Do Drug Rehab Clinics Work?

One of the few TV programs I watch is "Intervention." Each episode features a person with an addiction, usually to a drug such as meth, heroin, or alcohol. In a typical, formulaic reality-TV fashion, you follow this person in his/her day-to-day living. The show climaxes when the family arranges an intervention to try to get the person to pack up right away and check into a treatment facility.

(By the way, don't you agree reality TV is totally junk yet curiously addictive at the same time? Hmm, I'm addicted to watching others being addicted. Such a paradox of life.)

I'm always astounded by the sheer beauty and luxury of these treatment centers in Intervention. Quite inevitably they're in sunny places such as Florida or California, sometimes by the beach, always spa-like. They look like the perfect place to spend my honeymoon.

In real life it costs tens of thousands of dollars to check into one of these places for a month. And no one knows for sure whether these treatment programs work because these clinics are rather secretive about their success rates. Post-treatment or aftercare services are scarce; follow-ups with their patients 3, 6, or 12 months on are practically non-existent. But anecdotal evidence suggest that patients don't stay sober for long after discharge.

In the words of Thomas McClellan, chief executive of the nonprofit Treatment Research Insititute in Philadelphia (which I quote from the New York Times, Dec 23, 2008), "You go to Shady Acres for 30 days . . . And then you're discharged and everyone's crying and hugging and feeling proud -- and you're supposed to be cured. It doesn't really matter if you're a movie star going to some resort by the sea or a homeless person. The system [of drug rehab] doesn't work well for what for many people is a chronic, recurring problem."

Imagine spending a month at a rehab center in a picturesque setting. You make new friends, you have wonderfully supportive staff, you have a daily routine that comprises physical exercise, counseling, endless walks on the beach. You may even cultivate a passion for gardening. Then you say goodbye to this fairy-tale setting and return to real life that is your family, your community. Your teenager is still giving you an "f-you" attitude (or, if you're the teenager, your parents are still driving you crazy), you're still stuck in a dead end job, and every social gathering you go to has no lack of booze to take you right back to where you were a month ago.

You get the idea. You really can't expect addicts to break their habit without changing (a) their environment and (b) their response to the stressors in their environment. Most drug rehab programs would have you believe that addiction is a disease. Yes, we know about the hereditary factors that predispose some people to addiction, and that prolonged drug use can have profound impact on the brain chemistry and structure. I also agree that detox is often a necessary first step to recovery. So I'm not arguing against the biological and physiological dimensions of substance abuse and addiction.

But seeing addiction as a disease keeps us focused on treating the individual person, neglecting the ecology (such as family dynamics) that maintains the disease or the person's psyche that prevents him/her from using adaptive coping skills. An important skill to learn, for example, is emotional regulation. A person without this capacity is likely to want to escape from them whenever they threaten to overpower this person. In the quest to escape one's emotional pain, if the spa-like comfort house by the beach is not within reach, the bottle (or syringe) would once again look immensely promising.