Why America’s Addiction Treatment System Is Broken & What…
PsychCentral – By
We know a lot about addiction. We know that addiction is a complex brain disease – not a weakness or lack of willpower. We know its risk factors include “genetic predisposition, structural and functional brain vulnerabilities, psychological factors and environmental influences,” according to a groundbreaking 2012 report from the National Center on Addiction and Substance Abuse at Columbia University.
We know that the age a person starts using addictive substances can strongly predict risk. Research has found that in 96.5 percent of cases, people began using substances before 21 years old – when the brain is still developing and especially vulnerable.
We also know that addiction co-occurs with or leads to other conditions. According to the report, “Both risky substance use and addiction cause or contribute to more than 70 other conditions requiring medical care, such as heart disease and cancer, as well as mental health and behavioral disorders–including depression, anxiety, posttraumatic stress disorder, bipolar disorder, schizophrenia and other neuropsychiatric disorders.”
We know that while addiction severity, symptoms and course vary greatly, addiction tends to be a chronic disease.
But even though we know what leads to addiction and how it manifests, treatment options in America are largely inadequate. The above report from Columbia University reveals the sobering facts: To start, there’s no national standard of care for addiction. Second, despite addiction being a chronic illness, treatment programs tend to offer acute interventions.
This is one of the reasons outcomes are so poor across the field, said Ben Levenson, co-founder of Origins Recovery Centers, a comprehensive facility that offers treatment for substance abuse and co-occurring disorders. Levenson understands addiction firsthand. His mom has been sober for 20 years. She lost her brother to an overdose. Levenson also lost his brother in 2001, and personally struggled with addiction. “I almost died myself … prior to getting sober.”
“I was in the care of phenomenal physicians and compassionate clinicians. But I was a patient at a time when … and it is still the case, the model for addiction treatment was essentially an acute intervention for what we all know is a chronic disease.” After 30 days of treatment, Levenson was essentially expected to recover on his own.
Many treatment programs also offer unproven therapies and have little medical supervision. Some promise “one-time” fixes. Others charge exorbitant fees, “with little evidence justifying the cost,” according to the report.
Worse, the report said, “…there are no outcome data reflecting the quality of treatment providers so that patients can make informed decisions.”
Levenson agrees. “The field of addiction treatment has failed to measure outcomes. And the way in which we have measured outcomes has zero veracity.”
He cited the work of White and Godley (2005), who detail the weaknesses of local followup studies. According to the authors, “Some claims of treatment success rest on no scientific foundation and instead represent everything from honest estimates to self-serving fabrications. However, the more common problem is that well-intentioned individuals within local programs conduct follow-up studies of discharged clients using methods that are so different from those used in scientific studies as to render the results across these worlds incomparable.”
White and Godley note that local studies suffer from such weaknesses as: potential bias in design and conduct of the study (treatment programs naturally want positive results); the exclusion of patients who didn’t complete the treatment program; small sample sizes (“We have seen significant findings occur with 30 clients per condition only to be reduced to clinically trivial differences upon following up 50 clients per condition”); and solely self-reported data, which is usually collected over the phone (and excludes drug testing).
Another issue is that facilities don’t measure a patient’s response to treatment during treatment, Levenson said. He compared this to an oncologist diagnosing a patient with a malignant tumor. The doctor prescribes a specific treatment plan with chemotherapy and radiation. “Then six weeks into therapy, the oncologist fails to scan the tumor to see if it’s shrinking or not.”
This is why Levenson and his team at Origins measure each patient’s responsiveness while they’re receiving treatments, such as cognitive-behavioral therapy, dialectical behavior therapy and biofeedback. This lets them adjust the treatment in real-time, optimizing the patient’s responsiveness and ultimately their outcome, he said.
How to Find a Good Addiction Treatment Facility
While addiction treatment needs an overhaul, effective programs do exist. The key is to do your homework. If you’re looking for a treatment facility, searching online can give you information about different providers.
But “[the Internet] lacks the ability to match actual patient needs with actual provider capabilities,” Levenson said. This is where the interview comes in. “[I]t’s important that you ask the right questions when talking with the admissions department.”
Levenson suggested asking these questions:
- Are you licensed? For what level of care? For instance, if a person requires detox, the facility must be licensed for medical detox, he said.
- Are you accredited? “This means that [a facility is] held to higher standards,” Levenson said. The facility might be accredited by either CARF or The Joint Commission.
- Do you have full-time physicians and nurses on campus? Are they board-certified by the American Society of Addiction Medicine? Will I see a physician? “Addiction is a disease that never exists in a vacuum,” Levenson said. Again, individuals usually have co-occurring psychiatric and non-psychiatric conditions, he said.
- Do you have Masters-level therapists who are trained in a variety of treatments? For instance, cognitive-behavioral therapy is effective for addiction.
- How many individual sessions will I have with my therapist per week? Levenson said that it should be two or more sessions. “If it’s just one session, you can do that at home.”
- What is the typical continuum of care? The support a patient receives after treatment is just as important as what they receive during treatment. It’s vital to ascertain whether a program offers additional support after you’ve finished the inpatient program. A 28-day program with no aftercare help is like “giving a diabetic 28 days of insulin, and then patting them on the back and wishing them luck. On day 29 they’re going to have a problem,” Levenson said. Origins offers 30- to 90-day inpatient treatment and a treatment step down program along with a year-long monitoring and accountability program. You can learn more about their programs here.
- What type of aftercare is included in the cost? “At minimum, there should be a free alumni meeting every week that you’re welcome to attend.” However, preferably, they have some type of monitoring and accountability program that provides recovery support to the patient and their family for six months or more and includes drug testing, he said. The best scenario is that they’re “going to be involved in your life for 16 to 18 months.” Levenson noted that “treatment is just the first stage of care.”
- Are there separate programs for men and women? When men and women are in treatment together, “the data show we lose eight to 10 points in efficacy,” Levenson said. This is because men and women have different treatment needs. Compared with men, women are more likely to have mood disorders, anxiety, post-traumatic stress disorder and eating disorders. “In addition, because many of the issues that women must deal with in their recovery process is related to relationships, in the early phases of treatment being with men can detract from the therapeutic goals necessary to engage in the treatment process.”
How Loved Ones Can Help
“When addiction is present in the family system, the entire system gets sick,” Levenson said. “[O]ptimal outcomes happen when the entire family system is engaged in transformative work for recovery.”
For instance, if you’re a parent of a child who’s in treatment, Levenson suggested seeing a therapist yourself and attending Al-Anon meetings. While loved ones don’t cause addiction, they can help in providing a healing environment for the individual. Providing this environment also means making changes.
Addiction is a complex, often chronic, disease. Our addiction treatment system must evolve in order to help patients recover for good.
