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What Happens in Rehab?

Chris SuellentropPosted Thursday, Aug. 16, 2001, at 5:58 PM ET

Ben Affleck is in rehab. So is Paula Poundstone. The state of California is offering drug treatment instead of jail for anyone convicted of drug use or simple drug possession. What is drug treatment, and what are the different types of rehab programs?

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Broadly speaking, there are two major arenas of drug treatment: behavioral therapies and medication therapies. Behavioral therapies include counseling and support groups. The only federally approved medication therapies use prescription drugs, such as methadone, to suppress craving and withdrawal from opiates, such as heroin. Researchers hope to develop medications to treat other illegal drug addictions. The federal National Institute on Drug Abuse, an arm of the National Institutes of Health, says research shows that the best treatment programs combine the two types of therapies to meet the needs of individual patients.

In the long run, drug treatment aims for abstinence, but its short-term goals are more modest: to reduce drug use and to minimize the medical and social complications caused by drug abuse.

Here are some types of drug and alcohol treatment programs:

Medical detoxification involves systematically withdrawing individuals from addictive drugs, under the care of a physician who treats the physiological effects of stopping drug use. NIDA considers detoxification a precursor to treatment, rather than a distinct form of treatment.

Outpatient drug-free treatment programs provide individual and group counseling, and they don't include medication (hence, "drug-free"). Patients at these programs are generally employed or have extensive social support systems.

Short-term residential programs involve a three- to six-week inpatient treatment that resembles the 12-step approach of self-help groups such as Narcotics Anonymous. After the three- to six-week period, patients join an outpatient program or participate in a self-help group.

Therapeutic communities provide 24-hour care in a non-hospital setting. Patients stay for six to 12 months in a highly structured program. Patients often have relatively long histories of drug dependence or seriously impaired social functioning.

Maintenance programs for heroin addicts administer one of two drugs that block the effects of heroin use and prevent craving and withdrawal. Methadone maintenance programs last a minimum of 12 months. For heroin addicts, maintenance programs are usually more effective than therapeutic communities, and therapeutic communities are usually more effective than drug-free outpatient programs.

Research shows that most drug abusers require a minimum of 90 days in any drug treatment program for the treatment to be effective.

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Explainer thanks Jack Stein of the National Institute on Drug Abuse, and NIDA's Principles of Drug Addiction Treatment.

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COMMENTS

Reader Comments From The Fray:

I work as a judge in a northern state which shall remain nameless. Ninety percent of my caseload is drug and alcohol related. I am intimately familiar with the rehab options available for my cases (which are not the same ones available to movie stars, but are reasonably sophisticated and are cost-free to our mostly Native population). I am also intimately familiar with their phenomenal failure rate.

Experienced defendants and defense counsel always want to substitute rehab for jail. (This is so commonly done in many courts for offenses like DUI that even some lawyers think it's part of the law.) I think it is a mistake. Accepting the consequences of your behavior and recovering from an addiction are different things. Recovery from an addiction does not happen unless the patient wants to recover going into rehab--unless he considers recovery a life-or-death matter that takes precedence over everything else. (As Chesterton pointed out, you don't recover from some things by being patient but by being impatient). So if I get someone into rehab as merely a more comfortable place of confinement, I'm not accomplishing anything. I'm merely wasting a bed that might have gone to someone who really wanted to be there.

A former defendant said to me one day: "Treatment was fine, but jail is what got my attention." Since then, I've tended to see jail as a therapeutic option--maybe not a great one, but better at any rate than wasting higher-priced resources on a vain hope of recovery. I tell defendants, "I'm glad you want to recover. I support that. The first phase of your recovery is to serve the jail sentence I'm giving you. When you've done that, get admitted to a treatment program, but only if you wish. I won't order you to, because if you have to be ordered, we're both wasting our time. If you successfully complete rehab and stay clean and sober for a reasonable interval, I will consider modifying your conditions of probation. But we'll talk about that after you've demonstrated a commitment to overcoming your addicition."

Maybe this approach doesn't do an awful lot of good, but I'm pretty sure it does no harm, and it avoids wishful thinking, hypocrisy and waste.

--Yukon

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(8/20)

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