For a long time, I’ve been fascinated with how people who have substance abuse problems achieve sobriety. Having written a series of books about people who lost weight and kept it off (the Thin for Life books), I realized that obesity and addiction have common attributes. They both deal with compulsive behavior – and to get to a healthier place, the affected person needs to give up or cut back on substances that are extremely difficult to sacrifice. Both problems stem from physiological, genetic, and environmental causes.
About 12 years ago, as I was writing Sober for Good: New Solutions for Drinking Problems – Advice From Those Who Have Succeeded (Houghton/Harcourt, 2001) – my book about success strategies of people who’d achieved long-term sobriety – I approached Dr. A. Thomas McLellan, CEO of the renowned Treatment Research Institute in Philadelphia for information about addiction treatment programs.
Around that time, Dr. McLellan was working on a study of representative addiction treatment programs across the U.S., suggesting that there were serious problems in our system. For instance,he found that most were staffed by under qualified administrators, and many were exceedingly short on medical personnel and mental health professionals. According to Dr. McLellan, this was a pilot study meant to launch a much larger national study of the U.S. addiction treatment infrastructure. However, John Walters, who was director of the Office of National Drug Control Policy when this research was done, pulled the plug on funding because he was worried that the findings would be seen as an embarrassment to the agency and to the Bush administration. His findings planted the seeds for my new book, Inside Rehab: the Surprising Truth About Addiction Treatment – And How to Get the Help That Works.
About five years ago, spurred by the many stories of celebrities yo-yoing in and out of rehab and recognizing that the public was greatly uninformed about addiction treatment in general, I decided to proceed with studying the addiction treatment industry on my own (with some input from Dr. McLellan and many other experts along the way.) Part of my research involved going inside fifteen of the very places that provide treatment.
Did the facilities and clients know who I was and why I was there?
I was up-front with them about my mission and was quite frankly surprised at the number of programs that opened their doors to me, allowing me to observe client treatment in most cases. I think it helped, particularly with clients’ comfort level with my presence, that at the beginning of my experience at each rehab, I was clear about my purpose, letting them know that I personally had struggled with a drinking problem and promising that I would protect their anonymity. Because of my candor, I think the clients were “themselves” in treatment – that is, I think that in most cases, I got to observe treatment as it would have been had I not been there. Unless I was asked to take part, which did happen occasionally, I tried to remain a “fly on the wall.”
Did I consider going undercover and, if I had, would this have been a different book?
For a very short period of time, I considered going undercover, but I decided that since my style is one of forthrightness, it wouldn’t be fair to the clients to have an undercover writer in their midst. This is a book that involved earning a lot of trust from the many people who shared deeply personal information, as well as from the experts who let their hair down with me, and I didn’t want to violate that. I think the book provides an accurate portrayal because of this. Some might wonder if the stories are honest portrayals, but I heard many of the same accounts over and over. It’s a myth that “all addicts are liars.” I cite research showing that when people believe what they are telling you will be confidential—particularly that it will not incur adverse consequences—and they’re asked in a clinical or research context, then what they say tends to be reliable and valid.
What did I discover to be the top malady of rehab programs in America today?
Overall, I’d say the greatest problem is that traditional rehabs lack the state-of-the-art programming, adequate staffing, and professionals with the appropriate training to be dealing with what’s one of the toughest medical issues there is, addiction. As one expert I interviewed stated, “In few other fields do we place some of the most difficult and complicated patients in the health-care system with some of the least-trained folks among us.” Most experts I interviewed agreed that the minimum degree for an addiction counselor should be a master’s degree, as it is for other mental health professions. A team approach is ideal at a rehab – with qualified addiction counselors, as well as physicians and mental health professionals who have expertise with addictions. Unfortunately, many states don’t even require a bachelor’s degree to become a certified or licensed addiction counselor.
What were some of the positive things I found?
It’s interesting that people who went to the same addiction program at around the same time can have completely different experiences. And I was upfront with personnel at rehabs I visited that that would happen – that is, I said that I’d no doubt come across individuals who loved their program and others who had negative experiences. But what I found universally were staff members who genuinely cared about their clients – they were filled with compassion, caring, and good intent. As the book was drawing to a close, I also began to see signs that programs were moving in a positive direction. For instance, some were showing signs of using more science-based psychological and medical approaches.
What are some of your experiences with our addiction treatment system? What do you see as its strengths and weaknesses?
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Copyright Anne M. Fletcher