on February 9, 2013
Fifteen years ago, I sat shaking with a phone book in my hand. I had reached the end of a 25 year addiction to alcohol and I was desperate. I had decided to quit drinking and I knew, or at least I assumed, that I had to go to rehab to do it.
I'd heard many times that addiction is a disease so I naively assumed that it was treated like other diseases. You called the hospital and they helped you get better, using proven scientific protocols. So based on this assumption, I picked up the phone book, called a local hospital that had an affiliated rehab, and scheduled an appointment.
Since over 90% of rehabs in the late '90s were completely 12 step based, I naturally found myself in a 12 step based program. The main goal of the program was to connect clients to the 12 step community and convince them that the sole path to recovery was lifelong participation in a 12 step group. Its educational component consisted of movies, photocopied literature, and discussions about AA and the 12 steps. We worked steps, and the steps were posted on the wall of every room in the rehab. The sole clinical "credential" of the counselor I saw was that he had been an AA member for nearly 20 years (he did have a masters degree in an unrelated field). In retrospect I should have understood that there was nothing scientific about this experience, but I didn't question it as I might have under other circumstances. It is tough to be an educated consumer when your brain is addled with chemicals; tougher still to question authority when you are beaten down and full of shame as the result of an addiction.
But despite what I'd been taught in rehab, I just didn't care for AA. I thought the people were (mostly) nice and well meaning, and I found the social support helpful, but I saw the underlying premise of the program (that the power to recover comes from a "Higher Power"--from OUTSIDE the individual) as being illogical and counterproductive. It seemed to me, both in rehab and in AA, that the focus was more on finding a connection with this outside force than on actually learning skills to live life.
This led to a terrible internal conflict. Although I felt a deep disconnect with AA's philosophy, I'd learned in rehab that such thoughts were evidence that I was still sick. They were "the disease talking." So instead of moving on, I devoted myself to the program. I "acted as if": I got a sponsor, I worked the steps repeatedly, I went to meetings frequently (every day for the first two years), I sponsored others, I took on service positions...and I kept waiting for the moment when I'd finally "get it."
Days, months, and years of sobriety passed, but that moment never came. It was nearly a decade later--a decade of painful mental gymnastics later--before I finally came to the point where I understood that I wasn't "acting as if," I was living a lie. The truth was that AA was not a good fit for me, never had been, and never would be.
I decided to leave, but leaving was tough, almost as tough as quitting my addiction was. Even though the program had never made sense to me, I'd made such an effort at adapting myself to it that it took a couple of years before I could unravel what I really thought and felt. I essentially had to recover...from recovery.
This is not to bash AA or denigrate the recovery of those who find it helpful. It is simply to back up one of the many excellent points that Ms. Fletcher makes in this important book: one size does not fit all. Addiction treatment should be individualized. No one recovery pathway should ever, EVER be sold as "the only way." No person seeking recovery should ever, EVER be told that they are hopeless and doomed to die unless they follow a particular protocol.
I sincerely hope that anyone who is considering rehab will read this book before making any decision about how to proceed. Making your treatment choice carefully may save your life, your wallet, your sanity--or all three.
on February 9, 2013
Anne Fletcher became controversial in 2002 when she released the best-selling Sober for Good: New Solutions for Drinking Problems -- Advice from Those Who Have Succeeded. The book was based on her interviews with 222 "masters," individuals who had overcome drinking problems for at least five years. She was fiercely criticized by members of the addiction treatment industry because of the diversity of her recovery accounts, and her support of the idea that there are many paths to recovery (including moderated consumption). Nevertheless, her book earned awards from scientific societies. Her current book, Inside Rehab, will also be controversial. Controversy seems inevitable when an author is dedicated, as Ms. Fletcher is, to staying close to the scientific literature, and is writing about a field that does not have a similar motivation.
Inside Rehab describes current practices in the US addiction treatment industry, based on in-depth visits to a diverse sample of 15 facilities (including Practical Recovery, the San Diego addiction treatment system I founded and operate), and interviews with approximately 100 experts and facility staffers. She also interviewed dozens of treatment clients, who report their treatment experiences good and bad. What Ms. Fletcher documents should frighten anyone seeking US addiction treatment (including "rehab," the common term for residential treatment).
On average the US treatment system has a one-size-fits-all approach based on the 12-step approach to recovery. Some facilities do a good job, at a reasonable price, in providing this approach. However, most facilities suffer from under-qualified staff, failure to provide sufficient individualization of treatment, failure to provide the latest evidence-based practices, and failure to offer the client adequate information about treatment options. Among the evidence-based practices that are lacking are addiction medications (such as methadone or buprenorphine), which many facilities simply refuse to make available, inadequate assessment practices, and failure to include psychosocial approaches known to work while including others (e.g., confrontation) known to make people worse.
You may think Ms. Fletcher is exaggerating or misrepresenting what she found. Consider a statement in the Handbook of Alcoholism Treatment: Effective Alternatives (3rd ed., 2003, edited by Hester & Miller), in a chapter entitled "What Works? A Summary of Alcohol Treatment Outcome Research," by Miller, Wilbourne and Hettema. They state that "the negative correlation between scientific evidence and treatment-as-usual remains striking, and could hardly be larger if one intentionally constructed treatment programs from those approaches with the least evidence of efficacy." The 2nd edition of this book (1995) reached the same conclusion.
Or consider how similar her findings are with the report "Addiction medicine: Closing the gap between science and practice" released August, 2012, by the National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). The report's findings are summarized in the press release: "While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they rarely are employed. The report exposes the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services, including pharmaceutical and psychosocial therapies and other medical care."
An introductory chapter identifies myths (e.g., "most people need to go to rehab; group counseling is the best way to treat addictions; highly trained professionals provide most of the treatment in addiction programs") and identifies the facilities visited. The following nine chapters address what it's like inside a rehab, what it costs, what rehab should look like, why rehab is not needed for most addiction problems, how one-size-fits-all treatment is problematic, why teen treatment should be different than adult treatment, what to do when mental health problems co-exist with addiction problems (this "co-morbidity" is common but the lack of licensed mental health professionals in most facilities means it is commonly unaddressed), the importance of long-term care (and not relying on rehab as a quick fix), and knowing what to look for in a rehab. A companion e-book, Holistic Rehab Therapies: Are Alternative Addiction Treatments Helpful, Harmful, or Head Games? is timely because so many high-end rehabs incorporate holistic healing into their services.
For addiction professionals with a science-based perspective on recovery, and the opportunity to listen to individuals who had been through US treatment facilities, Inside Rehab contains no major surprises. We have known for decades the generally poor state of affairs in US addiction treatment. For years I have heard first hand accounts of how individuals actually get treated (it's bad) in even well-known facilities. However, it is exciting to see such a highly respected author report on this situation so thoroughly and systematically. With luck this book will help increase support for real change.
A major strength of the book is the positive emphasis on how to screen an addiction treatment facility. For many the final chapter, combined with the Appendix ("A consumer checklist for checking out rehabs") will by themselves be worth the price of the book. The book also points to resources from the non-12-step world. These resources are typically not provided to clients in 12-step oriented facilities. Instead these clients may hear that "12-step is the only thing that works." In fact the 12-step approach (either in 12 step groups alone, or in 12-step oriented treatment) is indeed helpful to many, especially if attendance is freely chosen. However, 12-step based recovery is a small portion of the entire group of people who recover from addiction.
How could the US addiction treatment system have been so bad for so long? I speculate that the feedback systems normally in place when consumers purchase services exist only minimally in this system. Addiction clients have been almost voiceless. When they complain they are told "that's your disease talking" rather than being listened to. Indeed, addiction clients have much to learn about recovery and about life, but they also have much to teach us about these same issues. Ms. Fletcher is to be commended for giving a powerful and compelling voice to these often mistreated individuals.
A. Tom Horvath, Ph.D.
on February 18, 2013
While I agree with many of the criticisms of the treatment field in Fletcher's book, such as that most treatment is 12 step based with not enough alternative, that not enough individual therapy is provided, that many counselors are undertrained, and that 28 day residential rehab as a stand along is not enough, I don't agree with her that residential treatment is mostly unnecessary. I don't think people are being overtreated--it is the 90% of people who do not get treatment and need treatment that is the problem. Treatment absolutely needs to be much better, but that does not mean residential treatment is not needed for various reasons. Combining residential treatment with a gradual step down to outpatient treatment over a period of months is offered by many treatment centers, not just 28 days. The problem with non-12 step based treatment is one of access and affordability. If one is to go to residential treatment for a few weeks only before outpatient, and for the family to attend family groups, the center must be close to one's home. Insurance coverage would be helpful, if not a necessity. So if there is no non-12 step program near one's home or covered by one's insurance as was my case for my son, I had to work with a 12 step based program.
Under my insurance neither the HMO or PPO provided residential treatment, so I ended up paying for residential. Here is why: My son went to numerous individual counselors specializing in addiction and various outpatient treatment programs and kept getting worse because he wanted to keep using and found ways to use substances even while in treatment and went back to heavy using as soon as he stopped the treatment. When he finally got to the point of seriously trying to make treatment work for him, he had suffered many consequences and was in crisis and was totally dysfunctional. People who go to residential treatment in my experience usually need it because: they have been arrested or jailed, sometimes numerous times, for DUIs, drug possession, assault, etc., they have overdosed on opiates or alcohol and might have died (many people do) or ended up in the emergency room, they became manic or psychotic or suicidal or depressed from substance abuse and ended up on the psych ward, they flunked out of college for the second time, they lost their jobs, never had one in the first place, and their parents or spouses kicked them out of their house and they are living homeless on the street or in somebody's garage, they were told by their doctor that if they drink or use again they will suffer organ failure and die, they lost custody of their kids, etc. Fletcher sounds like my insurance company when she says people are going to have to learn to live in the real world and rehab is not the real world. That is very true--but people in crisis need to be in a calm and isolated environment to regain their health and mental faculties, take meds, and eat healthy food and develop a routine schedule before returning to the "real" world. Their lives are in shambles and taking them out of the chaos is really necessary at that point.
Now maybe this is not MOST people who need treatment and maybe MOST people can stop on their own, but since this book is about rehab, I expected the author would focus on THOSE WHO NEED IT in the book. And most people who need rehab have to be somewhat coerced or cajoled or mandated into treatment, and from what I have read, evidence shows that those who go voluntarily don't necessarily do better than those who do not.
Regarding AA based programs, I myself wanted to find a non-AA alternative, and non-AA support groups like SMART RECOVERY would be my first choice, but there is a huge advantage to AA, which is why I think it is not so bad for a treatment center to recommend and encourage AA. I don't have many SMART RECOVERY groups in my area--the nearest ones are an hour away which meets 2 or 3 times a week. But one can find an AA or NA meeting every day, several times a day, within about 10-20 minutes of my house. AA does maintain that one should "keep coming back" and stay in recovery, but at least so far, my son is finding it useful to maintain sobriety. If he can maintain sobriety without AA eventually, then no one is going to force him to go to AA meetings for the rest of his life, but there are worse things, such as the situations I mentioned above. The treatment facility I chose has an aftercare program for a year, as many do, but also recommends AA meetings and working with a sponsor to supplement that. If treatment centers don't support the idea of AA or take them to some meetings, people will not tend to use this resource which is the most available help there is. My biggest gripe with treatment and AA which Fletcher does't mention is the smoking. Compared to dying immediately of an overdose, smoking is a slower death, and some people may be further put off from treatment if not allowed to smoke, but I read that evidence shows that smokers are 25% more likely to relapse. I think more thought needs to be put into this issue.
A couple other points: Fletcher suggests it is not a good idea to mix clienta of different ages, and that grouping younger people together would be best. For adolescents, yes, but I found that older people can be helpful to younger addicts in many ways and can act as mentors. Also, centers treating about 10-20 people at a time may not have that luxury. Regarding individual therapy, I believe both group and individual therapy are necessary, and I think if the treatment center does not offer enough, after a few weeks or during outpatient treatment, there is no reason why a person cannot also see a therapist or even two on an individual basis to augment treatment. My insurance covers unlimited individual therapy if the therapist is in network, so supplementing can be done if that piece is missing for those with insurance. A Sober Livig House is another good option, but they don't usually provide food or transportation so are not a good substitute for residential treatment in the early days.
If new recovery groups arise and if treatment centers adopt more "evidence based" therapies and insurance companies don't obstruct people from getting the help they need, including residential treatment, I would be so happy, but in the "real" world, it hasn't yet happened, and as a consumer, I am not sure I want to follow the footsteps of the person Fletcher mentions who spent $500,000 and still hasn't recovered, whose advice she quoted at length. I do think that if one thing doesn't work, it is insanity to keep doing it over and over, so if there is a next time I will do something different.
Ok, so why is a child psychologist reading and reviewing this book? It's because the majority of my caseload--upwards of 70% of the kids--are in treatment because of the substance abuse by one or both parents. Since a large percentage of my work is with foster and adopted children, this means their exposure to the effects of parental substance use has been extensive, and times, traumatizing. Independent of the fact that Breaking Bad was filmed in the city in which I work, a main drug of choice for many of these parents is methamphetamine. Thus, the kids I see aren't just exposed to a 'loaded' parent, but rather, to all that goes hand-in-hand with drug use: violence, sexual/physical abuse, neglect, poverty, nighttime raids, miscellaneous chemical smells ... you get the point.
Sadly, most of these parents don't just struggle with psychological and physiological addiction to drugs or alcohol. Rather, many--perhaps the majority--also have to contend with co-existing mental health problems, such as depression, anxiety, traumatic pasts, personality problems, etc. Add to that minimal internal/external resources for these parents and you have one big mess. That is why a good number of them will never have their kids returned to their care. Perhaps if more of them had the opportunity for relying upon evidence-based treatment--as advocated for in this book--these outcomes might be different.
The descriptions you see above are well-written, and there isn't much I can add to inform your understanding of what is in this book. I will add, however, that if the issue of substance abuse impacts your life--as a user, a partner, a parent, or a provider--this book is illuminative.
Though the book contains over 400 pages, I obtained the reality check and information I needed from the first and last chapters. This isn't to diminish the rest of the content, but rather, the bulk of the book serves to substantiate and justify the key points raised in chapter one. That is:
* While the knee-jerk reaction when someone has a drug or alcohol problem is "Get thee to rehab," the truth is that most people recover on their own; by attending self-help groups; and/or by seeing a counselor individually.
* The idea that someone goes away to a 30-day rehab and comes home a new person is naive.
* Although many say they use them, rehabs commonly fall short on implementing practices that studies show lead to best outcomes.
* Research clearly shows that certain prescription medications help people addicted to drugs and alcohol get sober and stay sober.
* Treatment experts agree that adolescent programs can't just be adult programs modified for kids.
The last chapters also include good tips for those who are seeking treatment for substance abuse, encouraging them to flex and use their consumer muscle when seeking services.
Anyhow, this is a well-written and informative book. Though research and studies are referenced, ample attention is giving to the voice of those affected by addiction.
on April 24, 2013
Our family's recent journey through rehab hell is like those chronicled in this book. Our family member has had multiple stints in rehabs and sober living facilities. From the esteemed univ. rehab that allowed a patient to bring in drugs to fellow patients (all of whom were kicked out) to the rehabs and sober living facilities that that excelled in kicking patients to the curb, we have seen it all and then some. While there are some good facilities out there, many have excelled at taking money and failed at treatment.
Every therapist, psychologist, psychiatrist and addiction counselor needs to have this book--it discusses multiple approaches, asks hard hitting questions, and provides invaluable suggestions on how your patients can get help they need. I bought a copy for our family member's psychiatrist. And we have just used it to get our family member treatment.
If you or a family member needs help, here's why you must buy this book:
--You need to know before you or your loved one goes into rehab, what are your options? What is rehab really like? Do you really need an in patient rehab? What kind of treatment should you consider? What should you consider for dual diagnosis (both mental health and addiction)treatment? What about insurance and costs?
--The questions to ask rehabs list, resource list and appendix are worth the price of the book a hundred times over. At a time when you are on an emotional rollercoaster, you need this book to get the right help. One of the most valuable tips is to take your time selecting the rehab and/or treatment. There is a lot of hype and pressure to get immediate treatment and that is not always the best course of action.
--It discusses options for treatment. Don't get tripped up by others comments on AA vs non AA, in patient vs out patient. The point of this book is that there are serious problems with addiction treatment in the U.S. and one size does not fit all. Fletcher provides insight and questions to make a better, informed decision on how to get help that works.
Addiction treatment is a long journey--we found this book to be an indispensable guide and a resource for the road ahead.
on April 24, 2013
Inside Rehab is the best book to date on the actual experience of people going through rehab. The fact that it is viewed as critical of the treatment industry is that the state of addiction treatment in the US today is abysmal and outmoded. So an accurate description of it simply points that out. Rehab is an approach developed in the middle of the last century, when there was not science nor real treatment. It was (and for the most part is) based on the 12 Steps of AA and an outmoded "disease concept" outlined in the Big Book of AA. It was developed basically as an introduction to AA. As Dr. Berger points out in review (I strongly disagree with his rating) 12 Step groups are not the same as treamtent programs that use some of AA principles. 12-Step groups are voluntary, anonymous and cost nothing. They provide peer support for getting and staying abstinent. They are not treatment. Treatment programs are businesses licensed by the state that charge fees for professional services. Treatment programs behave just like any other business: they have vested interests, strive to protect them, lobby, advertise, and so forth. In my opinion they have distorted the principles of AA, in the process becoming highly doctrinaire and rigid, while the founders of AA were very practical, humble, and welcoming anything that might help a suffering alcoholic. As Jung once said, "Got save me from the Jungians!" That is, followers often tend to distort and rigidify the teachings of the found (see: Christianity, Islam, Hinduism, Buddhism.)
Where Dr. Berger is wrong is his assertion that 12-step programs have been clearly shown to be the most effective way to recover. In fact, there are many routes to recovery, and only a small minority of people with addiction have long-term affiliations with 12-step groups. It is true that affiliation is correlated with better outcomes, but that does not imply causal direction. In fact the strongest predictor of affiliation is severity of dependence: the more severe it is, the more likely are people to affiliate. Severiy also predicts abstinence no matter how that's achieved. The may be because the choices between drinking and abstinence are the most stark for those the most severe addiction. For many, it's either stop or die. So, it's complex. Most people who attend 12-step groups do so for a few months or a year and then stop going. So,in my view, Dr. Berger has a strong belief in 12 step groups that is not supported by available research. At the same time, they offer a free, widely available approach that does work for many people.
What's important about Instide Rehab (in contrast to Davis Scheff's new book) is that is was thoroughly researched and thoroughly vetted with the top scientists in the field. (Disclosure: I was one of the experts consulted and I vetted the book for scientific accuracy, but did not and will not receive any payment or other financial benefit.)What the book shows is that it is time to move addiction treatment from the mid-20th century to the 21st century, that it be scientifically based and professional, and that is provided in more attractive, accessible and affordable ways. In the meantime: Buyer Beware!
Mark Willenbring, MD
on April 13, 2013
I'm a slow reader and 400 pages seemed daunting, but contrary to one reviewer's comment I read, I found Inside Rehab a page turner. Anne Fletcher's new book covers the topics stated in the subtitle as comprehensively as a textbook, but with the zest of a preeminent journalist. Reading this book motivates a desire to share it with others; especially the families of those with addictions, employee assistance Program (EAP) staff and the legal personnel who pressure, mandate and sanction people, often indiscriminately, into rehabilitation programs. By interviewing many people, both in the rehab industry, addiction experts and most amazingly, people who have been through rehabs - often multiple times - we learn not only about what really goes on in them, but also why most prove so ineffective.
We in SMART Recovery already know that one size does not fit all and have felt the challenge of finding science-based help. Yet many of us, knowing the problems people face, especially for people with addictions and their panicked loved ones, would still face an information shortage if called upon to advise others about what to look for, what is available and, importantly, what is to be avoided, in the hunt for help.
For them this book is crammed with practical advice. Anne suggests all the questions an enlightened consumer had better ask. She provides answers professional in this area ought to provide, even though many don't or can't. She has gone around the country visiting rehabs, both inpatient and outpatient, spoken to the leading experts, both academic researchers and those who run programs, and interviewed those who have been through the rehab mill, sometimes over and over despite repeated failures.
With examples from the rehab attendees and facts from the experts she interviewed she builds the case for using evidence-based practices, ending the hegemony of AA, supplying the individualization and skill that requires one-on-one counseling by mental health professionals rather than the endless stream of groups too often `led' by unqualified staff filling time with the proven least effective approaches of lectures, movies, and general conversation. More gripping yet are the stories of people being coerced and exploited, misinformed and mistreated. Especially teens cast into brutal tough love programs, as previously exposed in a book by our friend Maia Szalavitz - Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids. Similarly Anne Fletcher's current exposé, the many down sides created by the rehab industrial complex is revealed.
She exposes the gross indifference shown by most rehabs as regards mental health issues. She blows up the all too common and false myth that once one is clean and sober the emotional issues will evaporate. Indeed, this may be one of the most important of the many reasons rehabs, more often than not, fail. The evidence suggests that more mental health professionals be involved in addiction treatment on a one-to-one basis. Teaching skills in a group may be cost effective, but the groups at rehabs rarely teach skills. Bringing out sometimes embarrassing mental health problems in a group seems just plain disrespectful of the minimum need many people have for privacy and confidentiality.
And Anne addresses the costs in not just money, but time, energy and hope wasted. She makes it clear that for prices often charged of around $1,000 per day one could buy all of the rehab features, but better. For that money one could have a nice motel room, a gym membership, one-on-one counseling daily with licensed mental health professionals with expertise in addictions, and well led manual driven skills groups teaching methods that have been tested and shown to work. She clearly shows that more expensive rarely means better. In fact, some publicly funded programs for the poor provide a wider of services including helping clients with education, employment, parenting, mental health, as well as how to stay clean and sober; hence they do a better job than many of the most prestigious name rehabs.
And she makes the case for diversity with horror stories of those forced, sometimes even by courts, into programs based on AA or outright religious indoctrination, despite the judicial rulings against such practices. She also provides some leads on diversity, including listing all of the science-based and secular mutual support groups including our own SMART Recovery. Not surprisingly she cites rehab administrators who wouldn't send anyone to SMART Recovery and seem proud to know nothing about SMART. She also names and describes the best and worst approaches to treatment and warns that many rehabs falsely advertise offering evidence-based treatments which they have under trained staff provide poorly on a token basis or just don't actually provide.
Though she does not provide a list of the good and better programs, she certainly provides the reader with some good leads on programs and people to consult. I don't know that every reader will have the assertiveness to ask the questions and seek out the information, but Inside Rehab will give every reader a good start. Anyone interested in helping people with addictions needs to read this book.
Inside Rehab: The Surprising Truth About Addiction Treatment-and How to Get Help That Works
on September 27, 2013
Whether it's for yourself or someone else, this book has crucial information about rehab. It's primarily focused on alcohol, but is probably applicable for all types of addictions. The most important fact in the book - one that saved us a lot of money and stress when our son went through detox and recovery at home - is that the real reason people quit drinking is not that they went to the 'right' rehab, but that they made a decision to quit. The second-most important fact is that expensive rehab is very little different from 'cheap' rehab. And the third-most important fact is that most rehab facilities and their personnel have vanishingly little certification and/or oversight.
on April 17, 2013
Once again, Anne Fletcher has cast her critical and inquiring eye on the addiction treatment field, and has provided both the addiction-treatment professional and the public with a definitive and detailed description of what takes place within the various levels of care in the substance abuse treatment "industry" in the United States. As she did previously in Sober for Good, she has found a way to blend the individual and anecdotal experiences of patients and family members who had sought addiction treatment with objective, research-based findings about effective treatment approaches along with the observations and judgments of researchers and clinicians in the field. It is a compelling work, and provides validation for those providers working in the field who have seen alternative treatment options and viable outcomes beyond the traditional 12-steps approach and abstinence-only goal.
Perhaps without knowing it, Ms. Fletcher lays out in the very way she organizes and divides the questions that she asks herself in writing this book, a parallel process that the person searching for an addiction treatment program might well be advised to engage in. She discusses cost and the value of what as well as how treatment can be purchased; she examines the idea that rehab is not necessarily for everyone, and how one might proceed to decide if this is true in any one individual's circumstance; the need for a thorough and full assessment and evaluation to aid in decision-making about what is actually necessary and what might be useful; and the idea that, once in treatment, everyone generally gets the same thing. Finally, and often omitted when discussing addiction treatment, she addresses the issue of co-occurring disorders, which frequently underlie addiction problems and, if not addressed concomitantly with the alcohol or drug problem, is like only taking half the dose of antibiotic...the problem is very likely to reoccur. The searcher for a treatment program might well use the chapter headings as a guide for questions and issues to address with providers during their inquiry about the best treatment to get for themselves or a loved one. Providers and administrators of addiction programs would do well to read this book to see if there are ways to use the information to further improve the treatment they are already providing.
on August 8, 2013
Inside Rehab is a book about the need for change. Change at an industry level and change at a societal level. For years, authorities in the addiction field -- such as William White and Tom McLellan -- have been questioning the validity of much of the addiction treatment industry. They are academics. This book is for the masses. It is thorough and investigative and practical.
I have been in the addition treatment industry for 25 years. It breaks my heart to see how resistant my industry is for change. To this day, I know of many addiction treatment rehabs who do not question the "revolving door" cycle that occurs in virtually all rehabs. They spend almost zero time following the families and patients to know the efficacy of their work and become better at what they do. Addicted persons come back two, three, and four times for rehab. Rather than question what they do; my field keeps doing more of the same.
Inside Rehab asks all the right questions at a practical level. Some may question, as I do, all of the concrete suggestions in the book. That is too be expected. Alternatives to the addiction rehab industry are still in their infancy. A book like Anne's is a much needed step in the right direction. I hope it will cause a stir because the addiction treatment industry desperately needs it. I hope a book like this give families confidence on how to ask the right questions before they consume what the addiction industry has been selling.
Jonathan Todd Barlow, MS