“Does rehab work?” I get asked this question all the time. There are many ways to answer it: Yes. No. Maybe. I don’t know. “Is treatment effective?” I would answer, “in what way?” Because always behind these seemingly honest and innocent questions are hidden assumptions, so the real problem remains confusing.
Usually, what people are really asking is, by going away for a month, can someone achieve long-term sobriety? Most everyone who knows anything about this stuff will say, no, probably not.
You often hear about a 10 percent success rate. The apparent failure of the old 30-day programs is not a reflection on treatment, it’s more about the public not understanding addiction in the 21st Century.
Addiction is not like the other kinds of diseases we are used to. Instead, it is layers and layers of biological, psychological, and sociological abnormalities. And these different elements interact with each other in complex and very personal ways.
But we are a society that believes in simple, precise slogans. We get our information in twenty-second segments at a time, and we miss all the nuances in the process.
30-Day Treatment Model
Let’s look back at the history. The old ’30-day’ model worked fairly well for grown adults all throughout the 80s and 90s. Places like Hazelden and Betty Ford thrived on this success. Professionals, usually married, with families who depend on them, would enter treatment, and probably 50 to 75 percent of them would go on to achieve lasting recovery.
Then something happened leading up to the turn of the last century. We started seeing more and more young people who were suffering from addiction enter treatment.
One thing we know for sure, the 30-day model definitely does not work for young people, most of whom started using in their very early teens, and by the time they’re 20, have already graduated to intravenous heroin …
So what changed? The economy has played a huge role. These are difficult times for many Americans. So these kids were mostly raised by parents who are under incredible financial stress. This new low-wage economy we live in gives our young people very little to aspire to.
So with nothing to gain and nothing to lose – coupled with emotional pain – why not turn to drugs for comfort and escape?
What we need to realize is, young people have an even bigger problem than the drugs that are killing them in record numbers. They have a problem with living that will not be solved in a neat little 30-day trip to rehab. They need long-term help, and help that is specially designed for their unique situation.
For example, many of these young people have never really held a job for more than a couple of months, if at all. They haven’t been able to put together any kind of meaningful and purposeful education. So when they’re addressed in a treatment setting, we need to be sure they’re being taught how to live.
Parents need to push their kids into this kind of long-term treatment, and ensure that the place where they send them to has been especially designed for this generation of addicted young people, and specifically, designed to correct for the things that were missing in their children’s lives.
For example, getting a job is a developmental milestone that most people hit between age 16 and 19. Kids today aren’t hitting that, and literally, as a result, their brain development suffers.
Another important element in treating young people is an emphasis on healthy attachment, where family life may have been splintered, or where there was no connection, or when there was, it was not of the healthiest nature.
So parents need to accept that 30-day programs do not work for this generation of adults. Of course, the complication is, who’s going to pay for long-term treatment? I think that the answer lies in moving away from the old 30-day inpatient residential model, and toward lower levels of care, like day treatment and intensive outpatient, along with simple sober living housing.
Insurance companies haven’t quite caught up to this, and don’t seem to be willing to invest in the longer term care that is needed with this population of 20-something, poly-substance addicted, unemployed, or never had a job, high school dropouts.
Rehab today means something entirely different than it did 20, even 10 years ago, and parents – and especially treatment centers – need to catch up with the times.