Question: My son has a drug problem and we would like to send him to a drug rehab. We are looking around at the options available to us and we are finding it difficult to determine which is best. These programs are very expensive and we want to ensure that we are getting good value for our money and that we are sending him to a program that is going to give him the best chance at really beating his addiction. How can we compare the success rates of different programs? As medical facilities these places must keep records of their treatment success rates. Is there some database which compares the treatment success rates of different drug rehabs? I have looked online but I cannot find it, but I am not sure that I am searching correctly for it. I assume that such a database, if it exists, would be governmental in nature. If you any information on this or on other reasonable ways to compare the success rates of different rehabs we would be very grateful to find out. Thank you

Dr. David Sack Says...:

Choosing a treatment program is one of the most difficult decisions a client or family needs to make.  The best rehabilitation program is one where the client stays and completes their treatment.  If someone leaves treatment early they nearly always relapse.  Location, amenities, the number of clinical staff can all affect whether someone stays and the factors are different for different people.  A second important factor to consider is whether all clients are evaluated by a psychiatrist.  Nearly half of those entering rehab have serious psychiatric problems in addition to their addiction.  When these other problems go untreated, the risk of relapse is 3 times higher.  A related issue is whether the therapists have the training to address the mental health problems of the clients.  In general, this requires therapists with Masters level training or above.

Most programs are not set up to fully report on their outcomes.  Most accredited programs (CARF, the Joint Commission) collect a range of data about their outcomes and generally will share it with the public. 

There is currently no database that compares the results across programs.  An individual will do best when the setting is appropriate to their level of problems.  Clients who are addicted or abusing multiple medications, those with serious mental disorders, those with a longer history of addiction, and/or a history of suicidal ideation will do better in residential treatment.  Those who have strong social support and are compliant with treatment may actually do better in an outpatient program.

Be very cautious about any program that claims a success rate (a specific percentage). This is at best an unscientific guess and at worst an outright misrepresentation.

Question: Doesn’t it make more sense for me to stay at home and do an outpatient program? I went to rehab last year and everything seemed great while I was away but it was so artificial because I wasn’t near all the people and places I had always used with and in. I relapsed like within a month of getting out and haven’t been clean since. My parents want me to go back in, but I think that this time I should do an outpatient program so at least I don’t get that big surprise after graduation and my return to home. Does an intensive outpatient program make more sense for someone like me?

Dr. David Sack Says...:

Outpatient treatment is most successful when the course of addiction is not complicated by other factors such as a co-occurring psychiatric disorder, multiple drugs of abuse at the same time or recent or past suicide attempts.  One needs to look at whether it is even possible for the individual to cut down or stop in an outpatient setting.  As a rule people do best when they are treated in the setting that is most appropriate for their particular problems.  Transitions are difficult for most people in early recovery.  

At Promises we find that people are most successful when they find a temporary sponsor and commit to going to enough meetings in the first month (20-30 meetings) to find a home group they are comfortable going back to.  Continuing with outpatient therapy and medications (if they have been prescribed for depression or anxiety) can be critical to success.

Question: How important is it to get into rehab that uses saunas as a way to really sweat out all of the drug metabolites. Some programs seem to use them extensively and others very minimally or not at all. Is this a necessary part of a treatment program?

Dr. David Sack Says...:

Most drugs of abuse are metabolized by the liver and excreted by the kidneys in urine or by the liver in bile.  There is no evidence that perspiration, which is presumably the mechanism by which a sauna would work, contributes significantly to this process or achieves results that would not otherwise be achieved through normal processes.  With saunas there is also the risk of medical complications through electrolyte loss and imbalance, dehydration and hyperthermia.  Given the lack of scientific evidence to support detoxification through this method, I would not recommend it as a first choice for treatment.