I’m frequently asked what treatment I would recommend as an addiction psychiatrist. My answer — that I don’t often advocate rehabilitation programs — is usually met with surprise.
In the case of addiction treatment, rehabilitation is seen as a long-term inpatient or residential program. The prototype was built on the 12 steps of Alcoholics Anonymous in 1949, and it has been extended to cover various addictions since. The approach has succeeded in gaining a lot of attention for treating celebrities and has made a strong impression on the public
It may appear to be a smart idea to send people away for several weeks of intensive therapy in a controlled environment. However, does addiction treatment truly work?
Despite the fact that there have been numerous well-controlled studies, the outcomes are unimpressive. Despite nearly 70 years since the beginning of rehabilitation, and decades of research data, there is a too little signal for its advantages over outpatient treatment to be seen clearly. Overall, treatment setting has inconsistent effects, modest when present but dwindling with time.
Furthermore, the original design of the treatment model — as well as most of the research data — has been researched on alcohol, which may not be applicable to other addictions. Opioid addiction, for example, can effectively be treated pharmacologically with a modest role for complex psychosocial treatments.
Even worse, sending individuals who are addicted to opioids to rehabilitation facilities that do not provide pharmacotherapy with buprenorphine, methadone, or injectable naltrexone is a prescription for failure. After such programs, the overwhelming majority of people relapse and develop a tolerance for the drug’s deadly effects.
However, one must also consider whether it is better to continue using than attending programs that — rather than lowering the risk of relapse — reduce tolerance and INCREASE THE RISK OF OVERDOSE. But the answer isn’t to keep using; it’s to get evidence-based therapy. We do have life-saving treatments for opioid addiction, and
So then why does addiction rehab continue to be influential?
Furthermore, addiction’s inertia and upheaval may make long-term therapy appear obvious. Intensive therapies, on the other hand, are more suited to acute health issues such as stroke than chronic diseases like diabetes. Addiction is a lifelong and relapsing disease that is commonly treated as if it were an acute condition that can be relieved by means of intensive treatment