The Opaque Rehab Industry

Knowing what to expect gives both the sufferer and loved ones a leg up.

Posted Sep 23, 2019

Many people continue to make the unfortunate mistake of confusing alcohol/drug rehab with a “cure” for addiction, much like a prescription for an antibiotic can cure a case of pneumonia. This often leads to unrealistic and unfortunate expectations on the part of the substance abuser, and importantly his or her loved ones as well, and too often to disappointment. The truth is that rehab—getting sober—marks only the beginning of recovery. Staying sober is an entirely different matter. Life after rehab is where true recovery begins.

Upwards of 2.5 million Americans enter treatment facilities for substance abuse problems every year, and the need for treatment is, if anything, growing in the face of the opioid crisis along with steady increases in alcohol use. Many of these people defy old stereotypes of the addict, who are in fact younger and more middle class than those stereotypes suggest. The over 14,000 rehab facilities are currently at capacity and new ones are opening every day. And what these statistics do not reveal so obviously is that an equal number of families and loved ones await the return of those treated for substance use disorders following their stay in rehab. What about them? Where do they fit into the picture? 

Despite its ubiquity, rehab remains pretty much an opaque phenomenon, especially to the family members and loved ones of those who enter it. The vast majority of men and women who exit rehab do so with only sparse aftercare plans—and rarely including loved ones who after all are stakeholders in recovery after rehab as much as the newly sober addict.

Addiction is thought of today as a “bio-psycho-social” disorder, meaning that its causes include biological factors (genetics), psychological factors (depression, PTSD, etc.) and social factors (one’s family and broader social network). Yet unlike other medical diagnoses, addiction treatment stands alone in being pretty much opaque to the loved ones of those who enter rehab. In way of comparison, imagine that one of your loved ones was diagnosed with cancer or a serious heart condition. But rather than being included as a stakeholder in treating the diagnosis, imagine being told that you should let the doctors take care of that and that you should basically stay out of it and “take care of yourself.” How would that make you feel? How would you react? Yet this is essentially the message that loved ones get once the substance abuser enters rehab: “Let us take care of it. Your loved one will be all better when he (she) returns home.”

Rehab centers vary widely with respect to the “treatment” they claim to offer. Many suggest they advocate for the 12-step program of Alcoholics Anonymous, yet on closer inspection, it becomes apparent that the degree to which they actually do so can vary dramatically, from several AA meetings a week to no actual AA meetings. Some high-priced rehabs boast hot tubs with ocean views, or horseback trail rides through the desert. Others offer glossy brochures that advertise a menu of interventions (anger management, yoga) whose connection to sobriety is less than apparent and unsupported by rigorous research. And let’s not forget that to get to the point of needing rehab, the substance abuser has typically tried all sorts of “harm reduction” strategies (drinking only fine wine, using less cocaine, cutting down on prescription opiates) without success.

What actually goes on in rehab? Most loved ones surveyed essentially respond that they have no idea. But because what happens after rehab is where the proverbial rubber hits the road, and because loved ones are best thought of as co-equal stakeholders in the substance abuser’s recovery, this has to change, beginning with rehab itself.

Throw Back the Curtain

There are, to be sure, high-quality treatment centers that offer rehab. However, to be sure that you are signing up with (and possibly paying a lot of money for) one of these, you need to know what to look for. And that can be like throwing back the curtain in the film The Wizard of Oz. Is there anything of substance behind it? You have a right to know. To begin, when looking for a rehab (or talking with what may well be nothing more than a salesperson on the phone), I suggest you ask the following questions before making a decision:

  • Do you incorporate evidence-based interventions into your program? If so, which ones? Can you show proof that your staff has received formal training in these interventions?
  • Do you evaluate the outcome of your program after patients return home? If so, how? Do you have outcome data (on sobriety after rehab) that you can share?
  • If your center relies largely on group therapy? If so, what are the topics that are covered in these groups, how large are the groups and how often do they meet?
  • Do you employ medication-assisted treatment, and would that be appropriate for your loved one?
  • What kind of “recovery plan” do you provide for patients after discharge? Will it include psychotherapy? Medication? Group support (such as AA)? Do you help them arrange for this aftercare? Can you get a copy of this aftercare plan?