As the Co-Founder of WeRecover, the world’s first online booking engine for addiction recovery centers (essentially Hotels.com for rehab), my co-founder Max Jaffe and I have seen thousands of people go through hundreds of treatment programs and we have learned a great deal about what somebody suffering from addiction should be looking for if they are considering going to rehab.
Today, our nation is at the pinnacle of an unprecedented opioid epidemic. According to the US Center for Disease Control, 91 people die everyday of an opioid overdose, and over half a million Americans have lost their lives due to drug overdoses between the years 2000 and 2015. Just as the root causes of this are varied, the solution to it will not be found in a one size fits all approach. The end to this epidemic begins with each individual who is addicted making the choice to recover and taking the steps necessary in their own lives to move forward on that path.
To that end, rehab is a great first step. The Affordable Care Act makes discrimination based upon pre-existing conditions illegal, and thus, even an active heroin addict has a right to insurance. The Mental Health Parity Act mandates that insurance companies cover mental health like they would any other disorder. Between these two laws, very little is stopping anybody in America from getting the help they need to recover from their addiction.
With that said, if you are looking into rehab for yourself or a loved one (I use this term “rehab” broadly to include detox, residential inpatient, partial hospitalization and intensive outpatient programs), here are the top 10 characteristics of an excellent drug rehab.
While this may seem obvious, it is not standard practice by any means. Rehab is essentially one’s opportunity to work through years upon years of festering problems. Drugs are not the problem, but rather they are the symptom. Why one uses drugs - that is the real problem. And that is what the experience of rehab is designed to help someone uncover. Some people get addicted to drugs as a means of coping with trauma. Others get addicted due to depression. For some, addictions help escape symptoms of PTSD. There are countless reasons why people find themselves addicted, and each individual has their own. Rehab should be an opportunity for someone to get to know themselves, in which trained clinicians, therapists and counselors are there to help them uncover the deep-seated issues that have led to the addiction. And those issues, more often than not, can only be uncovered through in-depth, and frequent one-on-one sessions with a support team in which one reveals their vulnerabilities and works to swap out destructive habits with productive ones. Seek a rehab that offers at least one-on-one session with a counselor or therapist each week.
A clinical director with at least a master’s degree
While many sober people without master’s level degrees in behavioral health have opened rehabs and built great programs, more often than not these programs are not evidence-based. If you are looking for Alcoholics Anonymous, then go to Alcoholics Anonymous meetings. But rehab should be much more than just the 12 Steps. A solid rehab program should be rooted in evidence-based modalities, and the greatest chance you have of finding a rehab that offers such modalities is to look for a facility whose clinical director has at least a master’s level degree in a relevant field.
I have found that the easiest way to predict if somebody will remain sober after rehab is to look at whether or not they have a job. If they get out of rehab and find work, they will be far less likely to relapse than those who complete rehab and go back to their old life - to the people they once used with, and to the boredom that led them to use. Work, and the responsibilities that come with it, play a great part in one’s ability to stay sober after completing treatment. Therefore, I place “vocational support” at the top of my list of qualities you should look for in a rehab. Ask the rehab: what kind of vocational support do you offer? And see what their response is.
A success rate above 65%
Most rehabs do not track their success rates. Doing so is difficult. It requires following up with former clients months and years after they complete treatment. It requires maintaining relationships with clients and creating an organizational system for doing so. However, despite these challenges, most great programs do keep in touch with their alumni and track their success and progress over time. You should ask any rehab you are considering what their success rate is - success being defined as alumni who are still sober - and you should look for a facility whose success rate exceeds 65%. Note, there are exceptions to this rule. For example, if a particular rehab specializes in dual diagnosis veterans with PTSD, it might be expected that their success rate is lower. Another exception would be a standalone detox facility. In that case, the long-term success of the patient really depends on where they went after. In either case, ask the question - “what is your success rate?” - and listen to their response.
A family program
For any rehab other than a standalone detox facility, incorporating family into the program should be essential. There is a wonderful TED Talk by Johann Hari which posits that the opposite of addiction isn’t sobriety, it is connection. I agree with that. For one to maintain long-term sobriety, one must have strong bonds with other people, and the most logical place to start is with one’s family. Therefore, always ask a rehab you are considering: “What kind of family program do you have?” Then, listen to their answer.
This is critical - absolutely critical - and I cannot emphasize the importance of exercise enough. WeRecover has been working with Alex Lightman, Co-Author of 2016 Amazon bestseller Augmented: Life in the Smart lane, on a system for scoring rehab centers in addition to a protocol for treating addiction. One of the least obvious findings we have uncovered is the importance of exercise and nutrition. Exercise, particularly running, is a neurogenic activity - meaning your brain literally grows new cells and repairs itself. Exercise as a neurogenic catalyst is one of the key attributes of a great rehab center.
In addition to exercise, in accordance with our findings with Alex Lightman, nutrition is a key ingredient in a successful recovery. A connection we have uncovered is that cravings for one’s drug of choice are almost non-existent when one’s body is in a state of ketosis. This finding is novel, and I wouldn’t expect most rehabs to adhere to this diet yet. But, you should seek out a program that places great value on nutrition if you expect to repair your body and brain.
This may seem obvious, but many rehabs are not grounded in “evidence.” They were founded and are run by sober individuals, who, though they may have the best of intentions, have not rooted their programs in evidence-based modalities. Every other field of medicine aims to be evidence-based and mental health should be no different. If you are evaluating a rehab for yourself or a loved one, look at their website, and listen carefully to how they communicate their program. You should be looking for things like “cognitive behavioral therapy,” “dialectical behavioral therapy” and “motivational interviewing,” to name a few. Look for a rehab that goes beyond just the 12 Steps and offers numerous other evidence-based modalities.
Offers both Western and Eastern treatment modalities
Recovery from addiction is a lifelong endeavor that can be set in motion in a short amount of time at an excellent treatment center. Rehab is basically the process of detoxing from one’s drugs of choice, understanding why one used to begin with, and retraining the body and mind by swapping out old habits with new ones. To that end, while psychiatry, psychotherapy, and medicine are useful for the first portion of this process, when it comes to developing new habits, eastern medicine offers many valuable modalities - meditation, mindfulness and yoga among them. Eastern medicine is rooted in a more holistic approach, and it is that approach, if turned into new habits, that will carry one through life post-treatment. Rehab is the perfect time to begin replacing old habits - sugar, TV, sex, drugs - with new ones like exercise, meditation and yoga. Look for those activities on their websites and ask their admissions coordinator to what extent they are integrated into the program.
Connection-building activities among clients
This is hard to quantify and easy to overlook, but I will break it down simply. Nobody really got into an addiction by themselves. People engage in destructive habits as groups. And one cannot find their way out of an addiction on their own. If somebody could do it alone in their own home, then they would, and they wouldn’t need rehab. But for the vast majority of people who have reached the point in which rehab is necessary, one reason why is that they need to become a part of a group that is practicing healthy, nourishing behaviors and habits. The other people in the treatment center will become one’s support system and friends. All of them are on this journey together - at least while they are in treatment together - and activities which foster connection amongst clients are important. One rehab, an intensive outpatient program in Costa Mesa, CA called Tree House Recovery - places great importance on this. When a client is going to be admitted into Tree House, the admissions team steps out of the room and allows the clients already there to interview the individual. They decide if he (as it is an all men’s program) is a fit for the group. While that is an uncommon practice, it exemplifies the importance of a rehab that fosters camaraderie amongst clients. Look for this, and look for ways in which the rehab facilitates teamwork and camaraderie.