Alanna Berger: How rehab facilities fail their patients

Sunday, December 1, 2019 - 12:57pm

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In her new podcast series “Last Day”, author and activist Stephanie Wittels Wachs introduces listeners to her younger brother, Harris Wittels. She begins by detailing Wittels’s almost meteoric rise to success as a comedy writer, beginning with his first major writing job at age 22 for “The Sarah Silverman Program.” From there, Wittels was hired as a staff writer for NBC’s “Parks and Recreation”, where he eventually became executive producer. In this time period, he coined the term “humblebrag,” which eventually entered the dictionary and was the basis for a book he later published. As “Parks and Recreation” approached its series finale, Wittels was set to move to New York City to co-star in and write for Aziz Ansaris acclaimed series “Master of None.” But less than a week before the “Parks and Recreation” final episode aired, Wittels died of a heroin overdose at the age of 30.

What many in his life did not know was that throughout his various successes, Wittels had been struggling with substance abuse of opioids stemming from a previous back injury. He had entered and completed a rehabilitation program, which was successful for some time before he suffered a relapse. Soon, Wittels turned to injecting heroin for a cheaper, stronger high. By the time of his death, Wittels had completed three stints in different rehabilitation facilities. 

The three-time failure of rehabilitation facilities to provide lasting recovery for Wittels is not an isolated case. In fact, between 40 to 60 percent of those with substance abuse problems who enter treatment experience relapse. The reason for these failures is not because of an inability on the part of the patient to get clean, but an institutional failure on the part of the facility to provide therapeutic processes that actually work. In the United States today, rehabilitation for drug and alcohol abuse disorders is a multi-billion dollar industry, yet it is also an industry that fails in providing lasting recovery for those seeking help. In order to remedy this issue, society must look into why these facilities have been able to get away with their failures and hold them accountable for the lack of standards that lead to an ineffective system.

For individuals dealing with substance abuse disorders, rehabilitation centers are the first step on a difficult path to recovery. However, there is no nationally accepted definition of standards for rehabilitation facilities. This lack of definition means that there are no federally regulated standards that facilities have to meet to be considered a legally sanctioned rehabilitation center. The field of treatment for addiction is overwhelmingly underregulated and under-supervised. In many states, the process of becoming an addiction counselor does not even require that one gets a high school degree or has any specialized training. As a result, rehabilitation centers continue using old treatment programs that do not have scientific evidence that supports their effectiveness. 

To understand the programs that abound in most rehabilitation facilities, it is important to be familiar with the “12-step program.” This program has been the gold standard in addiction treatment for decades. In fact, the exact 12-step program used today in Alcoholics Anonymous was first developed more than 80 years ago, in a time when neuroscience was a fledgling field of study. Additionally, the program was developed to largely serve alcohol abusers participating in Alcoholics Anonymous, not those with addictions to drugs. Ruben Baler, a health scientist for the National Institute on Drug Abuse, emphasizes the popularity of these 12-step programs but states there is no scientific evidence they actually work. Baler further explains the only evidence used by rehabilitation facilities to prove the efficacy of such treatment programs is purely anecdotal.

The widespread use of the often ineffective 12-step program is just one manifestation of failures in addiction treatment. A 2012 study from the National Center on Addiction and Substance Abuse at Columbia University found that a low number of patients with alcohol or drug abuse disorders who seek treatment receive any care that even closely approximates evidence-based care. Instead, many rehabilitation facilities pour their budgets into treatments like equine therapy. While such facilities boast the benefits of equine therapy as stress-relieving and mood-boosting, there is no empirical data to support claims that they help in substance abuse recovery.

In the face of antiquated treatment processes, it is no wonder why many patients at rehabilitation facilities relapse shortly after finishing treatment. However, many substance abuse treatment centers boast inflated success rates. In fact, many assert success rates of over 80 percent for their patients. Yet, when they are pushed to provide evidence to support these claims, they are unable to do so. In more realistic terms, the generally prevailing success rate for treatment programs is about 30 percent. Even after the realization that 70 percent of patients receive no benefit from their time spent in rehabilitation centers, a figure many experts still believe is too low, the reality of rehabilitation treatment gets more abysmal. A 2015 study found that patients who solely received psychological support in their treatment program are twice as likely to die from overdoses than those who receive opioid replacement medications such as methadone. Despite this, three-quarters of substance abuse patients are treated without the use of replacement medications. 

As the opioid epidemic continues to reach crisis proportions, the market for those in need of treatment is as large as ever. When done properly, rehabilitation centers have the power to change lives for the better. But a lack of accountability and scientific evidence for treatment efficacy combined with a desire to maximize profits create an industry that fails its patients. Those with substance disorders are led to believe that these facilities prioritize patient recovery. Yet, the fact remains that there is more money in recurrent patient relapses for rehabilitation facilities than there is in long-term patient recovery. Perhaps this is the reason why treatment centers continue to utilize programs with no scientific evidence of their efficacy and simply perpetuate a cycle of patient recovery and relapse. It is a cycle that led to the death of Wittels, the famous musician Prince and millions of anonymous Americans seeking treatment. If rehabilitation centers want to become more capable of providing lasting recovery, they must abandon the 12-step program as a one-size-fits-all model. Additionally, they must increase access to medication-assisted treatment with drugs like methadone as an acceptable treatment model, allowing patients to ease themselves into a longer lasting recovery. Finally, the American public must hold the rehabilitation industry accountable for its unethical practices and corruption. In its current form, rehabilitation processes provide inadequate care to give their patients lasting recovery. By implementing these changes to the system, those suffering from substance abuse disorders can access the recovery that is all too elusive to them today. 

Alanna Berger can be reached at balanna@umich.edu.