Out With the Old

We recently shared a New York Times' article on our social media pages that we wanted to take a closer look into: Experts Say We Have the Tools to Fight Addiction. So Why are more Americans Overdosing Than Ever?1 

This article is a damning indictment of the prevailing treatment industry.

A brief background of the article: This op/ed is the story of Harris and his mother, Stephanie.  Harris attended four in-patient rehabs, one inpatient psychiatric facility and two outpatient substance use programs.  He also saw psychiatrists and psychologists, attended 12 step meetings and the gym.  In the end all efforts failed.  Harris died of an Opioid overdose at age 19 in 2013.

As a person in recovery and counselor, this is a typical story: someone struggling with addiction attends multiple treatments, costing tons of money, and it ends in overwhelming tragedy. Usually the parents are so grief stricken and ashamed about the addiction and so confused about what happened that they do nothing to investigate what went wrong and how it could have been prevented. Not this time!  Stephanie decided to try and figure out why treatment failed her son and so many others.

Stephanie was able move beyond this shame and blame to take a hard look at the treatment industry as a whole - something no government agency or prominent non-profit in the field has thought to embark on.  She started The Harris Project.  Why? Because we are a nation in a mental health and substance misuse/addiction crisis. Because, in our experience with Harris, the recovery programs he attended boasted at best 12% success rates.1

 

That’s right, 12% success rates.  Even if some programs are better, say they have a success rate of 20%, that means that only 1 in every 5 treatment attendees recovers. These are unacceptable statistics. The existing predominant system needs to go.  And what is this system? One that consists of promotional marketing, but generic programming. Treatment centers’ promotional material is not what treatment centers actually deliver. Again, from the Harris Project: Regardless of what rehabilitation programs promised, our experience revealed a treatment model that was almost always the same: abstinence from drugs, group therapy, minimal face time with psychiatrists and psychologists, often a removal of medication designed to aid with mental health challenges or a failure to augment or change medications that weren’t working, and ultimately discharge from the program.2  Patients are provided a generic service that can vary in cost from $20,000 to $100,000 per month and is characterized by relapse and low success rates.

 

The other common components of the current system are:

  • Intervention: The “patient finders” for treatment centers. A concerned loved one contacts a professional in the hopes of starting the process to guide their loved one toward treatment and initiate recovery. The interventionist then makes treatment recommendations and referrals. This unregulated service is how treatment centers obtain many of their patients, with costs ranging from $3,000 to $10,000 or more for the intervention.
  • AA/Al-Anon – Go to AA, Go to Al-Anon.  The usual referral for treatment centers, counselors and friends and family.  Addiction is the only medical condition where family and friends are told to “Let go and let God” as the solution for a loved with an alcohol or drug problem.  Not only has this advice killed so many of us, but it is absolutely contrary to well documented evidence that families and friends can be very influential in supporting a relative's recovery, IF assisted by a competent recovery coach or counselor.

 

These are just a few examples of how the current treatment model and system is cracked. Not only does this lead to low recovery rates, but there is an existing lack of integrity regarding accurate reporting. 

 

Misrepresentation on Recovery Rates:  Where are the Feds?

We've established that the current treatment model is ineffective and needs to go, but we also need to address the highly misleading or made up recovery rates.  It is common in the field to hear rates as high as 80% - 90% promoted to prospective payors (very often family members who are desperate to believe there is a quick fix and are contemplating paying a non-refundable large fee).  Some rates appear to be made up.  Others are based on highly selective data management. Unfortunately, treatment is one of the few fields of medicine not regulated by the FDA or consumer agencies regarding claims of success. This reinforces the author’s point that the field needs to be brought up to professional standards applicable to all medical conditions.  Reigning in false success rates would be a major reform and incredibly simple to enact at the federal level.

 

There are two professions that are doing what the rest of us aren't (can't): doctors and pilots. 

  • Doctors have 78% continuous abstinence at FIVE years4
  • Pilots have 90% continuous abstinence at TWO years3

 

Industry leaders are well aware that doctors and pilots have very high recovery rates: 78% at five years, 90% at two years, respectively.  I first learned about the high recovery rates for pilots in1998.  I spoke to administrators at the center treating pilots and asked to open the program to other groups, thinking specifically of my brother.  My request was turned down.  If the same scenario occurred in cancer treatment, there would be an outcry and demands for action from patients and their families.  But not for us addicts and our families – we just blame ourselves and meekly attend our grief groups.  Where is the anger? Why are we letting people die when we have the answers? 

 

 

The answer? Malpractice!

This recovery field is a field that is crying out for malpractice litigation.  A very common scenario is my brother, who went to treatment twice at a center that also offered pilots their specialized programs.  He was not offered this program and relapsed after both treatments.  Sounds like a potential lawsuit to me. But relapsing patients are so far into their shame, pain and self-blame that they are not able to pursue a claim.  What about going after the system that failed them? 

 

And my brother gave up – Treatment doesn’t work for me. A common refrain for so many who were intervened on, went to treatment and relapsed.  They give up, thinking most people recover and there must be something wrong with them.  (Another unforgiveable consequence of their highly misleading promoted rates.)  Or they become treatment savvy and cynical, hardened to attempts at change.  

 

Avoid the Current System

I say, avoid the current system at all costs.  Which is difficult to do, because that is all you get on the WEB – Pay for our fantastic in-patient treatment – that is the sell to families.  Forget calling an interventionist, an in-patient treatment center, AA or Al-Anon.  None of these are called “EVIDENCE BASED PRACTICES”. Simply put: they're not. If they were, there would be evidence to suggest and prove they work.  In fact, all the evidence says they don’t work – 12 %?  Better off doing nothing rather than shelling out several thousand for an intervention and multiple thousands for treatment, spending time in AA or Al-Anon and wasting an opportunity for recovery.

 

What Does Work?

  1. Detox - ER
    • The only part of the current system that works is detoxification.  There are stand alone treatment centers.  One in Minnesota costs about $4,000 for four days of medically supervised in-patient detox.  Or you can take your LO to an emergency room for detox. If your LO is medically at risk, call 911.  My brother has been to the ER so often, the EMT’s know his dog’s name and which room to put him in his house.  Or if violent, call the police. 

  2. Peer Specialist/Recovery Coach
    • You as the family hire this person privately, or if you are short on funds, find your local Recovery Community Organization.  The goal here is to have someone help you to encourage your loved one to seek help.  This is a long-term relationship, as addiction is a chronic disease that needs to be managed over the long-term, with several tries needed to obtain stable recovery.

    • What is a Recovery Community Organization – Here is a description of one: Minnesota Recovery Connection is a Recovery Community Organization (RCO), led and governed by representatives of local communities of recovery.  We honor all pathways to recovery and are not a treatment provider.  Rather, we exist to fill gaps in systems of care, connecting people to support and services that help to make long-term recovery from substance use disorder possible.  We do this by providing peer-to-peer recovery support services, public education and advocacy.

    • Key Point: Not a treatment center.  And cost.  Essentially, you can pay for as much peer support as you can afford.  It is normally not covered by insurance, but going costs are $50 to $70 per hour.  Forty hours for $2,000 = money well spent.  And you don’t have to sell your home to pay for multiple in-patient treatments.

  3. Counseling for You and Your Loved One
    • Use your insurance to pay for counseling for you and your family as soon as signs appear that there is something wrong.  Use your gut and observable behavior – don’t buy into the excuses and the BS (an addict’s specialty). Also, encourage your LO to seek individual counseling. 

  4. Education - learn more about what works (i.e. why are the programs for doctors and pilots so successful?)
    • Find out why they work and how to apply their program concepts to your LO as advised by your counselor, including incentive-based programs to encourage treatment compliance

  5. Drug Testing
    • Drug testing is critical because it keeps addicts honest.  It is key to picking up on a relapse so a new approach and plan can be implemented before use returns to old patterns.  Us addicts don’t like it, but WTF, too bad.  Use the same drug testing protocol used by the Physicians Health Program in your state.  (See https://www.fsphp.org/state-programs.)

 

Closing thoughts: You are going to have to be tough to reject the current system because it is based on exploiting your fears regarding your LO’s use of alcohol and drugs.  These very real fears make it easy to fall for what seems like a quick solution: intervention and in-patient treatment.  But this is not a solution.  It will only bring on more heartache, family disruption and alienation and is very costly.  Take some deep breathes.  Then call your local RCO and also find yourself a counselor.  

 

1 "Experts Say We Have the Tools to Fight Addiction. So Why Are More Americans Overdosing Than Ever?" New York Times Opinion. Jeneen Interlandi. June 24, 2022. https://www.nytimes.com/2022/06/24/opinion/addiction-overdose-mental-health.html

2 The Harris Project. July 3, 2022. https://theharrisproject.org/

3 Human Intervention Motivation Study. Providence Treatment. July 5, 2022. https://www.providencetreatment.com/about-providence-treatment/addiction-treatment-for-professionals/addiction-treatment-pilots/faa-hims/

4 The New Paradigm for Recovery. A report of the John P. McGovern Symposium Hosted by the Institute for Behavior and Health, Inc. November 18, 2013. 


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