Misleading Relapse Rates in Treating Addiction

We have all heard of the lousy relapse rates when it comes to treating addiction. But what about some of the success rates you hear about from various treatment programs or drug rehabs? Do these programs and rehabs really have the magic answer? Let’s take a look:

Keep in mind that sometimes the numbers are manipulated a bit, and a certain treatment method or a specific rehab might distort their numbers a bit. This occurs naturally as businesses want to look good and encourage more business, even if their particular method is not really all that successful at truly helping addicts and alcoholics.

How can success rates be manipulated for recovery?

One way is through the use of discounting those who relapse or fail through some line of reasoning. For example, a treatment center might do a follow up survey and ask all of the respondents if they were still clean and sober after, say, 6 months time. Many will say that they have relapsed, and the percentage of success will not look so great. So in order to improve that rate, the questionnaire might ask if they followed through explicitly with all of their aftercare recommendations (such as attending long term treatment, going to intensive outpatient groups, or attending 12 step meetings every day). If the person has not explicitly followed their drug addiction therapy (a highly likely scenario), then the survey results discounts this “relapse” from their results because the person did not technically follow through with their treatment program.

Another way that relapse rates are misrepresented is with the whole drug-of-choice argument. Say a person is addicted to crack and they go to treatment and they manage to stay off the crack when they are released and might even attend an NA meeting or two. In follow up surveys, they correctly proclaim that they have in fact abstained from their drug of choice, while in the meantime, they have started drinking heavily in order to self-medicate over the lack of their “real” drug of choice. Under such a survey system, this type of person gets counted as a success story, when in fact, they are simply switching one drug for another and are likely no better off then when they started.

A third way that relapse rates are manipulated is due to the creative use of time frame. An example of this would be to show how your treatment center might have a really high success rate at getting addicts clean and sober for at least 30 days. This seems remarkable at first, until you realize that this particular treatment center is a 28 day inpatient program in a strictly controlled environment. Basing the success rate on 6 months or years clean time would be much more useful, but obviously not as compelling when it comes to marketing purposes.

Action items – what you can do:

1) Don’t pin your hopes on a number. Success in recovery is not magic, and there are not short cuts. It takes work and dedication to achieve long term sobriety.

2) Don’t limit yourself to a single treatment philosophy. There are different methods and programs for staying clean and sober, and the choice of which one you use is far less important than what any single person will tell you. Why? Because everyone thinks that the method they used to get sober is the only true way that works. Simply not true. Which program you choose is almost irrelevant. What matters is your conviction to stay sober and your level of willingness.

Managing Chronic Pain in Treatment Centers

There is a recurring problem with treating addiction in drug rehabs: people who have chronic pain. Some of these people are addicted to painkillers, and opiate medications have become their drug of choice. Other people have chronic pain and are addicted to something else (such as alcohol), but they can’t use their prescription medications in a drug rehab facility, so that becomes a problem as well. A third group of people might have been self medicating for years with alcohol or other drugs, and now that they have checked into a treatment center and are getting clean and sober, they are starting to notice a chronic pain in their body that they might never have even known was their.

All 3 of these types of situations present a problem for recovering addicts.

Most treatment centers and drug rehabs take the approach that no client that is admitted to their care can use opiate painkillers while they are in treatment. This is just the approach that the majority of treatment centers have taken.

Most professionals have the attitude that it is important to try to manage chronic pain without addictive opiate medications, especially if the person is checking into a treatment center for any type of addiction (alcoholism, cocaine, whatever the case may be).

So here are some pointers about chronic pain that can help the recovering addict:

1. The pain is far less than people realize - this is because of the nature of opiate painkillers (such as Vicodin, Oxycontin, Morphine, etc.)–they do not really lessen the pain at all at the source….instead, they simply dull the brain into thinking that it doesn’t mind the pain so much–right at the level of the brain. They have found that patients given opiate medications can still accurately describe the level of their pain, even though their brain has been dulled into not caring about it so much. This is very different from how some other pain medications work, such as NSAIDS like Ibuprofen, which actually reduce the pain and inflammation right at the site of the pain itself.

2. Opiate addicts who have become dependent on painkillers are simply playing catch-up, trying to constantly medicate themselves from withdrawal symptoms. The withdrawal symptoms will eventually start to become indistinguishable from their original source of pain, so this is a long term game that they can never really win anyway. Kicking the opiates and finding an alternative is the best long term solution.

3. Alternative solutions will present themselves as people remain clean and sober, and coming to manage their pain effectively might be a learning process. If someone is taking a large dose of opiates several times a day to manage their pain, and they go to treatment and detox and get clean, it might take a month or two before they really learn how to get their pain down to a manageable level. Realize that this is very possible though! Their are alternatives to opiate medications, including both alternate medications and alternate therapies. Hypnosis, in particular, has proven to be especially helpful for some people in managing very serious chronic pain. But recovering addicts can learn what works for them and go far beyond the ideas here, using things like hot showers, massage, or even meditation to help them in alleviating their pain.

If you are addicted to opiates, understand that those types of drugs merely mask the pain, they do not lessen it, and many of the alternative therapies can actually lessen the amount of pain right at the source.

How to Choose the Right Drug or Alcohol Treatment Center

How can you best choose the right drug or alcohol treatment center?

This is a common question for anyone that is thinking about going to treatment, and it’s also a big question for the family of a struggling addict or alcoholic. How can someone choose the right treatment center so that they can insure that they will stay clean and sober?

There are a few issues you will want to consider here:

What level of treatment does the addict or alcoholic need? Some people need a medically supervised detox, while others do not. This will depend a bit on what substance or substances are being used. For example, alcohol poses a serious threat when it comes to detox, so that will definitely need to be medically supervised. Opiate drugs such as heroin or Vicodin will generally need a medical detox as well. Keep in mind that not all treatment facilities have a full medical detox. Knowing what level of care you need will obviously be a key point in your research.

Is this any different from previous treatment centers? A surprising number of addicts and alcoholics go to treatment and then relapse shortly after leaving. What’s really shocking is that many of these people continue to go back to the same treatment center, clearly blaming themselves for failing to stay clean and sober. This is a tricky argument here, but I can assure you it is valid: if you keep failing with one treatment center, why not try somewhere else? Likewise, if you go to several different treatment centers for short term residential stays, why not try going to long term treatment instead? This is a concept that is thoroughly endorsed in AA as well: “insanity is trying the same thing over and over again and expecting different results.” This doesn’t mean you shouldn’t try going back to treatment again. But it does mean that you might want to try a different drug treatment center, or even a completely different approach (for example, short term versus long term treatment).

Will this treatment center save someone that doesn’t want help? The answer to that question is no, which means that no treatment can help this particular person in their journey (yet). Unfortunately, no one can beat an addict or alcoholic into submission, and no treatment center can convince an addict to want to stay clean. Sometimes the best you can do is offer to help someone and then get out of their way.

A corollary to this idea is this:

“When someone is truly ready to get clean and sober, it doesn’t matter what treatment center you take them to.”

In other words, the success rate of the recovering alcoholic or addict is heavily dependent on their personal convictions, not on the strength of their chosen treatment program.

This can easily be confirmed to be true by interviewing a handful of successful recovering addicts and alcoholics. Simply ask them about the treatment center or method by which they got clean, and ask them which was more important: “That they were truly done using drugs and alcohol, and desperately wanted to change,” OR “That they found the perfect treatment center that somehow worked a miracle in them.”

I can guarantee that it’s personal conviction and level of surrender.

Treating Addiction – Why are Treatment Centers so Expensive?

Treating addiction is expensive. Period.

Actually staying in a drug rehab costs a lot of money, simply because it is essentially a health care facility similar to hospital. If the rehab offers detoxification services (and most do) then these will be medically supervised by nurses and possibly even doctors which will only add to the higher cost.

But the high cost of treating addiction goes further than this. It’s expensive to treat because addiction is so complicated.

For example, many addicts and alcoholics have co-occurring disorders–a mental illness diagnosis of some sort along side of their chemical addiction. Helping this type of person to recover from addiction will usually involve treating their mental illness as well. This drives the cost of treatment up even further, as psychiatric counseling and any necessary medications are not going to come cheap.

Not only is it expensive, but the financial implications with treating addiction and alcoholism are getting worse in the following ways:

1) Treatment services are becoming more expensive – as the cost of health care in general continues to rise.

2) Insurance companies become less and less willing each year to pay the cost of treatment.

3) Insurance companies are only willing to fund shorter treatment stays, which are proving less effective, requiring more visits in the future and ultimately costing more.

4) State funding for treatment is gradually being reduced over time.

You have to give credit to AA and 12 step fellowships. While they may not have the medical facilities necessary to safely detox an alcoholic, many people have skipped going to formal treatment centers entirely and made their way to a successful sobriety through the use of AA alone. Given that it is essentially “free” (self supporting through their own contributions), a person could feasible stay clean and sober without ever spending a single dime on their recovery, simply through the use of meetings.

What makes this even more maddening is that the success rates are very close when comparing treatment centers to AA. When looking at the success and failures in recovery, it almost seems like the initial stay in rehab was inconsequential. Long term sobriety rates point to the fact that it really doesn’t matter how you got clean, it matters how you stay clean. Rehab is short term, but sobriety has to last for a lifetime.