Inside Rehab

Practical information about addiction treatment and recovery

Going Inside Addiction Rehab

An author describes what motivated her to go inside the addiction rehab system and how she was received Read More

Thank you for writing this!

I am constantly amazed at how the failures of the treatment industry seem to fly under the radar. I have floated around the idea for a site or database similar to the "Angie's List" approach to consumer ratings of rehabs, since getting true statistics or even real information is next to impossible when searching for one to go to. Though I no longer have then need, I saw so many failures myself (and even more once I started researching them myself) that I feel the more coverage this subject gets, the better.

I had similar issues to what you discuss here, as well as what is highlighted in the review of your book at New Republic. Not enough trained staff, especially medical, as well as an over-reliance on the disease theory of addiction that led to complete dismissal of factors that played into people becoming addicted in the first place. I was in treatment with several women (though I was there for prescription opiates following an injury) who had started drinking after tragic family deaths, though had never drank much until those events, which happened mostly in their 50s. Explanations such as "the switch in your brain was turned on" just wasn't adequate for me, nor was the lack of grief and trauma counseling for these and other patients.

I had researched many facilities before just giving up and going to a local one, but found an overwhelming strain of counselors I got on the phone telling me I needed a "boot camp", and that as "an addict" I had obviously been babied too much and needed a facility that would get me to grow up. Not only that, but an obsessive reliance on the 12 steps, which though fine for some people, were not for me nor did they address some of the medical issues I was having (seizures were put down as "attention seeking", rather than what they were, seizures(!) and I was accused of using while there due to being "out of it" until I finally passed out, at which point the nurses realized that the blood pressure medication they had given me for withdrawal symptoms had dropped my BP to 70/30.) Yet there were no centers I could find outside of my area that seemed to treat patients differently, at least not from interviewing over the phone.

This was bad, but the worst part for me was being asked to participate in what I found to be emotionally abusive bullying of fellow patients. We had not only group haranguing in group sessions, but "hot seat", in which patients were placed at the front of the room while read anonymously submitted criticisms of their "character defects". That's bad enough for someone who is not emotionally vulnerable, but for vulnerable people unstable due to withdrawals, and with possible histories of abuse, it's unconscionable. It was bad enough for some patients that they withdrew completely, and a few committed suicide. For the rehab, this was naturally "the disease" being too strong to have been defeated and nothing to do with 30 days of emotional abuse, not to mention spiritual abuse. Surely the two hours of billable sessions we spent watching a bio-pic of Bill W. could've been better spent on actual therapy!

In short, it wasn't treatment (especially considering the insurance payments) as would have been seen for any other medical condition, and relied almost completely on a model of faith healing. Those amenable to the 12 step model were praised, those who weren't looking for a "spiritual awakening" but simply tools and treatments to get and stay clean and sober were subjected to abusive tactics such as having to wear signs around their necks and carry around items illustrating their "character defects". When I complained at one point that the myoclonic seizures I was suffering were likely causing brain damage (and were brain damage), I was told by a counselor whose main credential was having gone into "recovery" herself that "it was better to suffer brain damage to get clean than to suffer it from continued use"!

Studies of these centers is long overdue, as is regulation of some sort. No one deserves the dehumanizing nonsense I observed, nor that I have read about and heard from others since my own experience. They, like me, got clean despite this treatment, not because of it. I long to see more work done to publicize the failures of this system, and your writing will help shine a light on a huge problem for those trying to find their way out of substance abuse.

Apologies for the length, this is a very important subject to me.

I am so sorry that happened to you

Treatment for addiction is not based on science at all, it has been traditionally based on the 12 steps and the false idea that Bil Wilson (a co-founder of AA) had that all alcoholics were egomaniacs and needed their egos crushed. Combine that with power-tripping steppers who were hired because they've been sober a couple of years and will work for much less than someone with the actual education to do the job and you get abuse, nothing more.

I recall being told in treatment that they didn't think I really wanted to recover because I did not want to eat a low cholesterol diet, as I was instructed to do. And my treatment center treated us golden compared to what you described.

The bottom line is that people who suffer from addictions are easily cast into the trash, we are looked down on (in no small part to the descriptions of addicts that come from 12 step philosophy). Science is being done, from what I read, but science costs money to implement; not to mention the inevitable push-back from the 12 step adherents who dominate the field. For a lot of folks working in treatment being asked to try a different mode of treatment than 12 step would be like telling them their religion was wrong. We need to separate medical care from devotion to faith in order to ever show advancement in treating addiction.

Well, thank you mini vans.

In the beginning, and in fact in the end, the facts of Bill Wilson's life mean little to me. My goal was to get help, and I couldn't find that without intrusion of this model as you write of it.

I agree with the subtitle of the piece here, that consumers do have the right to know about this industry. The abuses that are frequently considered relics of the past are still going on, and you're quite right, many simply don't care about how people are treated if they get themselves into the condition that requires some form of treatment. As businesses, however, people have a right to know what kind of services they are to be getting as well as a means to complain. Since many rehabs are run as "non-medical facilities", many state boards of health will not take a complaint or even an interest in the problems that persist in their treatment of patients/clients.

I'm sorry you were treated as you were as well. I've heard that many times, that any dissent regarding any rule, however unrelated to getting off of substances, is followed by the accusation that you "don't really want to recover".

I can tell you, despite the harrowing description I wrote above, that I am extremely healthy and well now, and do very well with no medications whatsoever. It's important to not be defined by a bad experience with addiction, or an equally bad or worse one in treatment. To not talk about it, however, is to allow it to continue unchecked. Which is why I'm glad that Ms. Fletcher is writing about the subject and that there are so many reviews (and quite favorable) about it currently on the web!

Abuse in rehabs

Thanks so much for your account, Persephone. It is absolutely shocking and horrific that those seeking help with addictions should be treated like this. How is this supposed to “help” or motivate anyone to try to improve their lives in any way?

Just imagine if anyone seeking help for quitting smoking was subjected to such sickening abuse simply because they are making an effort to quit. Those who seek help for any other addiction are no different.

It’s high time that what goes in rehabs underwent some serious, objective, external scrutiny, and that anyone entering a rehab should be given a clear idea as to what this so-called “treatment” will consist of before they consent to being admitted. As it stands, it seems that rehabs are allowed to get away with outrageous bullying and abuse, misrepresent themselves in their advertising , deny informed prior consent, and are allowed to continue ‘under the radar’ without a murmur from any public, medical, or governmental body.

I hope that Anne’s book, and the courageous testimony of people like you, will start to raise public awareness of this scandal that has so far been allowed to go unchecked.

Abuse in Rehab

Right on Stacy. These abuses have gone on for as long as they have because there are lots of hands in the cookie jar. Billions of dollars are at stake ... snake oil salesmen along with the US court system have been raking it in for far too long.

You're comparison to nicotine addiction is one Stanton Peele uses often and it is powerful and fair ... and it's difficult for AA disciples to dispute it.

I'm enjoying Anne's book so far.

Stacy, thank you, and you're welcome.

I only enumerate it time and again to remind people of the horrors that many still face in many of the treatment centers in the U.S. I simply wanted to be taken care of medically while I faced withdrawals, and had no intention of using again (nor have I). I wanted some honest counseling from professionals, not to be told of these counselors' personal struggles with how they "came to the program" and "hit bottom". I didn't need to spend 30 days, after knowing I never wanted to use again, being told that I MUST accept a higher power, surrender my will, and participate in abusive attacks (encouraged by staff) on other patients/clients. We were paying them, we deserved decent service, not demeaning tactics, forced Christian prayer and substandard nursing/medical attention.

My insurance company, in short, wasn't paying $30,000 (many were paying cash or on credit, some still paying off that bill) for me to either watch or be chastised for refusing to attack the character of my fellow patients, nor to be billed for two hours of treatment to watch a Hallmark biopic about Bill Wilson when we could have been getting counseling, many of us needing grief counseling, not to mention counseling for other issues. One patient I was accused of "enabling", and therefore not allowed to attend his "hot seat" session, killed himself a month after being released, having been broken by the emotional abuse, and he went in there strong enough to have quit heroin and alcohol on his own. That he was beaten down and turned from a bright, young man with a future into a broken man with no hope (nor treatment for the horrible post acute withdrawal syndrome he was facing) is one reason I will continue to speak out on this issue.

It wasn't what they did to me, I'm strong enough to deal with that, it was what they to others, encouraging me and others to participate in, that I cannot stand. This was 2010 that this all happened, but I have called numerous times, and every single center in this entire chain of rehabs is still doing this to this day. In other words, several people THIS VERY DAY are sitting in the "hot seat" and having their "character defects" read out to them and then elaborated on by other patients. Usually these are personal gripes, and very cruel. And it is happening today, as it will tomorrow and the next day, and these patients will be made to wear signs or carry objects for their next week of treatment to illustrate and remind them of their "defects". THAT is why I write, because this is not something that happened in the past, it is happening this very day to other people.

This is why I'm so grateful that Anne Fletcher has written a book and opened up a discussion about this industry, I only hope that my copy is in today's mail. But I thank her yet again for doing this work and bringing it to the attention of the public.

Thank you.

Stacy, it doesn't help them at all.

Many go to rehab under threat of divorce, or being kicked out of the house by their parents, or other conditions on their lives that are stressful and depend on their success in getting clean and sober. They know they made mistakes, they know they're not at the top of their game. What they need is encouragement and hope, not the outdated hypotheses of Dr. Harry Tiebout about the "alcoholic/addict personality" or to be told that they are "self-centered to the extreme" and that they have to stop "playing God in their lives" (but to surrender to a "God" they may or may not believe in). Many are beaten and broken, and need hope, not speeches about how the rest of their lives will be filled with little more than a constant struggle and endless meetings.

I agree with you completely. There needs to be regulation and overhaul, standards that must be met, and more ability for past patients to be heard. Most centers (I have called dozens and dozens in my own unofficial research) will not even give a success rate, nor are there statistics available to potential patients/clients as to relapse rates (or suicide rates, for that matter), success rates, or even specific information as to the credentials of the staff or how the treatment itself will be conducted.

In any other business, and these are businesses (despite the non-profit status of many), consumers have rights and information must be public or the business is subject to penalties under the law. Consumers in this case have the right to know what they're getting, and the right to complain to and have the center held accountable when they are given poor service. Many of these centers ARE charities, as Ms. Fletcher points out, according to the reviews I've read, but many charge quite a bit of money, though I don't know the statistics on this particular.

Apologies for hogging the comments section a bit here, I just feel (obviously) very strongly about this subject.

Not hogging!

Goddess Persephone - you are not hogging anything. What you have to share is important. Very important.

I was in 16 rehabs, and they

I was in 16 rehabs, and they were all based on the 12 step model of Alcoholics Anonymous. The AA program taught me that I was a morally reprehensible person who was loaded with what they call "character defects." They never taught me any reliable skills to stop drinking.

I was finally able to quit drinking when I left AA, abandoned AA's idea that I was powerless to control my own behavior, and sought help through programs like SMART Recovery and a prescription drug called naltrexone.

Most rehabs are just AA indoctrination centers. AA is a religious cult dressed up to look like a treatment for alcoholism. AA takes advantage of vulnerable people for the purpose of unsolicited religious indoctrination.

Naltrexone

Gunthar - you are not truly sober if you are on meds like naltrexone, or psychotropics, or even NyQuil.

NOT.

It is perhaps most symptomatic of the

sick level that the dogma and systems that are in place in terms of substance abuse that someone would even sink to leaving an anonymous comment lashing out at someone for the method by which they got sober. Or to make such a judgment at all. I hope I never have to read another comment like the one I'm responding to now.

I laughed ...

Hold on though. I saw that before you responded and laughed. I think they were joking cuz it says NOT.

I think the "NOT" was an added emphatic statement,

not the outdated sarcastic usage of "NOT", but perhaps I am wrong. That's just how I took it, but personal attacks have been running a bit rampant on substance abuse threads lately. We'll let "anonymous" come back to let us know which is the case, if they choose to do so.

JOKE

Sarcastic joke. I understand, how some AA people can be with the attacks, makes you on edge.
Sorry for the confusion. People in AA are NOT good in the head. Take your meds like a doctor says, not the AA medicine doc who will only make you want to die.

;)

Thanks.

Really????

I will reserve a more complete response for when I actually read this book, which I will have to do now due to all the misinformed responses this book is triggering. BUT, using 15 programs as representative of the 20,000+ in the US. Really? Doesn't that stretch the limits of anecdotal?

How the research was done

I'd be delighted to have your feedback on Inside Rehab. If you read my first blog, you'll see a brief description of how I did the research for the book, as follows:
My new book, Inside Rehab, is the first one for which I’ve broken away from my model of studying “success stories” because, in interviewing more than 100 people who had recent experience with the addiction treatment system, many were still in the throes of addiction. My “subjects” were also the rehabs themselves – I studied the addiction treatment system in general and personally visited 15 treatment programs all across the country, from celebrity rehabs to outpatient facilities that treat indigent people. And as always, I looked at the scientific research and interviewed experts in the field – more than 100 rehab staff members and leading researchers who study treatment. Some of the stories were heart-breaking while others were uplifting. In the end, I think we have a lot to learn from people who have “been there”.

Far more details about the research and my citations of the scientific literature are in the book. I never meant to imply that they were a representative sample of all treatment programs in the country, just a variety of different types of programs were visited.

Objecting

Thank you for this most important work. Thank you also for this reply to the attempt to discredit your work. As you obviously know, you are sure to receive dissent from many of those who have been convinced that they can only survive with the spiritual awakening provided by their beloved steps. It is complete rubbish this belief that addiction is somehow cured by a higher power and labeling oneself powerless and diseased and morally defective. The indoctrination of ego deflation is so powerful that some of these people will defend this programme until their dying day, and they will only look for ways to discredit those who reveal the truth. You will most definitely be attacked for this great work. Stay strong. There are many of us who are extremely grateful to you for researching and writing this book.

For those of us who have been working on exposing the truth for years, your findings are not in the least bit surprising. Whenever I speak with someone with little exposure to the steps, they are fascinated to know that members are required to label themselves insane and believe that only by turning your will and life over to a higher power can you stay sober. They are fascinated to know that 12 step programs tell members that they can never leave the group if they want to stay sober. They will tell you that if you leave you will end up in three (and only three) places: Jail - Institution - Death. There is so much more like this it is mind boggling.

Thank you Anne. Keep up the great work.

Dr. John Gardin, not to downplay

the significance of Fletcher's research, there have been more comprehensive studies in terms of researching addiction treatment as it presently stands, and I don't believe the intention of her book was to serve as one of them.

Apologies for stepping in, Ms. Fletcher, as your explanation was sufficient in of itself. I was just baffled by the reference to "misinformed responses" in this comment. I doubt there is much variance in the 20,000+ programs you refer to, especially as many are owned by the same parent companies and are chains, if you take the time to look at how they are operated and owned. Even without shared ownership, is there much variance in the treatment offered, and can anyone really determine that without having spoken to the people who have been treated by these centers and the employees who staff them themselves?

And again, which responses do you deem "misinformed", as there have been quite a few responses and reviews written already? I'm just curious at which you are referring to.

Re; Really?

I look forward with great interest to your informed and objective research into the state of rehab, John. I would be especially interested in your investigation into those of the 20,000+ rehabs that don't use the 12 step modality. (15 will do, for the purposes of comparison.)

Yep really

I look forward to John's study too Stacy. Ms. Fletcher has got to know that she is going to get the 'we have the one way that works' mantra from 12 step disciples. I doubt that it bothers her personally. You're absolutely right, her sample and research methods are sound.

I'm still at the beginning of the book, but she explains exactly how, when, where and why she researched the way she did and how she came to her empirical findings. The book is hard to put down when it gets to the stories she recorded.

New Republic Review Indoctrination

The 5th paragraph of her review is an example of those who have been indoctrinated into this programme.

"To be sure, that folk wisdom has benefitted millions, including myself. Striving for honesty, communing with people who don’t judge, admitting when you’re wrong, working on the content of your character, learning humility, being of service to others—these are deeply valuable principles, ones this alcoholic needed to find after years of boozy nonchalance. In fact, the steps could be beneficial to anyone."

No, this is most certainly NOT sure. She is so accustomed to speaking of herself in negative terms (disguised as honesty), that she must call her drinking years 'boozy nonchalance.' She is so used to giving this programme all credit for saving her life that she must write an untruth such as 'the wisdom has benefitted millions.' Everything else in this paragraph is nonsense. You most certainly are judged by those who listen to you since you are labeling yourself diseased and morally reprehensible. If you confess that you are struggling, you will only get platitudes like, 'keep coming back, it works if you work it.' If that isn't blaming the victim, I don't know what is. You can't be honest. Humility is turning your life over to the dogma of the group. Your character is not defective and you are not morally defective.

Besides the obvious personal intrusion of this paragraph, the rest of it is nicely written.

Just resubscribing

Don't mind me....hit the wrong link.

Interesting comments, counselorchick, while I'm here.

My book was delivered an hour or so ago,

and I'm enjoying it so much already. Aside from a quote in the introduction I found somewhat jarring:

"Most scientists agree that the genetic, brain, and behavioral changes associated with addiction to not appear to be completely reversible--like other chronic illnesses, most cases of severe addiction can be managed, but not cured, with continuing care." (....)
-A. Thomas McLellan, PhD, CEO and Cofounder, Treatment Research Institute, Philadelphia.

I have been about ready to jump up and cheer! Ms. Fletcher, so far I have already read echos of the very sentiments I have been writing for over two years now to anyone who would listen. From the section about the insulting "joke" of "Q: How do you know when an addict is lying?" A: "When his lips are moving", which I also find insulting, to the myths being listed (which I also have found to be myths, especially the revolving door/ if it failed the first time, it's because they "didn't get" the program, etc.). Not to mention me just having to skip to the pages about your thoughts on disease theory, and seeing the "life sentence" aspect I have so long detested, finding it utterly dangerous to label people for life as being forever out of control of their own ability to control themselves. I was glad to see that you mention the problem of "the label" (p. 11) almost right off the bat.

Not to mention the fact that more expensive treatment doesn't equal a trip to the spa, which is why I eventually ended up at the horrific place I ended up at--after learning that where my family was attempting to send me, a rather famous, illustrious and expensive rehab, offered no better (well, I assume it would've been less confrontational perhaps and employing more credentialed staff) program than what was to be had locally. A focus on my "disease" and more of those darned steps.

This is, so far, very excellent and I must get back to it, but had to stop by with a glowing review of the first chapter.

Does anything work?

First, as a long-term AA member, who did get sober by going to an inpatient rehab, I would say that this book is very much needed. AA just really cannot work for everyone, and it is absurd to claim it can, and leave millions of addicts to suffer and die because they "didn't want it bad enough." Rehabs (and I went through a few, in three different states, over about 15 years, before I got sober) rarely do anything useful, except give the addict a few weeks to get his or her head clear and a (slim) chance of making better decisions. I'll stick with AA myself, because it does work for me, but let's be honest: AA just isn't for everyone, and the "educational" lectures and emotional brow-beating that they call therapy in rehabs is far from helpful for most people.

I do have question, though, about the claim in the book that there are some therapies that are proven to be effective. I know this book isn't meant as "research" in the scientific sense, but intended to raise awareness and open up honest discussion. Still, this claim bothers me. I would desperately like there to be SOME kind of therapy that really works, but I have studied the research regularly, hunting through the journals for any study meeting APA guidelines for "empirically validated" methods which has been successful with alcoholism or addiction. I have yet to find even a single study that demonstrates success with the approaches listed in this book. Some demonstrate a decrease in self-reported use, but no change in actual use according to blood tests. Others indicate an increased tendency to claim to want to stop, or to be considering stopping, but no actual decrease in use. The best results only seem to indicate a decrease in "problems related to use' while participating in the study. So, my question is, can anyone point out any scientific study of something that really does work? I would love to be able to suggest something to those for whom AA doesn't work, without lying to them.

If there is no evidence at all that any of the methods mentioned in the book as effective really do work (CBT, MET, etc.), then why not just openly say this, and demand that the industry stop relying on the same old useless approaches and start trying to investigate new ones? I know this is a whole different book, but it might be worth considering why there is almost no research being done anymore on therapy for addicts and alcoholics--all the research in the field is devoted to the use of medications, and so far, the success is very limited.

All in all, good book, and I hope anyone who knows an addict will read it before jumping to the assumption that she needs rehab and AA. But is there any real evidence that there is anywhere else to turn?

THoughtful response

Thanks for the thought-provoking response and questions, Tom. I think if you read the chapter, "GETTING THE BEST FOR YOUR BUCK", you'll see a thoughtful discussion of the approaches you mention and issues you raise. You're making a lot of generalizations that are beyond the scope of discussion here. There's a section in that chapter, "Does Science Matter" that examines the bottom line on this issue that you might find helpful. Certainly, when CBT, motivational interviewing, and 12-step facilitation are compared in research studies, they're shown to be equally effective. A problem is not only that 12-step approaches predominate, but that none of the approaches tend to be practiced as developed and intended according to research protocol. Nor is adequate clinical supervision provided to assure that such happens. Another issue is "treatment matching" - that is, in real life, what works best for one person isn't best for another and that's where good clinical training and skill enter in.I would also suggest that people interested in this topic check out SAMSHA's National Registry of Evidence-based Programs and Practices (http://www.nrepp.samhsa.gov/), which admittedly has some flaws but does look at research protocols and outcomes for various treatment approaches for substance use disorders.

THoughtful response-Does Science Matter?

Thanks for the thought-provoking response and questions, Tom. I think if you read the chapter, "GETTING THE BEST FOR YOUR BUCK", you'll see a thoughtful discussion of the approaches you mention and issues you raise. You're making a lot of generalizations that are beyond the scope of discussion here. There's a section in that chapter, "Does Science Matter" that examines the bottom line on this issue that you might find helpful. Certainly, when CBT, motivational interviewing, and 12-step facilitation are compared in research studies, they're shown to be equally effective. A problem is not only that 12-step approaches predominate, but that none of the approaches tend to be practiced as developed and intended according to research protocol. Nor is adequate clinical supervision provided to assure that such happens. Another issue is "treatment matching" - that is, in real life, what works best for one person isn't best for another and that's where good clinical training and skill enter in.I would also suggest that people interested in this topic check out SAMSHA's National Registry of Evidence-based Programs and Practices (http://www.nrepp.samhsa.gov/), which admittedly has some flaws but does look at research protocols and outcomes for various treatment approaches for substance use disorders.

Lack of Evidence

Yes, I did read the chapter, and that was my concern. To suggest that the approaches listed there have been proven effective is troubling. There has never been a single study demonstrating that any of them are effective. There are many, as you mention, which prove that they are no worse than some other approach that also doesn't work--that CBT works as well as "treatment as usual," or is not significantly different from being on a waiting list, etc. There are many that show some self-reported decrease of drinking or drug use during the course of the study. But I have never been able to find a single study that prove any kind of treatment can actually help anyone recover from addiction at a rate better than no treatment at all. I am familiar with the websites you mention, and the lists of "proven treatments" that appear on them. The problem is, these treatments have been studied, but none have been proven effective--there is a difference.

When we suggest to people that there are abundant effective treatments out there, then we place the blame back on the addicts: if you aren't sober, you just didn't try enough approaches to find the one that works for you. If we could just admit that none of them work, perhaps we could encourage somebody to try to develop a better approach. Claiming, simply asserting, that there are effective treatments when there aren't, lets the whole addiction industry off the hook.

I know I am making "a lot of generalizations" here--and it would take only ONE study, ONE specific example to prove me completely wrong. I am, quite honestly, looking for that one example, that one study of any one approach that has ever actually gotten people better. This has nothing to do with "following research protocols" in actual treatment--research protocol is almost always impossible to follow, with criteria for participation in a study that apply to almost no presenting clients (eg, addicted to only one substance, no comorbidity, stable home life, etc.). These things are symptoms of the "disease", and if a treatment can only be done with someone who has none of the symptoms of the disease, who needs it? And I know this is "not the place" for a serious discussion of these issues. However, when it comes to addiction, no place ever is, right?

If anyone can point out one successful study, I will be very happy--finally, a place to begin!

But thanks for this book. I wouldn't expect it to answer every question or solve every problem. It is important to raise awareness that rehabs and AA aren't miracle cures, so people can stop taking the easy way out and blaming the addicts for their problems. Would we tell a suicidal teen to come back when she wants to live? Or a depressed man that he can't get treatment until he cheers up? But we always tell addicts they don't "want it bad enough."

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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.

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