Inside Rehab: The Surprising Truth About Addiction Treatment-and How to Get Help That Works

“Forget what you’ve seen in those television dramas or on the big screen.”

“The research evidence clearly demonstrates that a one-size-fits-all approach to addiction treatment typically is a recipe for failure.”

The statistics might surprise you. A small sample of what readers of Inside Rehab can expect to learn:

• The United States has more than 13,000 residential and outpatient rehabilitation facilities.

• More than 22 million adults and teens have alcohol and drug abuse problems.

• Approximately half of those in addiction treatment programs have another, independent mental diagnosis.

• Forty to sixty percent of people treated once for a substance abuse problem go back to using again.

Anne Fletcher has crafted a comprehensive “bible” for those in need of treatment for addiction, their family, friends and clinicians. Akin to a thorough clinical trial, Inside Rehab represents the author’s extensive, diligent research and legwork, hundreds of interviews with substance abuse counselors, facility administrators, experts from the Treatment Research Institute, the Veterans Administration (VA), prestigious colleges and universities, think tanks and labs, and more important, individuals who have gone through the programs—some of them several times.

Forget what you’ve seen in those television dramas or on the big screen. In many cases, a 29-day stay at a rehab facility does not result in a new and improved person “clean” and ready to take on any challenge the world presents.

In reality, rehab involves a lot of hard work including detox, classes, lectures, therapy, and lots of sitting. In fact, Ms. Fletcher was not surprised to find snoozing individuals in some of the group sessions she attended. Rather than engage the men and women in active learning, facilities often forced them to sit—for hours on end—listening to lectures that would put the most attentive person to sleep.

For people still undergoing the detox process or attempting to fight a craving, stillness is the last thing they want or need.

You might expect a rehab facility to employ qualified, credentialed, licensed professionals who have training in various modalities. Not so, according to Ms. Fletcher.

Although she did find some programs staffed with masters or doctoral level clinicians, she also visited places that hired people with only a GED. Often those facilitating group therapy sessions were recovering addicts themselves. Although these individuals had first-hand knowledge of the experience, they were not qualified to handle some of the situations that arose.

In addition to a disparity in trained personnel, some programs used techniques that have not been clinically proven to help treat addiction. Programs that offer “treatment as usual,” a vague and confusing term applied randomly to a variety of plans in any number of facilities, should be viewed with some skepticism. When it comes to recovering from alcohol or substance abuse, an individual deserves to have a plan tailored to his or her needs, not an off-the-shelf version.

Any book that deals with addiction almost certainly has to include mention of AA and the 12-step program. Inside Rehab is no different. But in this case, Ms. Fletcher views the program with a critical eye, gaining insight from clinicians and individuals who’ve gone through the program.

Although the 12 steps may be considered the “gold standard,” the program earns mixed reviews for effectiveness from those on both side of the treatment coin. Readers may be surprised and interested to learn of the existence of some non-12-step programs that are well run, administered by doctoral level clinicians, and assess patients on an ongoing basis.

Throughout the book, Ms. Fletcher compares the health care a person with an addiction receives to the care someone with a medical illness might expect. In all cases, the former falls short.

She quotes one psychologist who says, “Do you know of any other chronic illness where we give people three to four weeks of therapy? That would be like sending diabetics to a spa for a month and teaching them diet and exercise—then saying, ‘Go to your support groups.’ It’s 1950s treatment. Would we settle for that in any other condition?”

During the research and writing process, Ms. Fletcher asked hundreds of questions. She encourages readers to do the same.

In court-ordered or emergency situations, families and individuals don’t have the luxury of shopping around for the most appropriate program. But in other situations, it pays to make inquiries about staff training level, types of programs offered, costs and fees, amount of family involvement, therapeutic options, and other regulations that might affect effective treatment.

A clear theme runs through the pages in this book: Every person with an addiction should have an individualized treatment plan, a message rehab facilities across the country should heed.

In fact, a 2012 CASA Columbia report on addiction treatment states: “The research evidence clearly demonstrates that a one-size-fits-all approach to addiction treatment typically is a recipe for failure.”

Ms. Fletcher drives home the point that every person—adolescent, adult, those with dual diagnoses and/or addiction with a medical illness—deserves to be treated as an individual with respect for unique situations within a program that allows for flexibility.

But it’s clear from Inside Rehab that the field of substance abuse has a long way to go.

Once the stigma that still comes with any type of addiction is dispelled and treatment for those with substance abuse problems/mental illness achieves parity with medical care, the industry will be on the right track.

Brimming with facts, figures, study findings, and personal stories, Inside Rehab truly is the book for anyone looking for information on how to find effective treatment for addiction.