This article appeared in the June 27, 2007, edition of Behavioral Healthcare
As executive director of a “ritzy rehab” program in Malibu, California, I read an article in the
New York Times on Sunday, June 17, with great interest.
1 The article was titled “Stars check in, stars check out” and subtitled “The secret of ritzy rehab is its low success rate.” It piqued my interest because I was eager to hear about these “success rates.”
Much as I expected, the rates quoted were from unnamed “experts in the field,” and they were specifically focused on programs based on the 12 Steps. In fact, the newspaper gave no real justification for the subtitle, that the rate of success for ritzy rehab was “low” as compared with anywhere else.
Directors of a few Malibu programs explained why they had no outcome data, but their statements aren’t what bothered me. My biggest problem was with the reporter’s premise, namely that a success rate is a simple number like a batting average. It is presumably the percentage of patients completely abstinent after six months and/or one year of treatment. While this is an informative measure, it does not sufficiently address the complex issue of treatment outcomes, and it is tied to the misunderstanding that addiction is an acute illness to be cured. McLellan et al demonstrated in 2000 that addiction is better understood as a chronic illness comparable to type 2 diabetes, hypertension, and asthma.2
The New York Times article embraces the perspective that McLellan et al tried to dispel, that the goal for rehab programs is to “rehabilitate and discharge them as one might rehabilitate a surgical patient following a joint replacement.”2 It is vitally important for behavioral healthcare practitioners and specialty programs to measure post-treatment results, but this means measuring many important domains, such as adherence to treatment recommendations, rates of relapse, measures of functioning, and measures of psychological well-being.
I would suggest that an addicted individual who uses drugs less frequently and who functions higher than he/she did prior to treatment is neither a complete failure nor a complete success. This is better understood in general medicine, in which people (professional and lay) are less judgmental about nonadherence to treatment regimens and relapses that necessitate ER visits and hospitalization. As McLellan et al document, rates of nonadherence and relapse for people with diabetes, hypertension, and asthma are comparable to those for chemical dependency. Thus, the real secret of rehab, ritzy or otherwise, is that it constitutes just the first step in treatment for a chronic illness.
Edward R. Jones, PhD, is Executive Director of Summit Centers Malibu and a member of Behavioral Healthcare’s Editorial Board. Have a comment? Send it to firstname.lastname@example.org.
1. Waxman S. Stars check in, stars check out. New York Times. June 17, 2007.
2. McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA 2000;284(13):1689-95.