If you’re thinking about recovery or have already begun your journey to sobriety, you’ve probably heard some scary statistics about inpatient treatment, residential treatment, detox, and outpatient drug-free rehab methods.
To distinguish between them, here are their definitions:
- Inpatient treatment provides a rigorous medication and counseling schedule in a relatively short (31 days, on average) length of stay.
- Residential treatment aims to change the lifestyle of an addict through a long-term (71 days, on average) stay that focuses on community. These programs use peer counselors more often than medical staff or medications.
- Detox relies on medications to ease the transition from using and are often combined with psychosocial treatments. They last 227 days on average.
- Outpatient drug-free programs use counseling rather than medication to help fight addiction. Addicts continue to live in their homes. These programs last 164 days on average.
Now for the statistics:
- Inpatient treatment costs $3,200 on average. 73% of addicts complete treatment and 21% remain sober after five years.
- Residential treatment costs $3,100 on average. 51% of addicts complete treatment and 21% remain sober after five years.
- Detox costs $2,200 on average. 33% of addicts complete treatment and 17% remain sober after five years.
- Outpatient drug-free treatments cost $1,200 on average. 43% of addicts complete treatment and 18% remain sober after five years.
Those numbers can easily lead someone to wonder if drug rehab actually works. If not even a quarter of people remain abstinent during a five-year follow-up, how can you make a case for rehab?
We’re going to look at the statistics for success in drug rehab programs and other treatment programs for commonly abused substances, as well as what makes a drug rehab program successful, so you know what to look for when seeking treatment.
How can you tell if drug treatment is effective?
This may seem like an obvious question; drug treatment is effective if an addict achieves sobriety and stays clean, right? However, it’s a bit more nuanced than that.
According to the Office of National Drug Control Policy, there are many factors that determine efficacy:
- Reduced drug use– including complete abstinence, using the substance less frequently, using a smaller amount of the substance in general and per instance of use, and longer periods of time between relapses.
- Improvements in employment– including working more days and/or getting involved in training programs or school.
- Improvements in education– including attending more often and getting better grades.
- Relationship improvements– including ones with friends, family, romantic partners, and coworkers.
- Improved health– marked by fewer visits to the doctor and the ER, as well as fewer hospitalizations.
- Better legal status– shown by fewer arrests and convictions, and fewer crimes committed.
- Better mental health– marked by improved mood and personality traits, higher levels of cognition, and reduced psychotic states and need for treatment.
- Improved public safety– including drug-related fires, car accidents, and trauma to yourself or others.
Complete sobriety is mentioned only once, yet there are twenty-three total factors listed. Furthermore, according to the National Institute on Drug Abuse, relapse rates for drug addiction vary between 40-60%, similar to the relapse rates of Type I diabetes (30-50%) and hypertension and asthma (both 50-70%). Since addiction is a disease, knowing that rates of drug relapse are comparable to other common diseases is a comfort.
Basically, the success rate of drug treatment programs does not depend on achieving complete sobriety, but rather on improving your quality of life as a whole. That’s something the statistics fail to measure.
Is drug treatment worth the cost?
Now that you know what makes drug treatment effective, it might be time to address the cost of drug rehab programs. As mentioned above, these programs are not inexpensive. However, the alternatives are far worse.
In a report published by the Office of National Drug Control Policy, the average monthly cost of cocaine per user was $833, while the average monthly cost of heroin per user was $1,457, the average monthly cost of marijuana per user was $208.34, and the average monthly cost of methamphetamine per user was $655. These figures reflect costs in 2010.
The average monthly cost of drug-related health care per user was $31.83 and the average monthly cost of drug-related lost wages per user was 63 cents. These figures reflect costs in 2009.
Furthermore, the average cost of a common drug-related crime (driving under the influence) is $10,900, which includes lost wages, attorney fees, court fines, insurance increases, DMV fees, ignition interlock device costs, towing, and bail. And that’s just for a first offense. The cost of “possession of a controlled substance” can vary from $100 to $100,000, depending on the substance, the amount, the circumstances, and your criminal history.
Of course, the highest price to pay is jail-time. As of 2006, the average drug-related prison sentence was 87.2 months. Is it worth continuing to use alcohol or drugs in the face of such costs?
What works best?
There are different approaches for different drugs when it comes to the success rate of drug treatment programs. Here are a few examples:
There are a few medications that assist with heroin addiction. Buprenorphine helps combat drug cravings while the body goes through withdrawal. Naltrexone is a non-addictive opioid antagonist that does not act as a sedative, but also helps. Methadone is a long-acting opioid antagonist, usually administered daily for people who cannot tolerate other medications. It should be used alongside counseling.
In a study conducted by John’s Hopkins University, researchers studied the effects of both Buprenorphine and Methadone and found there was a 72.7% success rate among participants. After beginning treatment, patients in the study reduced their use rate by as much as 90%.
When heroin users enter treatment programs, success rates differ. Outpatient therapy has a 35% completion rate, while residential programs have a 65% completion rate. Overall, the ideal method of treatment is an inpatient program where addicts can detox safely, access the medication(s) they need and learn how to live without using drugs.
Cocaine and crack
There aren’t any drugs that are currently approved by the FDA for the treatment of cocaine addiction, though there are some that show promise in the future. Disulfiram, a medication used to help treat alcoholism, is the most promising so far; however, the scientific community is not sure how it works, and variances in the gene that encodes the DBH enzyme seems to affect whether or not Disulfiram will be effective.
There is also a cocaine vaccine that has been developed that creates anti-cocaine antibodies. Early tests have been conducted, but only 38% of test subjects attained significant antibody levels and those levels only lasted two months.
So far, behavioral therapy is the most effective treatment for both cocaine and crack. Contingency management works by rewarding addicts for “clean time” with prizes or vouchers. This method resulted in a longer duration of abstinence than standard cognitive behavioral therapy, but only when prize/voucher value met or exceeded $560.
Computer-assisted cognitive behavioral therapy, on the other hand, teaches coping skills with the help of multimedia quizzes, games, and homework assignments. 36% of participants who took part in this method were abstinent from cocaine for three or more weeks, as opposed to 17% who only took part in cognitive behavioral therapy.
Overall, less than 25% of crack addicts remain sober for six months in most treatment programs. The biggest problem is that 90% of users drop out of outpatient treatment, suggesting that inpatient rehab is best. A review of inpatient crack addicts who stayed at an inpatient facility for six months or more had a 70% chance of sobriety over the course of two years.
One of the most prominent examples rehab for alcoholics is AA (Alcoholics Anonymous). While some studies have reported that 40% of participants drop out within their first year, statistics rise when addicts use other therapies simultaneously (i.e. motivational enhancement therapy, which helps boost the drive not to drink, and cognitive behavioral therapy). After a year of using AA in conjunction with either type of therapy, alcoholics were sober for 80% of the time and 19% were sober for the entire year.
Another study showed that 67% of people who attended at least 27 AA meetings in their first year of sobriety were abstinent after a 16-year follow-up compared to 34% who never attended AA. Using therapy also seems to help alcoholics. After 16 years, 56% of those who saw a therapist were abstinent versus 39% who did not.
When alcoholics are deciding between inpatient and outpatient treatment, a number of factors should be considered. Inpatient programs work best for people with:
- Co-occurring mental illness(es).
- Problems with delerium tremens, commonly known as “DTs,” a condition marked by sweating, shaking, anxiety, hallucinations, or psychosis.
- An unstable home.
Inpatient drug rehab will usually include detox, medication like disulfiram for cravings or psychiatric medication (in some cases, to treat either withdrawal or co-occurring disorders), therapy, and an introduction to AA. Outpatient programs work best for people with mild to moderate symptoms. After either sort of treatment, 25% of people are continuously sober and 10% use alcohol moderately and without problems (i.e. at a non-alcohol level).
Why and how drug rehab works
Across the board, the most effective type of substance abuse program involves:
- Personnel with at least a master’s degree.
- Physicians certified by the American Board of Addiction Medicine.
- Individualized treatment with a licensed addiction counselor.
- The ability to treat underlying mental health or social issues.
- A 90+-day timeframe for rehab, followed by outpatient treatment, therapy, and support groups.
- Access to medications, if needed or desired.
- Emphasis on using multiple forms of treatment.
Overall, the most important takeaway is that there are many forms of drug treatment and rehabilitation that use multiple methods in multiple contexts. Statistics show that the longer you commit to treatment, regardless of what you’re addicted to, the better you’ll fare at achieving sobriety. Remember also that complete sobriety does not need to be your goal; treatment effectiveness depends on so much more than abstinence.
Choose the method that’s right for you, your addiction, your price range, and your family. Try different methods until you find one that feels right. Combine treatments as you see fit. Ultimately drug rehab is worth it: to your health, job, relationships, safety, finances, and life as a whole.
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