Therapist Blog

350 People Die Of Addiction Each Day- Is It Time To Rethink Rehab?

Every year in the U.S., 120,000 people die of addiction. That’s 350 a day.

Desperate to save the life of an addict, a parent, family member or friend will turn to obvious treatment -enter a “rehab facility”. But what is the definition of a rehab?

Turns out, there’s no standard definition of it; instead it’s a generic word for a wide variety of treatments, including some that are outrageous. Exorcism? Tough-love programs in which patients are made to scrub bathroom tiles with a toothbrush or cut grass with scissors? Even in more-typical rehabilitation programs, patients are not seen by licensed practitioners — no doctors or psychologists — only self-anointed “experts” with no training or credentials, unless you count their own recoveries from addiction to heroin, alcohol or other drugs.

No one actually knows how often treatment works, but an oft-quoted number of those who abstain from using for a year after rehab is 30%. Even that figure is probably high. “The therapeutic community claims a 30% success rate, but they only count people who complete the program,” according to Joseph A. Califano Jr., founder of the National Center on Addiction and Substance Abuse and a former U.S. Secretary of Health, Education and Welfare. “Seventy to eighty percent drop out in three to six months.”

The treatment system fails because it’s rooted in an entrenched, inaccurate view that addicts are morally bereft and weak. If they weren’t, the belief goes, they’d stop using when drugs began to negatively impact their lives. Most treatment centers in the U.S. are based on an archaic philosophy that’s rooted in the 12-step model of recovery. These programs have saved countless lives, but they don’t work for a majority of people who try them. It’s not a fault in the program itself. Its founder, Bill Wilson, wrote, “These are but suggestions.” But many rehabs require them. This is particularly problematic for teenagers and young adults, the very people most susceptible to addiction. Twelve-step programs require people to accept their powerlessness and turn their lives over to God or another higher power. Many adolescents question religion, and in general teenagers aren’t going to turn their lives over to anyone.

In many 12-step-based programs, patients are berated and yelled at if they don’t “surrender” and practice the steps. They’re warned — in some cases, threatened — that if they don’t, they’ll relapse and die. It can become a self-fulfilling prophecy. Addicts don’t think they can be treated if they don’t embrace the program, and so they give up on the idea that they can be helped. They do relapse. Some die. When they do, they’re blamed. Blaming the victims is convenient for those who treated them, because it absolves them of accountability. They can take credit when their patients get well, but they take no responsibility when they don’t. But the bigger problem with 12 steps is that a growing body of evidence has proved that addiction isn’t a choice subject to willpower but a brain disease that’s chronic, progressive and often fatal.

There are alternatives to 12-step-based treatments that can improve an addict’s prognosis. These treatments don’t rely on best guesses or tradition. Rather than require contrition and prayer, they use therapies that have proved effective in clinical trials, including cognitive-behavioral therapy designed to train addicts to recognize and interrupt the cues that trigger the relapse mechanism; motivational interviewing, a therapy approach widely used to treat many psychological disorders that helps addicts engage in treatment; contingency management, which essentially rewards addicts for clean time; and psychopharmacology. Most researchers agree that no single therapy is appropriate for every addict. Often they’re used in concert.

Currently there’s a chasm between these and other evidence-based treatments (EBTs) and rehab programs. Every day addicts fall into it, and many never make it out. Thankfully, this is slowly changing. More people are being educated about the fact that addiction is a disease and therefore requires treatments based on the medical model. The more consumers are educated and demand EBT, the more the billion-dollar rehab industry will adapt and offer it. That is, the industry will adapt or it will die and be replaced. In the meantime, those who need treatment must do the best they can to find programs that offer EBT. The place to start is by receiving an assessment from a psychologist, psychiatrist or professional who is trained in addiction medicine.

Excerpts from David Sheff, author of Clean: Overcoming Addiction and Ending America’s Greatest Tragedy