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Why Outpatient Treatment for Addiction and Alcoholism may be a better choice than Inpatient Rehab, and why you rarely hear this

This is my first blog entry and my hope is that through monthly posts, I and my associates, Dr.s Megwinoff, Bassett and Gottlich can help shed some light and insight on our various expertise and experiences in addiction treatment. In listening to my patients and their families, I realize that there is a great deal about addiction and its treatment that is misunderstood. There are many misconceptions about addiction treatment. Often, people looking for help for addiction are hopeless and vulnerable to exploitation. Many messages are misconveyed in order to justify expensive and unnecessary treatments. Inpatient rehab and its utility is one of them.

Our website was recently and unknowingly put on a search website for inpatient rehab facilities. It seemed to be an informative website where one could look up various inpatient and outpatient drug programs, but in big bold letters on the top, was a 1-800 number that read “get 24/7 help. Free and Confidential”. I called to find out what this was, and it became clear that this whole directory was actually set up in a misleading way to attract vulnerable people looking for help. Of all of the listing of different treatment options, the website specifically directed them to one number that was actually a referral number only to about 6 or 7 inpatient rehabs owned by this large for profit company that owned the website!

Inpatient rehab and step-down living facilities are very big business. In fact, because they are so lucrative, many have been bought out and are now owned by big for profit corporations, private equity funds or hedge funds. Though they appear to be working in the best interest of the patient, many rehabs have one goal in mind: Profit. They have sophisticated marketing departments and take advantage of vulnerable people in times of hopelessness and tremendous guilt. In addition, rehabs, especially when private, do not abide by the same ethics and moral principles of say a physician or a not for profit hospital. In the case of the website above, a person may call the 1-800 number thinking they are speaking to a counselor who is evaluating their needs for treatment. That “counselor” is actually only trying to get them to accept admission to one of their private for profit rehabs. Most have trust that the counselor on the phone is a qualified ethical health care professional who has their best interest at heart, and will often go to where they are pushed even if it is clearly not a good fit. Often one will be told to pay upfront, in this time of crisis. The results can be devastating for someone who is high functioning, living with their family, and they end up in an inpatient facility that is not right for them, sometime for up to 90 days. Many rehabs are nothing more than a holding cell that ferry their patients to AA meetings and preach abstinence – I will address “What happens in Rehab” in another blog.

Success and long term results from inpatient rehab are no different in general than any other form of treatment. In fact, although many rehabs tout high success rates, these are usually not long term success rates. Even when they do seem to show a high rate after “one year” the many clients who relapse “are lost to follow up” and not included in their statistics. I have seen many families who spend tens of thousands of dollars or more on inpatient treatment with the hope it will change their loved one, with only minimal short term effects.

When is outpatient drug or alcohol treatment a good option?

It is a misconception that if one is serious they actually go to rehab. People can get sober in many different settings and using various treatment options. Even if someone is opiate or alcohol dependent, often they can be detoxed safely as an outpatient. Although I would highly suggest a full evaluation by an addiction psychiatrist before making any choice for treatment, many people can begin effective addiction treatment as an outpatient while living at home. Characteristics that suggest you may be able to begin treatment at home include having support at home, still functioning at work and in some relationships, and the ability to form a rapport with an addiction doctor.

The reality is that change comes from within, and it is a long term process. What sparks that change is unknown. Sometimes it can be that someone reaches a personal bottom, but only each individual person can define and experience that desire for change. Recovery, (or changing bad habits and self destructive behavior) is a lifelong process composed of many different elements that person encounters daily. Inpatient rehab treatment is a short blip in time which can sometimes help get a person on track, but is unfortunately overused, often at the (great) expense of people in a desperate moment, with minimal benefit.

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