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No More Square Pegs in Round Holes: Picking the Best Treatment Option for You or a Loved One.

Treating addiction is just like anything else when it comes to treating a disease, what works for one person doesn't always work for another. Families and loved ones often get frustrated, especially when they have already spent thousands of dollars, often times more than once, on various treatment programs, and the person in their life still continues to drink or use. It's enough to make you want to throw up your hands, believe that the whole treatment thing is just a big money making scam, or believe that your loved one just doesn't have what it takes to make it in recovery.


Let me let you in on a secret, one that many treatment programs don't mention in their brochures, or in their commercials...treatment doesn't always work, at least not the first time in most cases. Look, most treatment programs, ours included, are for profit. We all have bills to pay and if you choose our program over another then we get that revenue and can hopefully expand to help more people. With all that competition, it's natural that programs try and focus on their successes. I'm not saying they shouldn't, they have a right to be proud of what they have accomplished. However, the people who do the marketing get good money to convince you their program is the best. So with that in mind I want to try and offer some advice on what to look for, and what to look out for. If you or your loved ones are going to spend the money necessary, or even if you have insurance that will pay for the whole thing, you deserve to get what's best for you. Addiction is a disease and like most diseases it behooves you to do the research, and talk with professionals in the field of treating that disease about what the best way to do it is. So without further adieu, here are some things to consider.


1. Their are different modalities of treatment and what may seem like the best, might not be.- Throughout the history if the United States there have been hundreds of programs that have sprung up, both profit, and non profit who have all worked to help and in some cases claimed to “cure” the person with addiction. From asylums, to fancy hotels that provided room service and treatments while their patients got better, to the rooms of AA and later NA, and hundreds of other 12 step programs that have been around since 1935. Many programs and centers have come and gone. Some were straight up cons and quack medicine, while others simply couldn't sustain themselves when other more effective methods of treatments became available; but they weren't all identical, and they still aren't. Remember that in treating a disease, that there is rarely a one size fits all approach. So lets talk about some of those modalities.


2. Inpatient Treatment- Inpatient treatment centers are generally the ones you see advertised on television. The time patients spend there can vary from a few days to several months. The cost run from the hundreds, well into the thousands and even hundreds of thousands of dollars. Betty Ford Centers have been popular for years, Hazleden has also been around for decades and has helped thousands of people. These companies spend a good amount of money advertising, because they know you are going to have to fork over a good portion of money to go there and they want you to feel like your getting your monies worth


Most inpatient treatment centers include a medical staff. They often have detoxification services (those are usually extra) for people who need to be medically supervised after quitting certain substances. Patients are required to attend groups, see counselors, both addiction and mental health counselors, and the medical staff in most places are available to provide medications (usually only for the duration of the stay) to help with withdrawals or possibly mental health issues (anxiety and depression often become quite apparent shortly after quitting).


Not all inpatients are created equal and just because you shell out 75,000 dollars doesn't necessarily mean you are getting the best. Meals by 5 star chefs, and splendid views from the beach side rooms, doesn't always equate to effective treatment.


3. Detoxification Centers- Detoxification centers can run the gamut from more expensive options that generally only take private insurance to centers that accept low income patients and often accept  state insurances. Hooper Detox here in Portland has been running their program and helping people for years. At a detox center, peoples stays are usually much shorter, The idea is to help people get over the difficult first few days of being abstinent from drugs and alcohol, which is usually done under medical monitoring. Most detox centers require patients to attend groups also, see a counselor, and encourage people to have follow up or after care with another agency, perhaps one attached to the detox center itself. Some detox centers are walk in. At Hooper it may take a person going in several days in a row in order to get in, as they take the most severe cases first, and work in those who show motivation by showing up every morning in the order they get them. Other centers may take appointments and can schedule those for you over the phone


4. Outpatient- There are different levels of outpatient. Intensive outpatient, which is usually court ordered through drug courts, or even DUII diversion programs, are programs in which a patient is required to attend group, usually several times weekly at first and where the groups themselves are usually longer. Regular, or what we call Level 1 outpatien,t is where patients are required to see counselors, go to groups, but generally not as frequently and the groups generally are not as long. Some provide medications and others do not.


5. Daily Dispense- Often incorrectly referred to as “methadone clinics.” Daily dispense programs are set up to help people specifically with opiate issues (i.e. heroin or pain pills). They provide medication in the form of not only methadone, but also Suboxone or one of it's equivalents. Patients initially are required to go 6 days a week, during the clinics regular operating hours, which are almost always early morning until around noon or so. They receive their medication at the clinic and take it there as well. Patients are eligible to receive take home medication after time in treatment and following through with the program expectations. Daily dispense programs require their patients to see counselors as well as go to group. Access to the medical staff aside from the nurses who dispense the medication is often limited, however, as one medical director will be in charge of the entire clinic and is there in the capacity to write prescriptions, and usually does not have time to see the patients on an individual basis.


6. Office Based Medication Assisted Treatment- Office based treatment, which is what we are at Recovery Works NW, is one in which patients come to regular medical appointments, see a doctor, and are prescribed medications if called for to treat their condition (usually opiates). The medication most commonly prescribed is Suboxone/Buprenorphine or one of the alternatives. They also can prescribe and administer Vivitrol, a time released, non narcotic, monthly injection for treating opiate issues as well as alcohol issues. Doctors at office based practices cannot prescribe methadone for opiate issues. That currently is only available at daily dispense programs. Most office based settings require that patients attend groups and see a counselor. Even if they don't have those facilities on site, they may require that patients seek that care outside.


Which One is Best for Me or My Loved One and What Should I Look For.


As has already been said there is no one size fits all. So in looking for a treatment program it's not only important to evaluate what a person needs but what the program has to offer. I highly recommend that anyone considering treatment, who isn't sure what type or intensity of treatment is best, go and talk to a professional in the field, like doctor or counselor, to get an opinion before proceeding. That being said, here are some things to look for.


1. Watch out for programs that tout their “success rating,” or offer some percentage of success.- If a program tells you they have a 99% success rating, I assure you they're lying or not telling you the whole truth. The truth is that rarely do programs follow people who leave more than 30 to maybe 90 days after they leave, and so have no real data available on the long term success rates. The people they do get a hold of for follow up are inevitably doing well and are happy to talk about their success. The ones who aren't often don't want to admit they slipped or returned to addiction and so aren't included in their data. That percentage is a marketing tool to get your money and is not an indicator of the real success or effectiveness of their program.


2. Beware any program that tells you they have a cure.- I don't care what Pax Prentiss and his Kool-Aid cult in Malibu, California tells you, or what any other con artist that wrote some self help book, whose sole purpose is to part you from your money says....THERE IS NO CURE FOR ADDICTION! Addiction is a CHRONIC disease that does not go away. I like to say all the time, “Once you become a pickle, you can't go back to being a cucumber.” Addiction, like a lot of other chronic diseases (e.g. Diabetes) can be put in remission and kept there through ongoing efforts. Any program that tells you they have a cure or that they can teach you to drink or use in moderation like a “normal person,” is dangerously misinformed and any examples they offer in the form of patient testimonials are the exception rather than the rule. What's more likely is that the people writing those testimonials almost assuredly were having problems with abuse and not real addiction.


3. Find a program that has after care.- I went to a great lecture the other day and listened to a doctor who talked about an “Acute” model of care vs a “Chronic” model of care. Acute care is what you receive from your doctor when you have a cold or the flu. You see them, they treat you, you may have a follow up and then if you are better, case closed. Addiction is NOT ACUTE. Addiction like many other diseases requires follow up care even after the symptoms have been brought under control. Nothing infuriates me more than seeing people pay good money to go to a treatment program, finish it, get handed some “Graduation Certificate,” told “good luck with your life,” and then sent on their way. Now this isn't entirely the fault of the program. Many people with addiction themselves are misinformed, and try and treat their disease like it's acute. They just want to get better and move on with their lives. Those are generally the people who wind up in treatment again. People in addiction, even after completing a program should be having medical and therapeutic follow ups for months and even years after. Graduation or completion of a program does not equal being cured.

4. Find a program that requires counseling along with medical supervision- This isn’t to say every one needs medication. But addiction effects people in all areas of their lives. It does biological, psychological, and social damage to the people who have the disease, and to the people in the lives of the person with addiction. A persons rate of success goes up if they address all the aforementioned areas and not just one. Too often we see people who begin to feel better physically, and then develop the attitude that everything is “fine.” Those same people are the ones who leave treatment, only to return again and again until they finally (hopefully before they die) get that it's more than just feeling better; or just “quitting.”


5. Be honest with yourself or about your loved one when deciding how intensive of a program they need- Not everyone needs inpatient. Due to the marketing done by most inpatient programs, as well as the viewpoint of the media on what treatment looks like, many people believe inpatient is the only way to go. I promise you I have several patients who spent a good deal of time in inpatient programs and weren't successful. It's not always the best option.


6. Some people do need medication in order for them to be successful- This is not a weakness. It is not trading one addiction for another in the case of Suboxone/Buprenorphine or methadone. It is someone who may require a medication to help treat a chronic disease. Starting medication does not mean a person is on it for life. It means that some people benefit from having medication along with counseling or therapy to help them move forward. Some people who are pre diabetic or even diabetic are able to manage their diseases through diet and exercise. Others, for a variety of reasons are not and require medication. Those people aren't weak, they don't lack willpower or motivation. They are different. Different isn't bad, it's just not the same as others.


Let's wrap it up.


That's a lot of information in a short amount of time and it just brushes the surface of some of the considerations when it comes to treating a disease as complex as addiction. My best advice, which I will repeat again, is to talk to a trained professional and get their opinion. Often a drug and alcohol assessment, by a competent, licensed professional can give enough information to recommend a direction in which to begin treatment, or the intensity level that might be most beneficial.


At Recovery Works NW we have counselors and medical staff who can do just that. If you come to us and have an assessment, it does not benefit anyone for us to lie to you by, sugar coating things, or even telling you it's worse than it is. We will give you an honest assessment about what we think you need and if we believe we either do not have the tools necessary to help you, or as may be the case, you don't need as intensive a program as ours, we'll tell you. Almost all programs market and advertise. We’re no exception. We need to make people aware we are here so they can seek us out for treatment. But here's another secret....we aren't in any danger of running out of people to help. We are better served in helping you get the right type of help, rather than just taking your money, and hoping for the best. The majority of our referrals come from patients referring other people. Nothing makes us feel more proud of what we do than when someone comes in and says “my friend told me I should come here.”

We are not the perfect fit for everyone. No program is. What we do have is a staff with decades of combined experience both medical and clinical in treating and helping people manage the disease of addiction. If you or a loved one is struggling with addiction issues, please call us. If we can help you, we will. If we feel like we can't due to you needing a more intensive program or more help then we can provide, we'll tell you that as well. We want you to get better, to be successful, and to have the best quality of life possible. If that's with us, great. If it's not, that great too. In the end it's not about the program, the doctors, the counselors, the marketing, the fancy resort style treatments facilities, or the success rates some of us claim to have. It's about you and your life. You deserve what works best for you.


What Our Patients Say

If you want a Dr. who will tell you what you need to hear, and not want to hear, then go to him. He will help you, but you have to want to help yourself! I give him TEN STARS! I appreciate him and his staff more then he will ever know.