Choosing an addiction treatment program for a loved one can literally be a matter of life or death — a decision impacting not only the patient, but also entire families or even communities. Yet few of us know what facets of treatment should factor into such a life-changing decision.
Addiction treatment facilities have proliferated in the United States in recent years, driven by dramatic rises in opioid and methamphetamine use, addiction becoming a larger part of the national conversation, and research indicating that specialized care is integral to recovery. Despite these trends, affordable high-quality programs remain a rarity.
"Partially because of increased regulations and the increased reliance on HMOs and other forms of managed care, it has become very expensive to operate an inpatient facility," said Nicole Richardson, a licensed counselor in private practice in Austin, Texas. "As a result, facilities have either closed their doors or started to cater to people who can afford to pay for treatment out of pocket."
For patients and family members looking to navigate this complicated landscape, the first step is research to draw up a shortlist of prospective programs.
"The best way to research facilities is to ask several doctors and talk to families who have availed themselves of these facilities," said Judy Rosenberg, Los Angeles-based therapist and founder of PsychologicalHealingCenter.com. She suggested speaking to folks at 12-step meetings and asking for recommendations.
Community-based public health commissions, county-level resources and other government agencies can help guide the families of those suffering from addiction.
"These organizations are a great place to start, for a referral to a treatment facility or as a source of recommendations and recovery resources," said Greg McNeil, founder of Ohio-based Cover2 Resources, a nonprofit organization founded in memory of his son, Sam, who died of a heroin overdose last year.
It's important to identify the needs of your family member and to know which questions to ask, Richardson said. For example, do they need medical detox? Does your relative have another medical or behavioral diagnosis, known as "dual diagnosis"? How will you be paying for treatment and do you plan to use medical insurance?
Families should look for treatment facilities that, upon admission, conduct a thorough assessment of the patient's symptoms and cognitive function before beginning treatment, because there's no such thing as an effective "one size fits all" treatment for addictive disorders.
"It is critical to devise a treatment plan based on a thorough assessment of symptomatology, health and social history, and cognitive functioning," McNeil said. "A treatment plan should be individualized and appropriate for the individual based on a comprehensive assessment incorporating any prior treatment."
Ask the center to provide statistics on its long-term recovery rates. "It is critical that they offer measurable results to continue to document effective treatment, as well as to continue to build the data around effective treatment modalities," McNeil said. "That being said, treatment has to meet the needs of the individual."
There are important differences between evidence-based medical treatment methods and traditional 12-step recovery programs. The latter provide valuable fellowship to addicted people and can augment a medical approach. But they offer support, not comprehensive treatment.
Around half of patients with substance disorders are also suffering from co-occurring mental illness, according to the Substance Abuse and Mental Health Services Administration, an arm of the U.S. Department of Health and Human Services. It is crucial that addiction treatment programs are able to take a dual-diagnosis approach. An effective treatment program must be able to work with patients to identify underlying mental health issues. It should have staff trained to deal with dual diagnoses and licenses for giving this type of advanced treatment.
"Mental health and addiction are interconnected," Rosenberg said. "People suffering from borderline personality disorder and bipolar disorder, for example, commonly use substances to self-medicate."
Richardson pointed out the danger of overlooking these underlying problems: "If a client has an underlying and untreated mental or behavioral health disorder and it is not treated, they are at an increased risk of relapse as they have likely been self-medicating with drugs or alcohol."
Yet despite how common it is for addicted people to have other mental health problems, only around 18 percent of addiction treatment programs and 9 percent of mental health programs are equipped to treat dual-diagnosis patients, according to a 2013 report published in the Journal of Dual Diagnosis.
"Unless you get to the cause you're going to be left with managing symptoms," Rosenberg said. "You have to treat the hole in the soul. You have to treat the emotional dysregulation that is behind the need to use substances to self-regulate."
Ideally, an addiction treatment program should be staffed by intelligent, caring medical experts with track records of success and a demonstrated capability of both diagnosing and treating co-occurring mental illness issues. A facility's licensing and accreditation are valuable initial indicators of their standards in these areas.
Eleven years ago, the Substance Abuse and Mental Health Services Administration published a report describing licensing requirements from state to state. The review covers the requirements that facilities must meet, in addition to the licensing, certifications and credentialing of rehab staff.
A treatment facility should be accredited in its home state, but you should also look for national accreditation from the Joint Commission, the National Committee for Quality Assurance, or the Commission on Accreditation of Rehabilitation Facilities.
For people suffering from addiction, many experts recommend residential programs, where a patient is treated for weeks or months in a structured full-time setting away from the distractions — and possible temptations — of their home environment.
"Residential treatment programs offer the containment necessary to monitor patients, especially in the early stages of recovery," Rosenberg said. "They need hands-on care."
"For many, residential treatment is the treatment of choice because of the variety of treatment modalities available, no access to substances and peer-driven support," McNeil said.
The geographic location of an addiction treatment facility is another important consideration. Getting away from the societal context of their addiction can help some addicted people. But for others, being close to supportive family and friends is crucial and can prevent potentially destructive homesickness.
The distribution of mental health and substance abuse treatment facilities across the United States is uneven. This is in part because of the "not in my backyard" phenomenon, whereby some local governments and residents have opposed facilities in their communities. This resistance is often fueled by residents' unjustified fears that allowing these types of businesses into their neighborhoods will negatively impact property values and could bring drug use and crime — despite a lack of evidence to support these claims.
For example, in recent years, the expansion of drug and alcohol treatment facilities, sober living homes and group homes in affluent beach communities in Southern California has been a cause for concern among area residents. At times, local governments have imposed zoning regulations and moratoriums targeting patient residences and other forms of community-based housing, even though some of these areas have substantial demand for treatment.
Another consideration for families in search of the right treatment program is cost. Though residential addiction treatment can be expensive, there are excellent facilities that meet all of the criteria recommended above and yet, through insurance, remain accessible to regular folks.
"Insurance coverage is critical to access to treatment," said McNeil, adding that coverage for substance abuse treatment has expanded in recent years to provide more options. "Treatment has more to do with the expertise and training of the staff than the overall facility or cost. Suffice to say, with substance use disorder treatment, cost isn't necessarily a measure of the quality of the program."
One quality program that offers a trained medical staff and accepts most private insurance plans, with most of its patients covered, is available right in Orange County. Sovereign Health Group is a fully accredited San Clemente-based national provider of behavioral health services that operates residential treatment centers for addiction, mental health and dual-diagnosis care.
Sovereign takes a state-of-the-art evidence-based and medical approach to treating addiction and dual-diagnosis patients. This includes the latest technological advances in the mental health field, such as computerized testing for assessing cognitive function, and transcranial magnetic stimulation, a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain. Sovereign's treatment programs are also holistic and comprehensive, including therapeutic activities such as mindfulness meditation and yoga, and encouraging simultaneous 12-step support.
"Make sure [an addiction treatment program] goes to the cause of the problem. Visit the facility if you can and go by how it feels. Trust your gut," Rosenberg said. "Do not stop therapy once you have finished the recovery program. Seek therapy that … helps to express repressed emotions that lie underneath the symptoms [and] follow up with 12-step support."