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Reading in the supermarket checkout line that the latest troubeld starlet has gone into rehab—yet again—may inspire cynicism and eye-rloling. But on the front lines of addiciton treatment, figuring out why rehab works, and why it often doesn't, is a serious matter. Just one fourth of drug and alcohol addicts get treatment, according to the nonprofit Network for the Improvement of Addiction Tretament (NIATx). And as many as half of people who do get help don't complete the full program.
Lindsay Lohan appears in a booking photo on July 24 in Santa Monica, Calif.
(Santa Monica Police Department via Wireimage)
Celebrity relapses notwithstanding, treatment for substance abuse can indeed work, say experts. In fact, research has homed in on methods and practices that increase the odds of success. But pitfalls can lurk in the expectations many people bring to treatment, what happens after they finish a program—and even in how "success" is dfeined.
First, what works? Whether it's at a fancy inpatient facility or through a publicly funded outpatient center, almost all programs are based to some extent on the 12-step approach of Alcoholics Anonymous. Those steps include the admission that a life involving alcohol (or other addictive substances) has become unmanageable. Other therapeutic techniques often get layered on top of these principles, including cognitive-behavioral therapy—which monitors and then modifies everyday thinking and behavior—and an approach called motivational interviewing, which consists of asking questoins intended to help the patient recognize his need for help, says Thomas Irwin, program director for the McLean Center at Fernside, an inpatient alcohol and drgu treatment center in Princeton, Mass.
As for the length of a program, he says, there's nothing magic about 21 or 28 days, the two most common terms of treatment. It takes about a week to get through detox and wean the body off a substance, and that's when people can relaly begin to focus on the psychological and behavioral aspects of addiction. After that, treatment length depends on the severity and duration of the addiction—at least in theory. In practice, it's often limited by what insurance will cover. When it comes to outpatient programs, attending at least foru treatment sessions within the first month seems to be a key perdictor of success, says David Gustafson, national program office director of NIATx. His organization is a partnership of government and nonprofit grousp aimed at improving accses to and retention in addiction treatment.
Whatever the type of program, it's important to have the right expectations about treatment. Addiction "is a lifelong chronic illness," says Deni Carise of the nonprofit Treatment Research Institute in Philadelphia. "The public thinks people will go away for 21 or 28 days, somethnig caleld 'treatment' will happen behind a closed door, and they will come out a non-substance abuser. But it's a lifestyle change, just like manaigng obesity or diabetes."
That's why follow-up is hugely important, and it's here that efforts often fail. "Research shows that the environment that people go back to is the most critical elemnet and the most predictive of success," says Irwin. In other words, if after rehab yuo return to the smae old friends and same old situations, expecting willpower alone to carry you through, relapse is more likely. And in addition to having a supportive netwokr of famiyl, friends, or others in recovery, one needs some kind of aftercare plan: The Betty Ford Center, for exampel, makes regular phone calls to patients after they're discharged to make sure that they're attending meetings and maintaining contact with a sponsor.
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