Why Addiction Rehab Programs Are Often Unsuccessful

Here is what to look for and what to avoid.

Posted Sep 13, 2018

ESB Professional/Shutterstock
Source: ESB Professional/Shutterstock

By Lance Dodes

Sometimes it becomes imperative to seek inpatient treatment for an addiction. It may have become clear that one’s current treatment isn’t enough and imposing a break from a cycle of addictive behavior is necessary. If you decide you need that break, choose well. 

Here is what to look for.

  1.  Look for programs that do not have a fixed length of stay. There is no medical or psychological justification for staying in a facility for exactly 30 days, for example. Length of treatment for addiction should be individualized, as it is for every other medical or psychological hospitalization. You can find programs that have flexible stay lengths, but average shorter stays, such as two weeks. These are often able to charge less both because they are not as long and because they don't offer luxurious amenities such as horses, aquatics, or mountain views.  And a shorter stay means getting back sooner to the outpatient psychotherapy that will make the difference in the long term.
  2. A competent rehab should emphasize individual treatment with truly well-trained therapists. Don't be fooled by places that claim to offer individualized care when what they mean is that you can choose among several existing programs, none of which offer individual treatment. The ability to choose one lecture series over another or aerobics over swimming is not individualized treatment.
  3. Any rehab worth your time and money must offer a variety of treatment approaches without insisting you fit into their favorite one. A program may offer 12-step meetings, for example, but to be competent it must offer non-12-step treatment for those who cannot benefit from that approach. Ninety percent of people who attend 12-step programs fail to achieve sobriety according to the scientific literature over the past 50 years. This majority should be permitted and encouraged to engage in a different approach; a rehab must never be a boot camp to whip you into accepting their belief system. Ask if any program requires participation in a single treatment model, and if so, stay away.
  4. Look for fewer amenities. Every facility needs decent housing and food, but any center that believes irrelevant activities are appropriate to treat addiction is telling you they don't know much about what they're treating.
  5. Manage your expectations and those of your family. The unrealistic claims of many rehab centers have led to increased hopelessness and despair after patients leave and return to their familiar environments and behavior. 

Here is what to avoid.

  1. Poorly trained therapists: Rehabilitation facilities in the United States staff themselves any way they like. As a result, many are staffed by counselors without much training. Some even advertise that people can become addiction counselors via their own program in just one year. Meanwhile, to be a social worker, psychologist, or psychiatrist requires anywhere from three to eight years of formal teaching followed by years of practical experience before being qualified and licensed.
  2. Expense: Although many rehabs save on the cost of hiring well-qualified therapists, they still routinely charge from $30,000 to $90,000/month.  How do they justify such exorbitant charges?  The answer is that they offer, and heavily advertise, expensive "extras" which lead people to think they are getting something special. Unfortunately, these extra perks have nothing to do with treating addiction.
  3. Unnecessary services: Here are some examples from the public websites of major rehabilitation centers: equine therapy (riding or tending to a horse), ocean therapy (taking a ride on a yacht), fitness training, aquatic aerobics, work assignments, leisure skills groups, and qigong therapy.  These and similar approaches are common, with no scientific basis for relevance to addiction treatment.
  4. Lack of Outcome Research: The growth of services listed above is due not to scientific or clinical study but to the fact that rehabs compete with each other. The combination of spa-like programs with beautiful settings, spacious rooms, and gourmet cuisine add greatly to the costs for people and their families seeking help, yet are maintained because they have been successful in attracting people who believe that such luxury must mean it is accompanied by good care. When my co-author and I investigated the success rates of rehabilitation programs for our book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, we found that virtually none of them study their patients' outcomes despite claiming stellar results. 
  5. Lack of individual treatment: One-on-one sessions are especially important for the treatment of this essentially psychological problem. However almost all rehabs de-emphasize individual sessions in favor of offering group sessions. True group therapy is a completely legitimate treatment, but that is when sessions are led by well-trained professional therapists and participants are helped to explore their interactions with others in the group in order to learn more about themselves and their relationships. But almost entirely, what is offered in rehabs is a series of lectures and discussions on assigned topics, rather than psychological exploration of factors that are important to understanding the emotional compulsion to repeat an addictive behavior.

The addiction rehabilitation industry in our country is filled with false claims and unsubstantiated treatments. Rehab treatments frequently fail. Research has shown that the majority of alcoholics resume drinking within the first year after rehab. Many people who have been through rehab end up with an even greater sense of despair and personal failure.

Although brief hospitalization is beneficial for temporary relief from a cycle of addiction, it will not resolve its underlying basis. For that, psychotherapy based on a modern understanding of the psychology behind addictive behavior is needed. Finding a qualified therapist who is familiar with current psychodynamic knowledge will be far more important than any rehabilitation stay.

About the Author: Lance Dodes, M.D. is assistant clinical professor of psychiatry at Harvard Medical School (retired), Training and Supervising Analyst Emeritus at the Boston Psychoanalytic Society and Institute, and Faculty member of the New Center for Psychoanalysis (Los Angeles). He has been honored by the Division on Addictions at Harvard Medical School for "Distinguished Contribution" to the study and treatment of addictive behavior, and has been elected a Distinguished Fellow of the American Academy of Addiction Psychiatry.