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Choosing Rehabs – The Quest to Sort Out Fact from Hype

If you or your family member is a candidate for alcohol/drug rehab of the month-long (or longer) inpatient variety, we have noted in a previous blog post that your health insurance plan will probably not help you with the cost.  So you are in the position of trying to make a choice as an “educated consumer.”  This is not easy, even for us at LCL, since we make very few such referrals in this era when access to that level of care is beyond the means of most of our clients.  

Naturally, you will want to review the brochures or web sites of facilities that you are considering.  The helpful aspect of that process is that you do get a sense of how the tone of some settings differ others, e.g., the degree of emphasis on family involvement, spirituality, the personal recovery experience of staff, and whether they favor nontraditional add-ons to treatment such as “equine therapy” (horses) or outward-bound type physical challenges (programs that, of course, add to cost).  But all programs look pretty great on their own web sites.  You may wish to give advantage to those in Massachusetts – but the selection here is quite limited, while there is a plethora of facilities in states like Florida, Arizona, and Minnesota.  Since we make relatively few referrals, we at LCL may not be able to provide updated impressions of all rehabs that interest you (though we certainly can help you review your options).  The reports of friends/colleagues who have been pleased with their rehab experiences can be most valuable.

I also want to alert you to the relative uselessness of claims about rates of success.  There are too many ways to spin results of whatever kind of outcome research is done.  Here is an example.  A facility decides to follow the outcomes, success frequently defined as sustained sobriety, of 100 patients.   They asked 115 patients to participate, but 15 refused.  3 months after discharge, they send a questionnaire to all 100 “graduates.”  Of these, 50 bother to reply.  Of those, 40 are still sober.  They then report, in their brochure, an 80% success rate (40 out of 50 patients reached).  But what about the 50 they did not reach, and the 15 who refused to participate?  In all likelihood, a much higher proportion of this group of former patients has relapsed, and that’s a significant part of why they are not participating.  If we make the more conservative assumption that those who did not reply have not sustained sobriety, then the success rate plummets to 40%.  If we also include the 15 who did not participate (so that we are no longer, in essence, “cherry-picking”), the success rate further declines to 35%.  That, in fact, is a typical successful outcome rate in studies that are more scientifically designed.  [Keep in mind that “success” in this instance is defined as continuous sobriety; if one instead looks at the number of days of alcohol/drug use compared to the pre-treatment period, the rate of significant improvement is likely to be twice as great.]  Since better outcomes are, however, associated with non-treatment factors like steady employment and marriage, private facilities whose clientele can afford high fees probably do achieve a better-than-average success rate – that is, they aren’t taking the individuals who have worse prognoses.

Jeff Fortgang, PhD, LADC-I

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