Getting the addiction treatment you need: How effective is drug rehab?

You know there’s a problem, but whether you’re inquiring about addiction treatment for yourself or a loved one, you probably find yourself wondering: How effective is drug rehab?

It’s a valid query, and one for which you’re like to receive a great many mixed messages when it comes to answers. Rehabilitation for addiction or alcoholism, after all, is a lot more complex than physical health care for other ailments. With cancer or diabetes or heart disease, treatments are fairly straightforward, and a regimen of medication, along with recommended lifestyle changes, are universally accepted methods of treatment those diseases.

That’s because drug and alcohol treatment targets a disease that has so many variables, from a patient’s physical health to their mental well-being to their emotional relationships with family members and loved ones to the obsessive and compulsive thinking that leads them to betray their core moral values in order to obtain drugs and alcohol. In that regard, addiction and alcoholism, while recognized by science and medicine as legitimate medical illnesses, are much more difficult to treat that a straightforward physical illness or injury.

So of course you should be asking, “How effective is drug rehab?” Because while the answer may be more nuanced than you expect, it can still give you an idea of whether the facility you’re inquiring about can help save your life, or that of someone you love.

How Effective Is Drug Rehab? The Experts

It’s important, before we get too far into this question, to establish what the goal of drug rehab should be, and it’s reasonable to expect that stopping the use of alcohol and drugs is just one small part of it. After all, that’s another distinction between addiction and other physical maladies: With cancer, removal of the cells that plague the body, and the prevention of their recurrence, is the end goal of treatment. With drug and alcohol treatment, removal of the substances is the first step, but prevention of their recurrence involves so much more than just telling those afflicted to just say no.

As the National Institute on Drug Abuse (NIDA) points out, “In addition to stopping drug abuse, the goal of treatment is to return people to productive functioning in the family, workplace, and community.” And effective treatment can do that, the NIDA continues: “According to research that tracks individuals in treatment over extended periods, most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning.”

However, it’s important to note that the key word there is “remain,” because while treatment can help with the stopping, it can’t do much about an individual’s ability to stay clean and sober if those individuals don’t implement changes to all areas of their lives. And because addiction to drugs and alcohol stems from a broad swath of social, economic, racial, sexual and cultural backgrounds, it’s extremely difficult to design a one-size-fits-all treatment approach that can work for any and all patients in a typical 30-day rehab stay.

As the writers of a consensus study report for the National Academies Press point out, “Drug treatment is not a single entity but a variety of different approaches to different populations and goals. Response to treatment is not a matter of all or nothing, complete success versus total failure, but of degrees of improvement. Moreover, the setting for evaluation is not the quiet purity of a controlled laboratory experiment but the tangled complexity of real lives and programs under pressure from many directions.”

In other words, as one Princeton University study points out, “A wide array of factors complicate the assessment of treatment effectiveness. The chronic relapsing pattern of drug abuse, the heterogeneous composition of the drug-abusing population, and the problems created by patient self-selection of treatment modalities are some of the problems” that prevent a foolproof determination of treatment’s effectiveness. In addition, Princeton researchers write, there are other intangible components that can play a role in whether a quality drug and alcohol treatment program meets the needs of its clients, including patient expectations; the abilities, attitudes and experiences of staff members; and more.

So how effective is drug rehab? In many instances, it depends on the individual facility.

How Effective Is Drug Rehab: Ask Questions

Last year, journalist German Lopez spent months investigating the effectiveness of drug and alcohol treatment in the United States for the online publication Vox, and as part of that series, he asked a number of experts how individuals and family members could find the best treatment possible.

Over the last decade or so, that’s gotten progressively more difficult, as a 2015 piece in Forbes pointed out, due to a number of contributing factors, including facilities with “advertised success rates of 80% (or higher) with no scientific evidence.” What the experts told Lopez was that “patients should go for the most comprehensive and individualized treatments possible. It’s crucial not to settle for a one-size-fits-all approach, even if those worked for someone you know. Addiction is a complicated illness that varies from individual to individual, so different approaches can work better for different people. Programs should assess patients and adapt based on their needs.”

To determine if a prospective facility meets those needs, Lopez, with the help of those experts, came up with a list of 11 questions that individuals should ask of a facility, if the information isn’t available on its website:

1. Does the facility “diagnose and treat physical and mental health conditions, besides addiction? Drug use can cause physical health problems, and addiction can co-occur with different mental health issues. If these aren’t treated as well, recovery can be much more difficult.”
2. Does a facility use Medication Assisted Treatment in some form or fashion? (Medication Assisted Treatment is the use of federally approved medications designed to aid in the recovery process.)
3. What long-term options does a facility have? According to the NIDA, “generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes.” With that in mind, does a facility offer intensive outpatient programs for post-residential care? Is there a sober living facility? Is there aftercare planning to help addicts and alcoholics transition back into the “real” world?
4. If a patient relapses, what is the protocol? As Lopez points out, “There are legitimate safety and security reasons for preventing and stopping drug use at treatment facilities, but experts say relapse shouldn’t be used as a justification for discharging a patient. Instead, relapse is a sign that someone actually needs more treatment. It’s important to make sure that facilities will work with people who relapse and, if necessary, connect them to higher levels of care.”
5. How effective is drug rehab? Ask! According to Lopez, “Addiction treatment typically succeeds 50 to 60 percent of the time. If a program claims a success rate of 80 percent or more, it’s likely not being honest with you.” While facility spokespeople may not be able to quote a certain percentage depending on the metrics they use to track success, a credible facility can at least offer a measure of proof that its modalities work.
6. What kind of treatments are offered? It’s important to find a facility that offers “evidence-based treatments like medications, cognitive behavioral therapy” and other psychotherapies that are backed by scientific studies.
7. Are first-time patients eligible for enrollment in outpatient treatment, or is every potential client shepherded into a residential program?
8. Does a facility employ licensed medical professionals? As Lopez writes, “Look for MDs, nurse practitioners, and physician assistants. If no one on staff has the kind of certification you’d expect at a doctor’s office, that’s a big cause for concern.”
9. Is a facility linked to a broader health care system, like a hospital network, and if not, does it have relationships with other health care systems for referrals?
10. What insurance plans are accepted, and what measures do staff members take to make sure treatment is covered? “Not only can this save you money, but it can be a sign that the treatment facility is more likely to be legitimate. If it has connections with health insurance companies, that can be a good sign.”
11. Is a facility accredited? “Accreditation from the Joint Commission and CARF is not a guarantee of success, but it does suggest the facility at least meets some baseline standards and is open to some accountability.”

So What’s the Bottom Line?

How effective is drug rehab? As effective as the individual’s willingness to get better, in many cases. At the risk of sounding redundant, a “one size fits all” approach is often ineffective, and highly touted “success rates,” according to a 2014 article on the financial news website MarketWatch, often “depend on how ‘success’ is defined. In some cases, the figure may only refer to the completion rate – that is, the percentage of people who finish the program. Or it could mean a relatively short period of post-program sobriety – say, a year after completing treatment. And any post-program figure may be questionable since it could be a self-reported one (in other words, it’s a number that’s only as good as an addict’s word). The bottom line, says Dr. Akikur Mohammad, a psychiatrist who teaches addiction medicine at the University of Southern California, is that any success rate that sounds too good to be true probably is.”

So what does that mean for those who need effective drug and alcohol treatment? First and foremost, it means that they should leave no stone unturned when it comes to vetting a particular program. That may seem like a lot of work, and it is, but it’s also necessary. As the American Society of Addiction Medicine points out, “Today addiction treatment is virtually all short-term while the disease of addiction is a life-long threat. The risk of relapse remains even after years of stable recovery. Recovery can be thought of as a ‘remission’ of the symptoms of the disease of addiction, not its elimination.”

With that in mind, it’s important to ask questions, read reviews, talk to a facility’s alumni (if possible) and do everything you can to arm yourself with the information you need to make an informed choice. Asking, “how effective is drug rehab?” may lead you to more questions than answers, but asking those questions is the first step toward assurance that the rehab you’re considering can make a difference, and perhaps save a life.