Addiction is a disease that affects people from all walks of life — men and women, rich and poor, young and old. But no matter their demographic category, the vast majority of people suffering with substance abuse don't get the help they need.
Todd Crandell was a hockey player turned pharmaceutical sales rep in Ohio who spent years addicted to drugs and alcohol, going in and out of rehab without ever seeing results. "I tried inpatient, outpatient, hypnotists, counselors and other modalities," he said. "They didn't work. I wasn't ready to have anything work."
Ultimately, Crandell ended up quitting cold turkey thanks to vigorous running and racing in Ironman competitions. "I took my negative addiction and turned it into a new focus," he said. He went on to become a drug counselor and to found the nonprofit Racing for Recovery, a fitness and health-focused program based in Holland, Ohio, whose goal is to help people suffering from addiction and those affected by them.
"I always ask people, 'What are you looking for?'" Crandell said. "The ideal program is one that meets that individual's needs and desires."
Unfortunately, Crandell's dissatisfaction with the traditional treatment options is fairly typical. The vast majority of addicted people don't get any treatment or, if they do, go in and out of rehab repeatedly. A 2013 survey by the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services, found that 22.7 million Americans needed treatment for substance abuse at a specialized facility, yet only 2.5 million of those people got it.
There are many reasons for this huge gap in treatment, including wariness about the treatment experience itself and skepticism about whether it can really help. All people have their own story and need to follow a treatment path that meets their individual needs, which is why treatment programs offering a one-size-fits-all approach aren't particularly successful.
So what would the path with the greatest likelihood of full recovery for the patient look like? What would that treatment program entail?
Today, most experts agree with Crandell that personalization is key. Programs should offer a wide range of services — from support groups and confidence-building activities to medical and mental health care — in order to customize a long-term plan that fits the unique needs of each individual.
Initial evaluation creates a roadmap
Before treatment specialists can create a roadmap for an individual addicted person, they need an accurate picture of how that individual became addicted in the first place. A comprehensive initial evaluation not only helps the treatment providers understand the person's history with substance abuse, but also life history, including past trauma and mental illnesses such as depression that will need to be addressed in the course of treatment.
According to the National Institute of Mental Health, about 40 percent of people suffering from addiction have co-occurring mental health issues, and diagnosing these issues accurately allows the provider to address them — and to evaluate whether they might be the underlying cause of the addiction.
"These co-occurring conditions are becoming the norm rather than the exception," said Ashish Bhatt, chief medical officer at Sovereign Health, a residential rehabilitation treatment company based in San Clemente. "We have to treat the root of why people are using drugs. We have to get to know the person and not just take any previous diagnoses at face value."
Bhatt said that Sovereign's evaluation process includes psychological testing to help diagnose personality disorders and look for cognitive deficits caused by long-term substance abuse, as well as genetic testing to help determine what kinds of medications, and at what dosages, might work best.
The Sovereign evaluation also involves looking for symptoms of mental disorder, differentiating between addiction and mental health, and speaking with friends and family members to get their perspectives, Bhatt said. "Once we identify whether the patient has primarily a substance abuse issue, primarily a mental health issue or a dual diagnosis, we tailor the treatment program to place them in those respective tracks."
That kind of flexibility could raise the likelihood of success in helping the addicted person stay sober. In the addiction treatment industry, however, many programs offer less nimble, less nuanced approaches to treatment that often amount to forcing a square peg into a round hole.
"Say you have a treatment center that offers a certain program and adheres to a particular methodology or philosophy, and at the other end is a person suffering from addiction who most likely has zero understanding of the best path for their successful treatment," said Harold Jonas, a licensed therapist who created Sober.com, a website with listings and reviews of treatment facilities. "The facility may be evaluating if that potential client is capable of complying with the treatment model they have available, rather than determining if it's the right path for the client's long-term, successful treatment."
Getting family and friends involved
Family and friends often have to take the lead in finding and evaluating treatment facilities on an addicted person's behalf. When they do, there are many factors to consider. Jonas recommended looking at reviews from others who have attended the facility, along with checking licensing boards for a history of complaints and seeing which professional organizations the company is affiliated with.
"Many treatment centers have brochures that resemble five-star hotels, but luxury amenities do not make a better treatment center," Jonas said. "What is important is the clinical philosophy they adhere to." He recommended asking treatment specialists to describe their intake and treatment process, to share qualifications of staff members, and to explain what separates them from the other treatment programs.
If it's a residential program, Jonas added, it's important to ensure the program provides stable, supportive housing for at least 90 days and a social support program thereafter to help patients stay sober over the long term. "Without social support, addicts are going to regress," he said.
Evidence increasingly shows that the support of friends and family members is a core component of successful treatment for a wide range of health issues, from substance abuse and mental health to terminal diseases and chronic medical conditions. But unlike traditional health issues, addiction and mental health problems carry the added weight of stigma, which can drive a wedge between addicted people and their loved ones.
"Many people think of addiction as a moral weakness, and family and friends often hold onto that, blaming and shaming the addict for their disease," Sovereign chief medical officer Bhatt said. "We try to help educate family and friends that this is brain disease, and that quitting is not just a simple choice."
For those who have an addicted person in their life whom they hope to help, there are a number of things they can do to guide that person toward successful recovery.
"To begin with, educate yourself as much as possible and try to understand what drives the person you care about to choose drugs or alcohol," Jonas said. "If you want to help them succeed in their recovery, provide them with unconditional support, don't be judgmental, be attentive and listen carefully, and create a substance-free environment when they're with you."
Often the people involved in the life of someone suffering from addiction can benefit greatly from some form of counseling themselves. As Jonas put it, "To help them, you often must help yourself also." Family or group therapy along with the addicted person is one option. Alternatively, individual counseling or an independent support group that offers a safe space to vent may be helpful.
A multifaceted approach
Once patients enter a rehab program, the path they follow should depend on their individual needs. Many providers, however, simply follow some form of the 12-step model that has been the dominant form of treatment for decades. Modern evidence-based programs are beginning to move away from this rigid and unscientific form of group therapy, with its largely unsuccessful track record and high relapse rates. Instead, many of today's programs incorporate treatments and activities designed to repair and retrain the brain, along with medical care, counseling, social support and group therapy.
"When a patient first comes to one of our facilities, they'll likely start with some form of detoxification or withdrawal management," said Bhatt. "They may see a doctor, therapist or psychiatric specialist in the initial assessment period. If needed, we can offer them specialized programs for issues like eating disorders or pain management."
Then, as patients move into the phase of treatment in which they learn to live without drugs or alcohol, they participate in group sessions. "The difference between what we do and 12-step programs is that we don't just look at it as talk therapy," Bhatt said. "This is only one piece of the puzzle. We're also doing cognitive testing and brain exercises to repair cognitive damage, individual or family counseling, and we can offer medications to help rebalance the brain chemistry as they heal."
Patients might still be healing long after they complete the program. For many, the biggest challenge isn't just getting through the treatment, but staying sober after they leave. That's why ongoing social support is an important part of any program, as is checking in with the patient after they leave, for at least six to 12 months, to track their progress.
For former addict and drug counselor Todd Crandell, it's this post-treatment stage that he considers vital to an addicted person's recovery.
"People don't just stop using drugs or alcohol because somebody tells them to," he said. "They need to be presented with something new that shows them the positive benefits of coming off addiction. We don't just focus on not using drugs, but also … living a happy, productive lifestyle."