Most recovering addicts – or “ex-addicts” as some choose to term it – prefer to keep their personal struggles with addiction as quiet as possible when dealing with the general public. In the interest of drawing an important example, however, I will disclose one key element pertaining to my own previous struggles with substance abuse. Looking back from when I first reached the point in my addiction that required admission to rehab, to my very last treatment center not too terribly long ago, one consistency boldly stands out. As the years and numerous trips to rehab went by, the level of posh & luxury progressively diminished. From private accommodations and 5-star cuisine to skid row shelters and army cots in a gymnasium-type setting, my affluent upbringing and formal education became nothing more than a distant memory.
Today, I have the fortune of not only living a life beyond my wildest dreams, but the experience of having had numerous opportunities to work in various formal and informal addiction treatment settings, all of which have played an integral role into who I am today. Over the years I have been approached by many friends and family members of addicts that often pose the same question which is, and I paraphrase; “what type of treatment program works best?” And before I go any further let’s just get one thing very clear. The reasons as to why I did not remain sober following my initial trips to the nicer rehabs had absolutely nothing to do with the quality of care. My reasons for going in the first place were based upon nothing more than to get back in my family’s good graces, or to get the girl back, or to get the job back, or anything else along those self-serving lines. I had no intention and no desire to apply myself whatsoever toward a life of sobriety and hence, the long, arduous & painful road of active addiction lay ahead.
There are many variations of treatment, most of which will integrate a variety of elements which are often referred to as the treatment “modality.” Among the more common modalities out there are; 12 Step, Behavioral Therapy, Cognitive Therapy, Holistic, Faith-Based, Work Therapy and others. The growing trend in recent years has been to incorporate a multi-disciplinary approach in which the facility will utilize certain elements of each treatment type in order to come up with their own modality and often market it as resulting in a higher level of success. The question then becomes, “what is their definition of success?”
Looking first at those treatment centers which are state, county and charity funded, they essentially offer what they offer and that’s about it. If you like it then great and if you don’t like it then leave, because there are likely 30 people standing in line behind you whom are desperate to get your bed. These are the types of programs that will usually provide an extremely “core-purpose” environment which, often begins with getting the addict off the streets and into a rigorous structure that involves group therapy, 12-step panels and meetings, work therapy in order to help the facility cover its costs, social-model structure that involves residents working with and overseeing each other’s day to day behaviors & actions, etc. These types of programs are also commonly offered by churches and religious non-profits which provide a religious “faith-based” format in conjunction with the other elements previously mentioned. In most cases the majority of the residents living at publicly funded facilities are either indigent or just coming out of jails and prisons and are mandated to the facility as a condition of their parole.
There is no evidence suggesting that the above treatment facilities are less effective, however, than span of treatment options available are definitely narrower. My personal experience with publicly funded treatment is that most of the clients have been struggling with addiction for many years and already have a good base of knowledge pertaining to recovery. Also, it is much more common to see a bit of a rougher client mentality in such facilities as opposed to those focusing on private-pay clients due to their history of incarceration, gang life or living on the streets & shelters. In most cases however, the staff is extremely diligent in their efforts to change these behaviors and not allow things like “prison talk” and gang-type clothing.
For those with health insurance and/or the means to pay out of pocket there is a world of options! Among those are; luxury rehabs, holistic rehabs, non 12-step treatment, adolescent treatment, multi-disciplinary facilities, intensive outpatient settings, faith-based treatment, eating disorders centers, wilderness-type facilities, hospital-type facilities, medical & rapid detox locations, and others. One of the primary differences is whether or not the facility operates by what is termed the “Disease Model” approach, that being, providing treatment based on the belief that addiction IS or IS NOT a “disease.” It is most commonly agreed that addiction – whatever type it may be – is in fact a disease which is progressive and potentially fatal if not treated. Those that operate by this belief will nearly always incorporate the 12 step philosophy to varying levels (i.e., Alcoholics Anonymous).
Over the past 20 years or so there has been a growing trend of treatment options that do not operate under the Disease Model and boldly stand by the belief that addiction is a curable malady. These programs infuse a variety of components into their services such as; holistic treatments, vitamin & nutritional complexes, yoga, spirituality, physical exercise, specific therapeutic approaches, individual therapy, etc. Each facility is different and will be able to offer substantially more information based on the specifics of their approach than I will. Many higher-end Disease Model facilities will also utilize some of the above components in addition to 12 step education and meeting attendance.
In the case of luxury and higher end treatment centers, the key element to consider is what role does the luxury factor play into the core purpose of the program? One key difference in higher end treatment is the ability to fully customize a client’s treatment plan with much greater flexibility based on his/her individual needs. There also tends to be a stronger focus on individualized therapy and the ability to cater to any other co-occurring issues such as grief & trauma, PTSD (post traumatic stress disorder), bipolar disorder, depression, anxiety, etc. Most mid-range facilities will treat co-occurring disorders as well but will often times not have an actual psychiatrist on staff and contract out this type of service on a case by case basis.
The range of treatment options in the middle of the cost curve are extremely broad; more so than in any other segment! Their modalities vary, and their ability to take insurance and provide financing options will vary as well. Many treatment centers in this realm will not take a singular approach to treatment, that is, they may operate under a disease model and take their clients to AA meetings in the evenings while also providing various holistic and unique therapeutic approaches during the day which are completely separate from the 12 step regimen. Most of these programs will have group therapy as well as individual sessions, however, the focus may vary depending on the foundation of their approach to recovery. Some will also take a religious approach called “faith-based” treatment which is utilized within the program structure to varying degrees and is most often based on Christian philosophies.
There has also been a dramatic rise in adolescent treatment as in lieu of the growing numbers of addicted teens. These types of programs operate under very stringent guidelines and are faced with regulations and protocols that extend beyond adult treatment environments. Some of these are actually in a wilderness setting that offer a broad focus on navigating through life by means of literally forcing the client to navigate through rugged terrain on various levels. The mentality behind this is that as addicts, we learn best through our own personal experiences, struggles and triumphs. Adolescents facilities are also mandated to provide formal education to the client based on state laws. For instance, if a 10th grader is forced into treatment due to addiction it does not necessarily mean that their schooling must be placed on hold. While some are more elegant than others, the one common denominator is that there must be an emphasis on growing up and taking responsibility for our own actions.
Across the board, regardless of what type of treatment setting we’re talking about, there are several common denominators. First, intermingling of clients on a romantic level is highly frowned upon and in many cases may result in expulsion from the program. Second, honesty is foremost. We’re all human and we all make mistakes and bad decisions from time to time, but those with the ability to be honest and forthright have a much higher likelihood of remaining sober. The chances of being removed from the program are much higher in cases when a client lies rather than in those in which he/she did something wrong but had the courage to remain honest, regardless of the anticipated consequence. Third, respecting fellow patients and staff alike is required. Addiction treatment is a bubble, a separation from real life enabling addicts to re-learn and enact many elements that outwardly may not seem to have any direct correlation to sobriety, but they do. The element of respect and decency plays an integral role in sobriety as well as life in general, and if the patient refuses to adhere to these principles and act accordingly then problems will always arise.