If you or someone you care about has a substance use disorder and wants to get better, maybe you’ve wondered if a rehabilitation center is the answer. It’s a treatment facility for people who have an addiction disorder involving alcohol or drugs. Some people go daily (or even less often) to an outpatient center for care, while others live at a center for a period of residential care.
Some people with a substance use disorder really need residential care. But there are tons of facilities to choose from, and not all of them have your best interests in mind.
"The ethics piece is really important," says Marvin Ventrell, CEO of the National Association of Addiction Treatment Providers (NAATP), "because as treatment centers have boomed, there are some charlatans out there. They’re not the majority, but they are out there."
But quality treatment does exist, and there are ways to find reputable centers and avoid scams. Here’s how to get started.
Find Out if Rehab Is Right for You
There are a wide range of treatments for substance use disorders. Not everybody needs to start by going away to a residential program, which is the most expensive option, says Margaret A. E. Jarvis, MD, DFASAM, chief of addiction services for Geisinger Addiction Medicine and the Geisinger Neuroscience Institute.
Paul H. Earley, MD, DFASAM, agrees. He’s the immediate past president of the American Society of Addiction Medicine, a professional medical organization that creates widely used guidelines to improve the addiction treatment system. You may know about their ASAM criteria, a set of guidelines to help determine the best course of action for a person with addiction.
Earley says that some people who don’t have urgent and severe physical or psychiatric problems are able to reach "remission" by getting regular care from an addiction specialist like a therapist or a recovery coach. Remission is when you go a certain number of months without meeting the medical benchmarks for having a substance use disorder, other than cravings.
If that doesn’t work, the specialist can work with your primary care doctor to gradually ramp up the level of care. A residential rehabilitation center may be an option to consider down the road.
If you decide you want to look into treatment centers right away, an addiction specialist might be able to recommend a program matched to your needs. You could also ask for recommendations from people you know who are in recovery.
"If you have friends who have been through a type of program, ask them what worked and what they thought of that program," Earley says.
Jarvis and Earley both recommend using the online tool ATLAS (Addiction Treatment Locator, Assessment, and Standards Platform) on the nonprofit site Shatterproof.org. It can help you get an idea of the level of care you might need and where you can find a facility that provides it.
ATLAS is up and running in six states -- Delaware, Louisiana, Massachusetts, New York, North Carolina, and West Virginia. The plan is for it to expand nationwide.
Tips to Search Safely Online
Proceed with caution if you decide to search the internet for a drug or alcohol rehab center.
"Online can be a dangerous place to be," Jarvis says, especially when it comes to treatment facility advertisements. "If it looks too good to be true, then it is. If there are promises of cures, [addiction] is not a disease that can be cured. It can be managed."
Be skeptical of ads that emphasize the creature comforts a center offers, like a detoxification diet, yoga, or equine therapy. Those things are fine in and of themselves, Earley says, but there’s no research to show that they're specifically helpful to treat the core of someone’s substance use disorder.
"The things that tend to have glamor around them tend to be things that don’t have an evidence base around them," he says. They’re expensive, too.
Some ads claim that you can get treatment in your area, but the advertiser doesn’t actually have a treatment center there.
"If you’re in any location, you don’t have to fly 500 miles or 1,000 miles to treatment. There’s probably a good treatment program in your area," he says. "This idea that you have to go to Florida or Southern California if you’re not there is not accurate."
Ventrell also suggests you check the NAATP’s industry directory. The association is a nonprofit professional membership group of addiction treatment providers, including treatment centers.
"All NAATP members are licensed and accredited for everything they do in every location. They follow our quality assurance guidebook, and they follow our ethics code."
Rehab facilities that are members of the NAATP are prohibited from posting deceptive or misleading ads. They also have to deliver the services they promise and follow a number of other ethical rules meant to protect patients’ health, rights, and finances.
Beware of ‘Patient Brokers’
"There are people in this world," Jarvis says, "who are hired by rehabs simply to get patients. And they get some sort of financial compensation for each body they deliver to the rehab."
This is patient brokering, and it’s not an ethical business practice, she says. Ventrell agrees.
"A broker is bringing in a patient based on the treatment provider’s promise to pay, not on the clinical assessment of what a patient needs," he says. "It is fundamentally problematic and not allowed in any area of medicine."
The NAATP forbids its members from offering or receiving financial rewards, gifts, or other types of compensation for patient referrals.
So how do you know if you might be talking to a patient broker? To start, they may sound far more eager to make a sales pitch than to discuss your health and needs.
"If it’s a high-pressure sell, that’s something to be concerned about," Jarvis says. "If the person you’re speaking to doesn’t start asking you enough to do some kind of a [health] assessment, that’s an issue too."
Ventrell recommends that you:
- Ask the person you’re talking to who they work for. Make sure they’re employed by the treatment center that you’re considering.
- Be suspicious if they try to tempt you with perks like plane tickets to an out-of-state facility or offer to waive your insurance deductible.
- Call a treatment center directly. If you find a phone number online, compare it to the number listed on the center’s official site.
What a Rehab Center Should Ask You
Once you know you’re talking to a representative at a treatment center, it’s important that they assess your health and life circumstances. Jarvis says a reputable facility would ask you things like:
- How severe your substance use disorder is
- What other physical or mental health conditions you have
- Whether you have a place to live, transportation, and resources to manage your life
"If those kinds of things aren’t being considered, then that’s a sign something may not be well," she says.
And if the representative says that "everybody who calls needs to go to residential treatment, that’s not credible," Ventrell adds.
What to Ask a Center
Whether you’re visiting a facility or talking to a representative on the phone, ask questions like these:
Are you licensed and accredited? The center should be licensed for providing addiction treatment, Ventrell says. It should also be accredited by an outside organization that makes sure its staff meet certain standards for care and performance.
What evidence-based treatments do you use? These are science-backed treatments for substance use disorders. Some of them are:
- Cognitive behavior therapy (CBT), which can help you spot and change negative thoughts
- Dialectical behavioral therapy, which can help you control strong emotions
- A type of counseling called motivational interviewing
- Medications that treat opioid and alcohol use disorders
If a representative at a residential rehabilitation center tells you they don’t believe in using FDA-approved meds for alcohol or opioid addiction, that’s a red flag, Jarvis says.
Do you have specialty programming for me? "Ask about your specific circumstance and how they would manage it," Earley says.
For example, if you’re a young adult who began abusing drugs or alcohol in your teens, your treatment needs are going to be different than a 50-year-old who’s had a substance use disorder for 30 years, he says. Or, if you have depression or anxiety, it’s important that the center has an addiction psychiatrist on staff.
Make sure the facility can meet your specific needs and that they have experience treating people whose age and life circumstances are similar to yours, Earley says.