This is my first HuffPost article and I want to talk about the substance use disorder treatment industry, specifically in South Florida, in response to a recent New York Times article that will be followed by tonight’s Megyn Kelly story. If you pick up from my tone that I am frustrated, maybe even a little angry, that is because I am!
It’s important to educate those who might not understand the terms and all the pieces of the puzzle. Many who have been reporting on or trying to make changes in the industry don’t seem to grasp the differences.
I will be writing a series of articles, but in this first one I will address: the difference between a sober home and a treatment center, the different levels of care in treatment, responses to recent media stories, and what to expect from treatment.
I will start by getting out of the way that there are people in this industry, as in all industries, that are unethical and taking advantage of the system. Some who went in to the field did so because they wanted to help people, some to make money, some a combination of the two. And let’s be honest, even those who came in to the industry for the right reasons, might not know what they are doing which can also create problems. I see this a lot as a consultant: Individuals who opened either sober homes, treatment centers, or both, but really don’t understand substance use disorder from a psychological or a medical perspective but they do mean well.
What Is the Difference Between a Sober Home and a Treatment Center?
While the media, politicians, prosecutors, and many others often speak about the two interchangeably, a sober living facility (aka sober home) is NOT the same as a substance use disorder treatment center (aka rehab, treatment center).
Sober homes are group homes where people who are in recovery live together. Most sober homes have full time, or at least part-time supervision and structured rules including curfews, although some are more lenient when people have been abstinent/sober for longer periods of time (usually referred to as 3/4 homes). Some are privately owned, and some are owned by companies. Some are operated by the same people who run treatment centers, some are not. Some sober homes are affiliated with treatment centers, while others are not at all. At sober homes affiliated with a treatment center, there are usually behavioral technicians who help clients. At these homes, there is often a house manager, who is usually an individual who is active in recovery and lives in the house free of charge in exchange for overseeing the other residents, making sure no one is drinking or using drugs, that the house is kept clean, rent is paid, etc.
Living in a sober home—and paying rent, buying their own food, living by rules, remaining sober—helps a person in recovery take responsibility for their life and regain their independence.
A treatment center is a place where an individual struggling with abuse of alcohol or drugs goes to get treatment. At treatment centers, there are licensed mental health professionals and physicians involved in treatment. There are different levels of care at treatment centers, including detox, residential, day/night treatment (sometimes referred to as partial hospitalization), intensive outpatient, and outpatient treatment.
Levels of Care in a Treatment Center
It is becoming less common for people to enter residential treatment as their first step because insurance companies make it difficult to be reimbursed for the cost. Residential treatment is the safest first step in recovery from a substance use disorder because there is 24-hour supervision. It is important to remember that whatever level of treatment someone is in, they are almost always there voluntarily. When someone is an adult, over the age of 18, they can leave whenever they want to.
Due to the difficulty in getting coverage for residential treatment, people typically start substance use disorder treatment in a day/night (D/N) treatment program which include a minimum of five hours of treatment, five days a week. There are two licenses one includes community housing and one does not. While most D/N treatment centers do offer housing for their clients, it is not required if the license is without community housing, and must be paid for out of pocket. So too bad if you don’t have family or friends who can help with rent and food! In addition, individuals rarely are allowed more than 30 days of this level of treatment by insurance companies. Then it’s off to an Intensive Outpatient Program (IOP). IOP are a minimum of three hours of treatment a day, three days a week. Again, many treatment centers own housing to ensure that clients have a roof over their heads, but clients must pay rent and buy food on their own. Individuals are lucky to get two weeks of IOP allowed by insurance companies.
The client is then stepped down to an Outpatient Program (OP). This is almost always a decision made by the insurance company. If licensed clinicians disagree and the treatment center is willing to allow the client to continue at the higher level of care without being reimbursed for that level of care, then insurance companies will not even cover OP treatment.
OP is typically one hour of therapy a week, and good luck finding a place to live, be it a sober home, or independent living. Again, if you do not have family and have not during the roughly six weeks of treatment recovered from the physical, mental, and neurological effects of the drug(s) you were using, found a job, and saved enough money for a place to live, then you are back on the street. How’s that for setting someone up to win?!
Many argue that people in recovery should find jobs and make money. But let’s think about the reality again. Can we expect an individual who has been using for a good amount of time to come off a drug, be neurologically and emotionally sound, get a job (a challenge considering that many of these individuals have criminal histories because of their drug use), and save at least $800 to be able to move in to a sober home? The system is set up for a struggling individual to fail!
Understanding Some Realities of the Industry: Responses to Recent Media Stories:
The recent New York Times article and Megyn Kelly story provide only a piece of the puzzle. Drug and alcohol treatment in South Florida is nothing new. It is something we have been known for, and in a positive light, for a long time. Community support is important in recovery and South Florida has historically been able to provide that.
There have been unethical practices and abuses in the treatment industry. People in the industry have been paying for clients (considered human trafficking), providing clients with drugs so that they would have a positive drug test and remain in treatment, overcharging insurance companies for drug tests, paying independent sober homes to bring clients to their treatment facility, and in the one extreme case that has been mentioned repeatedly, being prostituted. These abuses are awful. But they involve a small percentage of the many excellent treatment providers who support clients in changing and saving their lives. You do not hear about the success stories, the good providers, and the positivity in the South Florida treatment world. Why would you? That’s not sexy or exciting, right? To me it is!
The media tells you that we have more people dying of overdoses than anywhere else, and it is all because of our “sober home problem”. That’s just not true. Ohio, West Virginia, New Mexico, New Hampshire and Utah are among states where overdose rates are higher.
We have a societal problem, not a South Florida drug or sober home problem. The state attorney and task forces have been cleaning up our problem. They have written and passed new legislation, and arrested those with unethical and illegal practices.
Of course, there are negative things in the world of substance use disorder treatment, but we are leaving out a lot of the positive.
In most cases, people are not overdosing and dying because of bad sober homes. They are overdosing and dying because they are abusing substances, their tolerance is lower after being sober for a period of time, the drugs are more potent or synthetic, and because the insurance companies are not allowing them to remain in treatment to get the help they need.
Research has shown that the longer you are in treatment, the more likely you are to remain sober. It also tells us that the longer you stay abstinent from drugs and alcohol, the more likely you are to continue being abstinent. Research also shows that a variety of treatments used in combination are most effective. But all treatments are not reimbursed by insurance companies, i.e. neurofeedback. Insurance companies do not give people the time they need in treatment to have the highest chance at success.
I hope you can see that unethical and illegal sober home operators are few and far between. South Florida has many great treatment providers and a lot of individuals who are getting help, changing their lives for the better, and staying sober! Let’s highlight some of those success stories!
Parents, remember, if your child is not in a residential treatment center, they are not being supervised 24 hours a day, 7 days a week. They are living independently, and even if they have “supervision” some of the time, they are not always monitored. Just as they drank and used substances when they were living with you, they can leave their sober home to do so as well. They can sneak drugs or alcohol into the sober home as they probably did in your family home. If your children are no longer minors, they have a right to leave treatment, or refuse to allow treatment centers to release information to you. They are not prisoners. I don’t mean to be harsh, but it is important that everyone knows the facts and understands what to expect.
I am going to do a series of articles on substance use disorder and treatment including questions for loved ones to ask to ensure the treatment center they are sending their family to is a good and legitimate one. Please feel free to comment or ask question