By now, we all know the drill. A celebrity goes out without her knickers, mouths off to a cop or does something equally tabloid-worthy, and before you know it, the magic word inevitably appears all over the news—rehab. Although the travails of Britney Spears, Lindsay Lohan or Mel Gibson, might capture headlines, the phenomenon of drug and alcohol rehabilitation is hardly confined to the upper echelons of Hollywood. Rehab is big business. In a given year, there are as many as 1.7 million people in the United States admitted for substance-abuse treatment. Spending on substance-abuse treatment reached $20 billion in 2003, the last year for which figures are available. Even the least expensive private treatment centers cost nearly $5,000 for a monthlong stay, while more-exclusive rehab centers charge at least $50,000 a month.
You’d think that anything costing so much would guarantee success. But as we know from tabloid reports, such as Lohan’s drunk-driving incident days after leaving treatment last year, rehab rarely does the trick. Scientific studies of substance-abuse treatment show that only 40 percent to 60 percent of patients will be completely clean a year after treatment. Further out, those abstinence rates drop to as low as 20 percent. By contrast, the 70 percent to 80 percent success rates touted by many private rehab centers are misleading at best (and bogus at worst) and rely on unscientific data, such as telephone surveys of those who completed the rehab program, to determine success. Those numbers don’t even count patients who left the program before finishing treatment.
When officials at these rehab centers try to defend methods they use to determine success rates, quite frankly, they sound silly. We couldn’t believe it when the director of one clinic that touts a 70 percent success rate (based only on self-reporting by former patients) told us that success rates aren’t a major factor when patients choose a rehab program. But then he had the audacity to say that if the rehab center’s success rates were much lower, he probably wouldn’t reveal them.
Lack of Coverage: Health Insurance Companies Are Part of the Problem
To be sure, many people have had successful experiences at rehab centers that have set them on a road to sobriety they never would have found without such help. However, even at their best, residential treatment centers might be no more effective than outpatient treatments or comparatively minor interventions by primary-care physicians. These methods not only cost much less than rehab, they might even be free. At their worst, rehab centers are high on hype—in some cases, luring patients with extravagant amenities, including fancy sheets and gourmet meals—and provide little of the kinds of treatment proven to be most effective in managing the disease of addiction.
“The dirty little secret is the kinds of treatments most often used in the United States have the lowest levels of success,” says Scott Walters, of University of Texas’s School of Public Health, who has worked on definitive studies about alcohol treatment success rates.
NEW VIEWS ON TREATMENT. The newest prevailing thought among independent experts suggests that most private clinics have it all wrong. Today, experts believe that a person’s addiction to alcohol or drugs can be “managed,” that some patients don’t need to be cured, and that relapses are part of recovery. In other words, the goal shouldn’t necessarily be to make someone stop drinking immediately; the goal should be to get a person to first reduce the amount he/she drinks. In some cases, experts say, that will solve a person’s addiction problems. In other cases, the approach represents the first step in getting a person to curb a dependence on alcohol.
This new thinking raises some red flags as far as we’re concerned, because we think it will give private clinics who adopt this approach the opportunity to essentially move the goal posts. It means these clinics could simply offer more ambiguous claims of how beneficial their programs will be. So far, however, few private clinics have converted to this new thinking, and it’s uncertain if or when they will do so.