Rehab's Role in Treating Addiction
Experts explain the treatment process at rehab clinics -- for celebrities and for regular folks.
How Addiction Works
It's the same old story: Celebrities check in. They check out with stories
of a miraculous turnaround. And then, sometimes, they check right back in
again. Is it poor self-control, or poor treatment?
Rehab experts say treatment can be very effective. But to understand how to
gauge effectiveness, it's good to know a bit about how addiction works.
Experts now agree that addiction is a brain disease with a genetic
component, Gordon says. But it's also affected by behavior. This behavioral
component makes addiction comparable to other chronic illnesses such as diabetes and high
cholesterol. Medicine has not found a way to "cure" these
diseases with a pill or an operation. Instead, they require a lifetime of
treatment, coupled with lifetime behavioral changes.
While most addiction treatment programs set abstinence as a goal, a relapse
isn't a reason to give up on a patient as hopeless -- just as you wouldn't give
up on a diabetes patient who goes on a sugar binge, says Michael Scott, MD of
the Sierra Tucson treatment clinic in Tucson, Ariz. "Addicts have their ups
and downs, but you can take that information and work with it to see how to do
better," Scott tells WebMD.
About 50% of patients at Butler Hospital's programs remain clean and sober
for a year after treatment, Gordon says. But many of those who relapse
"don't go into a black hole," he says. Instead they return to treatment
to build on the behavioral skills they learned the first time.
Studies show a connection between treatment success and the "length and
intensity of treatment," says Galusha. That usually means at least three
weeks of treatment lasting several hours a day (whether as an inpatient or
outpatient), followed by frequent attendance at AA or other group therapy for
about a year.
Who Benefits From Inpatient Care?
A 30-day stay in a clinic used to be the standard treatment for addicts. But
with the rise of managed care in the 1980s, insurers balked at the costs,
Gordon says. Many clinics shut down, and for years it was very difficult to get
an insurer to cover any inpatient treatment. Now some insurance plans will
cover inpatient stays at relatively inexpensive facilities, Galusha says.
Experts say inpatient treatment is most needed by addicts coming from a
chaotic environment or who suffer from a severe psychiatric illness. For
example, if family members are substance abusers, "an inpatient program
will get them out of that environment so some intensive work can be done,"
Berger says. By contrast, outpatient treatment may be fine for a patient who is
married and has a steady job.
A homeless single mom in a drug-infested neighborhood might well qualify for
inpatient treatment, experts say; so would a hard-partying celebrity who is
constantly traveling between movie sets or concert stages. The difference, of
course, is that celebrities can spend a thousand dollars a day or more on
treatment, while the homeless mom is at the mercy of the public health