and women, and from what she told me is pretty intense. 3 nights per week, 3 hours per night, and urine tested. I believe it is for 18 weeks. The other nights are AA. And she also has her own therapist she meets with during the week. Perhaps this time will take hold and help keep her sober.
Something I also heard is that when alcoholics relapse after treatment, look out... They generally relapse hard. For my EXAG this has been proven to be true. Others experiences may be different.
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