The rehabilitation industry in our country is, unfortunately, filled with false claims and bogus treatments. When I investigated the success rates of rehabilitation programs for my book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, I found that virtually none of them even study their patients' outcomes, despite claiming fabulous results. And, sadly, rehab treatment usually fails. Research has shown that the majority of alcoholics resume drinking within the first year after rehab, and a substantial percent of these people are drinking regularly every week. Too many people who have been through these expensive and ineffective programs end up with a sense of despair, and even a sense of personal failure. To avoid this, it's first necessary to know the inadequate ways rehab centers treat addiction.

Rehabilitation facilities are allowed to staff themselves any way they like. As a result, most of them are staffed by counselors with negligible training which would not qualify them to be therapists in a more professional setting. Hazelden Treatment Center, for instance, advertises that people can become addiction counselors in just a year, while training to be a social worker, psychologist or psychiatrist requires from three to eight years followed by more years of practical experience before being licensed. And even though most rehabs are saving the cost of hiring well-qualified therapists, many of them charge from $30,000 to $90,000/month.

How do these rehabs justify such exorbitant charges, if it's not by providing highly trained treatment staff? The answer is that they offer, and heavily advertise, expensive "extras" which lead people to think they are getting something special. But these non-therapy extras have nothing to do with treating addiction. Here are some examples: equine therapy (spending time with a horse), "ocean therapy" (taking a ride on a yacht), fitness training, aquatic aerobics, work assignments, leisure skills group, and even more strange approaches (Sierra Tucson offers “qigong therapy” which it describes as an ancient form of Tai Chi, and claims that its benefits include “enhanced immune system,” “increased energy and vitality,” “improved intuition and creativity,” etc.; there is no scientific basis for these claims). In our book , we published the complete daily schedules from the Betty Ford Center and Hazelden which list many of these irrelevant and unproven "treatments."

The most famous and expensive rehabs also compete with each other to offer beautiful settings with spacious rooms and gourmet cuisine, all of which add to your cost, and none of which is relevant to treating addiction. If living for a month with a view of the mountains or the beach treated addiction, there would be no addiction in lovely areas of the country.

All of these programs also de-emphasize individual sessions. Instead, they offer multiple groups. Group therapy is a legitimate treatment, of course -- but not the way they do it. True group therapy, led by a well-trained professional therapist, provides an opportunity for individuals to explore their interactions with others in the group, in order to learn more about themselves and their relationships. What is offered in rehabs as "group" treatment is mostly lectures and discussions about assigned topics.

However, if you are forewarned, it is possible to find alternatives that are both better and less expensive. Here's a short guide:

1. Look for programs that do not have a fixed length of stay. There is absolutely no medical or psychological justification for staying in a facility for exactly 30 days, or any other fixed number. Length of treatment for addiction should be individualized, as it is for every single other medical or psychological hospitalization. You can find programs that average shorter, 2-week stays, and are able to charge less both because they are not as long and because they don't have horses, aquatics, or ocean views.

2. A competent rehab should emphasize individual treatment with truly well-trained therapists. Don't be fooled by places that say they offer individualized care when what they mean is that you can choose among several existing programs, none of which offer individual treatment. The ability to choose one lecture series over another, or horses over swimming, is not individualized treatment.

3. Any rehab worth your time and money must offer a variety of modalities without insisting you fit into their favorite one. A program may offer 12-step meetings, for example, but to be competent it must offer non-12-step approaches for those who cannot benefit from a 12-step approach. A rehab must never be a boot camp to whip you into accepting their belief system. Ask if they are based on a single treatment model for everyone, and if so, stay away.

4. Look for fewer, not more, amenities. Every facility needs decent housing and food, but any place that actually thinks horses and scenery treat addiction is telling you they don't know much about addiction.

Sometimes it makes sense to be hospitalized, because you have tried outpatient treatment and are not doing well. There's nothing wrong with taking a break from a cycle of addictive behavior, followed by depression, leading to more addictive behavior. But if you decide you need that break, choose well, on the basis of the most qualified care.

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