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Did You Know Outpatient Substance Abuse Treatment Often Outperforms Residential Treatment?

Movie stars and musicians do it. So do televangelists and politicians. Residential substance abuse rehab is the high-profile face of addiction recovery, bringing with it a hefty price tag and promises of a clean new life. But while residential rehab programs advertise innovative treatment options, personalized recovery plans and more, they actually deliver -- and achieve -- far less. Recent research on addiction and recovery reveals that flexible, low-cost outpatient treatment programs offer more services and treatment options than their residential counterparts, with a far higher long-term success rate.

For many people and their families, residential rehab programs are the first choice for treating addictions to substances such as alcohol, opioids and street drugs. These programs are heavily advertised as a one-stop "fix" for these addictions, typically promising 30 days of separation from addiction triggers, intensive therapy with highly trained addiction counselors, and customized substance abuse treatment plans that may include activities like yoga or journal therapy.

The price for all of those services is steep. A month in a residential rehab can range from $15,000 to $50,000 or more -- assuming insurance covers the whole 30 days of treatment. Some insurance plans cut off payment after a week, 10 days or three weeks. But completing a full 30-day stay in residential rehab still isn't enough to support long-term recovery. In fact, only about 30 percent of alcoholics (some say the number is much lower) can expect to stay sober for one year after completing a 30-day residential rehab, and the numbers are even lower for those addicted to other substances.

Residential rehab programs do have an important role to play in the ever-evolving field of addiction and recovery, and for a very small percentage of people, a residential program may be the best first step on the road to recovery. Some people also benefit from a break from the toxic environment that triggered their addictions, or from a safe place to regroup after a traumatic experience. Residential treatment may also be the most appropriate option for someone who needs medication monitoring, has other illnesses or presents a danger to self or others. But as author Anne M. Fletcher points out in her book "Inside Rehab," for most people struggling with addictions, a residential rehab program probably should be the last, not the first, option to consider.

While high costs and the disappointingly low success rate are certainly reasons to reconsider spending a month in a residential treatment program, another issue, as Fletcher notes, is the failure of residential programs in general to deliver the rehab experience they advertise. Rather than getting individualized attention, residents typically follow the same schedule of groups, meetings with therapists and activities, regardless of their situation. The "highly experienced" addiction counseling staff may have minimal training and no degrees, and most programs are still built on the 12-step model, with no alternatives for those with different belief systems.

A client who recently completed treatment at a residential facility and came to me for aftercare said that the program advertised non 12-treatment approaches such as Smart Recovery and Refuge Recovery. "But there weren't any of those meetings in their area," she said, "so all we did was AA." This is a common report from former residential treatment clients.

While the difference between what's advertised and what's delivered in residential treatment plans may be large, another factor contributing to the low success rate of these programs is the residential experience itself -- clients are removed from home, family, work and familiar surroundings for the duration of the program.

This kind of break from the stresses of daily living may help in the short term, but when clients return to their homes, they end up facing the same stresses and issues that they left behind, with few or no new skills to handle them successfully. Those kinds of struggles account for the "revolving-door" nature of rehab for many people, who may cycle in and out of treatment programs a dozen times or more, with no real change. Imagine spending $30,000 for a 30-day residential rehab, only to return home to a family that thinks you have been “fixed” and you relapse! The shame surrounding the relapse can actually drive someone to drink or use even more.

With far less fanfare and a much lower profile, outpatient substance abuse programs, like Fusion Recovery, quietly outperform their residential counterparts on just about every front. Offering a wide range of individualized and community-based services and support at a fraction of the cost, outpatient rehab programs often combine outpatient detoxification, medication, group and individual counseling, psychiatry, medical support, mind-body practices and life skills training. To really understand and resolve serious underlying issues, outpatient also offers a much greater length of treatment.

Addiction is a chronic illness, much like diabetes, cardiovascular disease, cancer, epilepsy or obesity. You wouldn’t expect to spend 30 days anywhere and no longer need treatment for any chronic illness. You’d be asking questions about effectiveness, side-effects, and the qualifications of the clinician treating you. But somehow, many people treat addiction differently, often with disastrous consequences.

As author David Sheff notes in his book "Clean," to successfully treat addiction, it's essential to address not just drug use itself, but also the factors behind it. With that in mind, many outpatient rehab programs take a holistic view of addiction and recovery. Since clients continue to live and learn in the real world that also contributed to their to drinking or drug use, these programs can provide a framework for long-term recovery that draws not just on the services of therapists and counselors, but also on the support of peers, family and community resources.

Outpatient programs are far more economical than residential addiction treatment, too. The $15,000 that marks the low-end cost for month in residential rehab could provide the services of a skilled outpatient clinician for six months or more -- along with an array of services such as medical care, family counseling, and even alternative healing modalities like biofeedback, acupuncture and mindfulness training. For the average cost of around $40,000 for that month in rehab, an outpatient program could potentially offer years of ongoing support and professional services.

Residential rehabs typically recommend that clients begin an outpatient program after their stay, a clear acknowledgment that a month is simply not enough to address all the issues that affect a person's long-term recovery. Since that's true, why not start (and end) with flexible, economical and highly effective outpatient substance abuse rehab in the first place?
Outpatient programs like Fusion Recovery, in Silicon Valley, are beginning to emerge around the country and offer a wide-range of evidence based treatment that can lead to long-term recovery of this chronic illness. We invite you to visit us online at https://www.fusionrecovery.com to learn more.


Michael O’Brien, NCAC I, SAP, CSC is an Addiction Specialist and Co-Founder of Fusion Recovery in San Jose, California.

Sources:
Fletcher, Anne M. Inside Rehab: "The Surprising Truth About Addiction Treatment - And How to Get Help That Works." New York: Penguin Books: 2013

Roan, Shari. "The 30-Day Myth." The Los Angeles Times. 10 Nov 2008. http://articles.latimes.com/2008/nov/10/health/he-addiction10

"Relapse Prevention." National Institute on Drug Abuse Clinical Report. US Dept of Health and Human Services. Accessed 4 Jul 2016. http://lib.adai.washington.edu/pubs/Relapse%20Prevention_NIDA%20Clinical%20Report%20Series.pdf

Sheff, David. Clean: "Overcoming Addiction and Ending America's Greatest Tragedy." New York: First Mariner Books, 2014.

 

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