Is Addiction Treatment Really Effective?

By Myles B. Schlam, JD, CAP/CCJAP/ICADC

Addiction Treatment Effective

Drug addiction is a complex medical problem with negative consequences that can affect almost every part of a patient’s life. To be successful, a drug addiction treatment program must be ready to address these issues by not only focusing on the patient’s addictive behavior, such as drug use, but also offering solutions to ancillary problems. Many programs now offer job skills training in order to help the patient become a productive member of both his family and society at large. This aspect of drug addiction treatment is an essential part of encouraging patients to stay sober by giving them something to be sober for.

Drug addiction treatment can be found in a variety of environments, using many different behavioral and pharmacological methods. There are over 10,000 drug addiction treatment facilities in the US that offer counseling, behavioral therapy, medication, and case management to those suffering with substance abuse.

In addition to formal drug addiction treatment centers, many drug addicts can get valuable assistance in doctor’s offices and medical clinics from doctors, nurses, counselors, psychiatrists, psychologists and social workers. Drug addiction treatment can be offered in outpatient, inpatient and residential settings and, although some treatment models are typically associated with a particular treatment environment, many effective methods are flexible enough to be offered anywhere.

Since drug addiction is such a major public health issue, much of the funding for drug treatment comes from local, state and federal government budgets. Although private or employer-subsidized health insurance policies can provide coverage for addiction treatment and the resulting medical fallout, benefit caps have resulted in shorter stays or the total elimination of certain programs. Although the US Congress recently passed a mental health parity law, it does not apply to all insurers and there are significant loopholes available for corporations to use in order to avoid having to pay out benefits.

Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse. According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives.

People typically do more research when shopping for a new car than when seeking treatment for addiction. They search on the internet and see these beautiful resort-type facilities with beaches and palm trees promising to cure them or their loved ones of addiction. They call an 800 number and a “treatment consultant” tells them exactly what they want to hear. A recent Colombia University report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors actually suggested that such insufficient care could be considered “a form of medical malpractice”.

Contrary to the 30-day stint typical of inpatient rehab, people with serious substance abuse disorders commonly require care for months or even years. The short term fix mentality partially explains why so many people go back to their old habits. Good Case Management, as I addressed in last month’s article is severely lacking. “You don’t treat a chronic illness for four weeks and then send the patient to a support group”, said Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism in an interview. “People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it.”

While it is true that some people are helped by one intensive round of treatment, “the majority of addicts continue to need services” Dr. Willenbring said. He cites the case of a 43-year-old woman “who has been in and out of rehab 42 times” because she never got the full range of medical and support services she needed. Strong and consistent Case Management is vital to ensure the continuum of care throughout the treatment process.

Before committing to a treatment program you should do your homework. The first step is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with any specific program. For any treatment center we consider placing a client in, we check on the credentials of the program’s personnel, who should have at least a master’s degree. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine. We also meet with the therapist who will treat you and ask what your treatment plan will be. It should be more than movies, lectures or three-hour classes three times a week. You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all.

Our mission at ASI is to provide quality assurance to the clients before, during and after the actual treatment. We do the research for our clients to ensure that they are placed in a treatment facility that will treat the whole person and meet all their ancillary needs as well. It is important to have an independent professional who will oversee the entire treatment episode and facilitate appropriate aftercare. Oftentimes staff at a particular treatment facility are hesitant to question tactics employed at their facility for fear of “rocking the boat” or even losing their jobs. As independent Case Managers, we will say the things that need to be said and take action when necessary without these conflicts of interest. Our primary concern is for the client to receive the very best individualized treatment for their condition. Because no one treatment facility is the right fit for everyone, we work with a wide network of treatment facilities that have various sub-specialties. If a treatment center is not providing a high level of services to our clients, we will cease to refer clients to that facility.

Unfortunately insurance companies will rarely pay for the full extent of treatment that is recommended. That is where the necessity for thinking outside the box comes into play. Many of our treatment providers have agreed to discount their rates for our clients so that they may continue in treatment once insurance benefits are exhausted. When it is not feasible to keep the client in that facility, we will use one of our community-based facilities that are either free or on a sliding scale.

If you are in need of treatment for alcohol or drug abuse for yourself or a loved one, we are available for a free consultation. It is recommended that a full bio-psychosocial assessment be conducted for every client prior to selecting a treatment facility. Assessments and In-custody evaluations are available by appointment only.

*Myles B. Schlam is a nationally recognized expert in Drug Addiction and the Criminal Justice System and an Internationally Certified Alcohol and Drug Counselor (ICADC). He is one of approximately 100 Criminal Justice Addiction Professionals (CCJAP) in the State of Florida. Mr. Schlam is a graduate from St. Thomas University School of Law (Class of ’02) where he specialized in criminal law and interned with the Public Defender’s Office. ASI is licensed by the Florida Department of Children and Families and operates throughout the State of Florida.