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Adiction treatment needs to be revamped?

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belfort

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Nov 2, 2005
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i red articles, listen to experts say across the board that the best doctors get at best a 83% relapse rate..this is awful yet people pay hundreds of thousands for rehab yet just come out and relapse over and over..we they going at it the right way or should it be 100 revamped and changed?the counselors ive seen were not exactly qualified imo as they didnt even know what PAWS were..i knew more about addiction than many of them but they were trying and it was a low income treatment center..

anyone been to these fancy rehabs?are they any different from the low income centers/even dr drew, a man i truly respect and admire said his own relapse rate is around 83%..so, obviously what they are doing isnt working imo and needs to be revamped...

anyone have any ideas how addiction treatment can be changed to get better results?i just think addiction almost always comes with mentall illnes and when u combine both, its like exploding shrapnel and u need to gather all the pieces and and try to piece them together again..a very long time consuming process with low odds of actually making big changes from what ive seen..i hope that doesnt come across as negative but very few addicts seem to ever change, they just seem to transfer their addiction to something else, exercise, na meetings, bungee jumping, drinking 20 pots of coffee daily and some have even turned to sex..

honesty is appreciated and if this comes off negative on this forum, i will change it but i feel a strong need to be honest from what ive seen and experienced since ive been in and out of addiction for the past 15 years..
 
I am right there with you belfort. I have been working on a new recovery protocol. Basically, I had the same thought: "If the relapse rate is so high, and the success rate so minimal, than why are we still using the same dusty, archaic model from the 30s if it truly is a life and death problem?"

I had the same thought about the mental health. Most addicts don't have the resources to go to a fancy rehab, and generally the wealthy parents of addicts send them there, which as we all know is not healthy. They have to want it. The rehabs that are attainable are often very shoddy, and not very helpful. If you have read the detox and rehab thread, you will see that the good ones are few and far between. The psychiatrist, and the licensed therapists are often overstretched across so many patients that the patients do not get the care they need in order to move past the mental aspect of addiction and work on the problems they face. Some don't even have psychiatrists or licensed therapist instead opting to have previous clients with only a year sober leading groups. Oftentimes insurance only pays for 28 days, when it is proven that for opiates and benzos you need at least thirty days to get through the withdrawals to a point that you can actually work on your problems.

The first thing that needs to be done is we need to take money away from the failed war on drugs and pump it into education, and rehabilitative services. Also, I have noticed that the religious, and 12step rehabs often still look at addiction as a moral problem, and not a health problem. This leads to addicts not receiving the mental health help they need, and being put in a position that they feel shame for being an addict.

There are also lots of rehabs that are cults. Consider synanon, or teen challenge. Those two pretty much try to indoctrinate you into a religion and claim you can only get sober if you find god. This is not true. Many of these rehabs that are christian based are workcamps that only offer prayer and religious services in lieu of actual treatment. Behavioral healthcare models of rehab are good, but are drastically underfunded. There are too many addicts in need of help with too few beds. Every rehab I have ever gone to I had to call everyday to see if there was a bed and one took over a month. Sometimes an addict doesn't have a month. Can you imagine how many people have OD'd or committed suicide while waiting for a bed?

Suicide is another thing. If you are fed the lie that addiction is a moral failing, you often have so much guilt and shame for the things you did while using. I went to multiple AA meetings everyday for over a year and at least three people in one group that had over 5yrs of cleantime ended up committing suicide. If that is not a good indicator that it isn't working, then I don't know what is.

I leave this thought and I hope other's can expand on it: Most rehabs are based around making profit. In a capitalist economy (which most private rehabs follow the capitalist model) if something has only a 17% success rate, and most addicts end up defaulting on their bills due to heading back to active addiction...how are these still open? I know the fund for rehabilitation is anemic at best...but rehab is big business.
 
A good healthy outpatient program is really what is most important to sustainable treatment. It has to be flexible yet remain rigid just enough to hold people accountable to what they SAY (not simply what they sign).

Inpatient can be a god send, but it is the most expensive form of treatment, and rehabs make billions a year, it is a HUGE industry, just in SoCal alone. It is sick.

Outpatient is so much more important and so underfunded because the big buck are made by rehabs billing insurance plans hi sums for inpatient care as opposed to small sums for outpatient care.

I get the economic sense of preferring the large over the small payoff, but it doesn't take sense even them.

You'll get more money faster with inpatient, but with long standing quality outpatient where the patient actually WANTS to participate in his or her treatment is going to make more money for the clinic or doctor's office in the LONG RUN (or even the mid run).

Either way, this consumer culture we export worldwide makes me sick. You know what I say? Fuck Coca Cola. Fuck McDonalds. Fuck them all to hell. Won't be making anything off me, but I guess that is my luxury and not that of the millions of the poor they thrive off. Opps, my post-Marxist leaning my be becoming expose a bit here ;) The frankfurt school boys, the frankfurt school is where it is at %)

I'll stick to my rice and beans and french press coffee thank you. Nothing fancy for me, but then again I'm a broke upper middle class kinda douche when I get cocky like this :\
 
^^^exactly my point. Its like politics...take the fucking money out of rehab and politics. Most addicts don't have the funds to even support going to outpatient and they may end up in the free yet archaic cult that is AA/NA (which has quite a few predatory people in it)
 
I agree that there are quite a few predatory people in the 12-step programs. I just look at it like a crossection of society. I found great people, I found people who really helped me grow. I met people who loved to see others fail. I met people who were the worst kinds of users. But after being in the spoon for 35 years, I thought it was a trip to see people who were the same as me and were living life as something other than junkies. I didnt know that could happen. When we were young, there were only 'kick-pads' - where you pay like $20 a day and you got a mattress in some basement somewhere and you just - kicked. So I guess the 12-step thing it was better than that!:)
 
More emphasis on mental health!
I got some good experiences from inpatient rehab so I wouldn't say it was useless, but they didn't do anything to address my real needs. They were all about detox detox detox. I wasn't even physically addicted to alcohol and didn't suffer withdrawals, I was a few days sober coming in. But they drugged me out of my mind with phenobarbital and offered me serious prescription drugs like Seroquel and Trazedone just for sleep. They followed my list of medications from my own doctor but didn't check for interactions with their drugs or if their drugs were safe for someone with bipolar.
The first week or so was a haze because I could barely stay awake. So obviously I wasn't getting anything out of classes or group and they were aware that we all had this problem at first and told us it was fine to fall asleep in our chairs as long as we showed up.
I saw the actual psychiatrist 3 times, one when I was admitted, and one when I was discharged so really only once as a real session.
One on one therapy only happened every few days.
All they seemed worried about was to get me to stop drinking but they didn't care why I was drinking.
 
Mmp85 said:
More emphasis on mental health!
I got some good experiences from inpatient rehab so I wouldn't say it was useless, but they didn't do anything to address my real needs. They were all about detox detox detox. I wasn't even physically addicted to alcohol and didn't suffer withdrawals, I was a few days sober coming in. But they drugged me out of my mind with phenobarbital and offered me serious prescription drugs like Seroquel and Trazedone just for sleep. They followed my list of medications from my own doctor but didn't check for interactions with their drugs or if their drugs were safe for someone with bipolar.
The first week or so was a haze because I could barely stay awake. So obviously I wasn't getting anything out of classes or group and they were aware that we all had this problem at first and told us it was fine to fall asleep in our chairs as long as we showed up.
I wisaw the actual psychiatrist 3 times, one when I was admitted, and one when I was discharged so really only once as a real session.
One on one therapy only happened every few days.
All they seemed worried about was to get me to stop drinking but they didn't care why I was drinking.
Click to expand...

You make some excellent points. Rehabs are closed systems that seem to have a problem interacting with doctors outside of that system. I think for recovery to happen eveeryone needs to be on the same page and kept in the loop. Your primary doctor, therapist, and phychiatrist outside the rehab all have to be clued in. Otherwise when you leave in 15-30 days the work they did with you will be lost this is because 30 days is not enough time for any kind of change to be sustained. In my experience I will never go to another IOP again because I don't feel like they have enough trained practitioners for the work load they are give.


Anyway great post.
 
That is so true, especially it seems in places where there is still an burdensome influence of prohibition/DLE and abstinence as apposed to more of an emphasis on public health and harm reduction. It is amazing how systems will differ for certain populations too.

So often people are placed in totally inappropriate levels of care - IMO this is actually how the industry seems to sustain itself, by putting people in inpatient programs who'd benefit more from outpatient, and putting people in outpatient programs who'd benefit more from individual therapy and counseling.

The lack of trained professionals and professional standard communities (think of lawyers and doctors, they have the bar and ethics boards, but addiction counselors don't have any standardized unified bodies - or rather those in place are so ineffectual they are a joke and product of 30 years ago when things were very, very different.
 
With my insurance, inpatient treatment was cheaper than outpatient, go figure.
Inpatient was probably too much for me and the level of my drinking habits but at the time the idea of getting away from my life for a bit was very appealing.
Doing one on one therapy with a "real" (as in not just a recovered addict with a certificate) therapist who specializes in addiction and is also a recovering addict is has been so beneficial but I realize I really lucked out finding him.
Also the fact that so many rehabs are 12 step based is a problem. Not opposed to AA or NA even though it's just not for me, I just hate seeing it preached as the only way without ever showing other options especially when patients are at their most vulnerable.
 
Mmp85 said:
With my insurance, inpatient treatment was cheaper than outpatient, go figure.
Inpatient was probably too much for me and the level of my drinking habits but at the time the idea of getting away from my life for a bit was very appealing.
Doing one on one therapy with a "real" (as in not just a recovered addict with a certificate) therapist who specializes in addiction and is also a recovering addict is has been so beneficial but I realize I really lucked out finding him.
Also the fact that so many rehabs are 12 step based is a problem. Not opposed to AA or NA even though it's just not for me, I just hate seeing it preached as the only way without ever showing other options especially when patients are at their most vulnerable.
Click to expand...

The rehab I went to in new york gave you one free go around paid for by the state. The only problem is I went during the winter and you end up with crazy homeless people trying to escape the cold. All in all it was good, other than the fact you are mixed in with homeless people and people choosing rehab over jail (the drugdealers were the worst...they literally were detracting from other people's recovery. There was one fellow that realized he was addicted to the game and realized he wanted to change his life because he hated how it was...but that is the exception and not the rule).

12 step and religious based rehabs are really not helpful. At that stage of early recovery people are so vulnerable to indoctrination into that type of mentality that they may not see that there are many paths to the same point. At that stage an addict needs warmth, comfort and a dose of reality, not crazy religious bull honkey and slogans.
 
12 step have helped many so not fair to bash it because it didn't work for you
Addicts need it tough. People should be held accountable for their actions. Not treated like nothing was their fault (blame parents,blame life etc..).
The present model don't give good results but it's better then nothing.
 
That is the point, the present model does not work well. Confrontation is shown to give very, very poor treatment outcomes. When you try to force someone to get sober when they dont want to, or are unsure if they want to, or use blame and guilt to try and get them to change, the best possible outcome is the creation of a dry drunk - someone who may remain abstinent but is just as, if not more, fucked up than they were when they were using. And that applies to all substance and behavioral related addiction issues.
 
You have to quit for yourself. No one else does it for you.

Out-patient based programs with medication prescribed to the patient (methadone, suboxone, etc) work best. That's what I believe in.

This isn't a deterrent to anyone doing it another way. If you got clean, then that's what counts! <3
 
I merely talk about detox and early recovery. Once an addict has their faculties back and their wits about them, then the addict can make a choice over which route to go. The reason for inpatient treatment is to detox fully. It is also a start of therapy which is important in recovery, and a way to get stabilized on meds. Forcing twelve step during detox has caused many addicts to leave rehab AMA.

Whether an addict needs a firm hand or kid gloves in early recovery is up to the addict. An addict needs to be offered what works for them as each addict is an individual and there is no one size fits all answer.
 
I think i believe in total abstinence method; i don't see how methadone or suboxone could really help people grow past their addiction long term versus remaining a slave
 
That is the idea, it is generally viewed as most effective because it is a step, a step not just to abstinence, which is kinda besides the point, but in increasing the individual's quality of life, them and those around them. If that means abstinence, then that is great. If not, the is great too.

It's all about quality of life at the end of the day, abstinence is just how some do it (well, in our strictly prohibitionist culture it is how most have to do it, but that is a cultural/social thing, not necessity; it's hard to have a high quality of life when you're constantly discriminated against, stigmatized and treated like a deviant criminal).

What people often overlook is that 12 Step philosophies and group DO NOT have any monopoly on an abstinence based approach. Harm reduction includes the same type of approach, its umbrella is just much more inclusive and tolerance of our diverse paths to recovery.
 
cire113 said:
I think i believe in total abstinence method; i don't see how methadone or suboxone could really help people grow past their addiction long term versus remaining a slave
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Methadone and suboxone are different routes to the same place. Opiates fuck your brain up so bad and relapses are so fucking deadly that the safety net maintenance allows is vital.
 
cj said:
Methadone and suboxone are different routes to the same place. Opiates fuck your brain up so bad and relapses are so fucking deadly that the safety net maintenance allows is vital.
Click to expand...

Exactly. Using ORT is a way to get your life stabilized. When using, many people are homeless, jobless, penniless, and in poor health. It is what happens when use becomes the way of life. That person's life is so out of control that in order to get clean they are going to need to have a time of stability (which ORT {when done correctly} offers). My girl is a prime example of someone for whom ORT has worked. She needed the structure it offered, as well as the stability of knowing she is not going to have to go sick. I on the other hand have not had success with it. I end up using because I end up craving something more.

It is up to the individual what will work. If it saves you from yourself then I would look at it as a success.
 
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