Inside Rehab: The Surprising Truth About Addiction Treatment--and How to Get Help That Works

by Anne M. Fletcher

Overview

An eye-opening tour of the addiction treatment industry explores the gap between what should happen and what does

Inside Rehab is the first book to give readers a thoughtful, sensitive, and bracingly honest insider’s view of the drug and alcohol rehab industry in America. It examines its strengths and weaknesses while exploring the disturbing gap between best practice and reality.

Respected health and medical writer Anne M. Fletcher visited fifteen addiction treatment facilities, from outpatient programs for the indigent to famous celebrity rehabs; from the sites of the renowned Twelve-Step centers to several unconventional programs.
Drawing on cutting-edge research as well as hundreds of interviews with clients and staffers, Inside Rehab tells the stories of real people facing the challenges of addiction and shatters a number of longheld myths, including “rehab is necessary for most people to recover from addictions;” “highly trained professionals provide most of the treatment in addiction programs;” and “drugs should not be used to treat a drug addict.”

But Fletcher’s most important finding is the alarming discrepancy between the treatments being employed at many rehab centers and the treatments recommended by leading experts and supported by scientific research.
For people seeking quality care for themselves or a loved one, Inside Rehab is essential reading, offering a wealth of accurate information and wise guidance.

Product Details

ISBN-13:	9780670025220
Publisher:	Viking Adult
Publication date:	02/07/2013
Pages:	448
Product dimensions:	6.48(w) x 9.10(h) x 1.38(d)

About the Author

Anne M. Fletcher is a nationally known health and medical writer and the author of seven books, including the national bestsellers Thin for Life, Eating Thin for Life, and Sober for Good. Her articles have appeared in Vogue, Good Housekeeping, Redbook, Better Homes and Gardens, Readers Digest, and many other publications. Among her many prestigious awards, she has received numerous National Health Information Awards. She lives in Minnesota. Visit www.AnneMFletcher.com.

Table of Contents

Introduction: What's Wrong with Addiction Treatment? What Will Help? 1

An Introduction to Inside Rehab A. Thomas McLellan

Chapter 1 Rehab Nation 5

The Questions and the Issues

Chapter 2 Going Inside 43

What It's Like to be in Rehab

Chapter 3 The Cost of Rehab 93

From the Wallet to the Heart

Chapter 4 Getting the Best for Your Buck 122

What Addiction Treatment Should Look Like

Chapter 5 Rehab Isn't for Everyone 179

In Fact, It's Not for Most People

Chapter 6 One Size Doesn't Fit All 205

How Cookie-Cutter Approaches at Rehab Get in the Way

Chapter 7 When It Comes to Rehab, Teens are Not Just Little Adults 246

More Questions than Answers?

Chapter 8 When It's Not "Just" a Drug and Alcohol Problem 299

From Depression to Sex Addiction

Chapter 9 Helping People Stay the Course 335

On Using in Rehab, Repeat Visits, "Success," and Improving the Odds

Chapter 10 Getting What You Need 379

Advice from the Pros and a Look at "Dream" Treatment Models

Acknowledgments 403

Appendix: A Consumer Checklist for Checking Out Rehabs 407

Selected References 411

Index 417

What People are Saying About This

From the Publisher

“Eye-opening... Ms. Fletcher’s book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.”
–Jane Brody, The New York Times
 
“The information and perspective Fletcher provides are indispensable. Anyone in the unfortunately position of needing her advice on how to find the best addiction treatment will find this book invaluable, but the rest of us have a lot to learn from it as well.”
–Salon.com
 
“Inside Rehab is an invaluable addition to addiction literature. It is fascinating, insightful, and unafraid to upset the establishment. And Anne Fletcher is a measured, detailed, and insightful reporter. Her book is also a great tool for any family struggling with an addicted loved one. Getting sober is hard. Staying sober is hard. Having more options to get clean just might mean that more people do so.”
–The New Republic
 
“Fletcher presents what works, why, where to find it, and how much it costs. It’s startling, difficult, and important information for those traveling toward recovery, and anyone who wants to help.” –Publishers Weekly (starred review)

"Fletcher’s book has much to recommend it as a layperson’s guide to the way substance abuse is treated in the United States and how this treatment can be improved." –Health Affairs  
“Fletcher... provides answers to fundamental questions: How much does it cost? How long does it last? What do people actually do there? Inside Rehab is a valuable road map for navigating the multiple pathways and programs dealing with the problem of substance abuse.”
            –Booklist (starred review)
 
“An extensive, critical overview of modern treatment methods for substance abuse. A valuable guide for individuals seeking help and for their families, as well as for policymakers.” –Kirkus
 
“With the degree of addiction in this country, cutting across all communities, this book looks to be an important purchase.”
–Library Journal
 
“Like her stunning Sober for Good, Inside Rehab is a transformational read that distinguishes myth from reality in the murky and uncertain world of addiction treatment. This isn’t just a useful guide to addiction treatment, Inside Rehab is landmark: it is a brave, bold and paradigm-shifting contribution to the literature. Inside Rehab is a must read for anyone with a stake in addiction treatment.”
            –Howard J. Shaffer, Ph.D., Director, Division on Addiction, The Cambridge Health Alliance (A Harvard Medical School Teaching Affiliate); Associate Professor, Harvard Medical School
 
“This is an extraordinary book. I know of nothing like it. Objective, informative and extraordinary detailed, this book tells the truth about how addiction treatment measures up to modern science and medicine and how you can find a quality addiction treatment program.”
            –David C. Lewis, MD, Founder, Brown University Center for Alcohol and Addiction Studies
 
“The stigma, desperation, and fear that accompany addiction are so often exacerbated by our ignorance of where to turn for help, what to expect, and what to ask. No longer. This long overdue resource informs and empowers suffering individuals and families to know what effective treatment should look like, to ask the right questions, and ultimately, to obtain the quality care they deserve.”
–John F. Kelly, Ph.D. President, Society of Addiction Psychology, American Psychological Association; Associate Professor in Psychiatry, Harvard Medical School; Director, ARMS Program, Mass. General Hospital
 
“What a great book – so needed and timely! If you’re asking yourself, ‘What should I do?’ for yourself or for a loved one struggling with an addiction, you should read this book. Combining personal stories with in-depth research, Anne Fletcher offers you invaluable inside information about the currently available treatment options. As a professional who has long worked in this field, I learned some useful things that I know I will return to.”
            –F. Michler Bishop, Ph.D., CAS, Director, Alcohol and Substance Abuse Services, The Albert Ellis Institute
 
“Finally, a book that takes an inside look at  addiction treatment by blending an investigative-reporter feel with research-minded rigor—invaluable for patients, policy makers, service providers and program administrators.  It also offers a fresh perspective on the complexities of treating a person suffering from chronic addiction.  To accomplish this with such empathy toward the predicament faced by patients and treatment providers is a real achievement.”
            –Ken C. Winters, Ph.D., Professor, Department of Psychiatry, University of Minnesota Medical School
 
“[Inside Rehab] is carefully researched, draws upon considerable expert opinion and research data, and communicates with compassion, ideas about how to navigate this unnecessarily complex field.”
–Mark P. McGovern, Ph.D., Associate Professor of Psychiatry and of Community & Family Medicine, The Geisel School of Medicine at Dartmouth
 
“Fletcher has written one of the most important clinical books in the past decade. Before spending a dime on rehab, for yourself or a loved one, read this book! Her work may do more to help people get and stay sober than millions spent in high dollar rehab facilities.”
–David Ley, Ph.D., author of The Myth of Sex Addiction
 
“This is the definitive guide to effective rehab – not only a cogent and highly informative summary of what good rehab should look like, but also a bird’s-eye view of what it’s like to get good and bad treatment. Finally, consumers will have a way to know how best to help themselves or their family members.”
            –Michael V. Pantalon, Ph.D., Research Scientist, Yale School of Medicine & CEO of the Center for Progressive Recovery
 
 

Editorial Reviews

Some things never change. And as Fletcher (Sober for Good) finds in this bold report on 15 rehab facilities—from high-end, celebrity-friendly outposts to those treating people on welfare—that fact especially pertains to addiction treatment. Collecting stories from more than 100 interviews, Fletcher methodically dissects the myths about the programs that treat 2.5 million people every year. She finds, for example, that rehab isn’t necessary for recovery—some heal on their own, attend self-help groups, or see therapists; that most of the treatment in rehab programs is handled not by highly trained pros but by counselors with varying levels of education and training. She debunks myths, such as that the “12 steps” of Alcoholics Anonymous are essential for recovery. Fletcher concludes that traditional programs, such as group treatment, 12 step programs, and counseling, work for some but not for all. Dimitri, for instance, began abusing drugs at 15 and cycled in and out of programs that failed to help him. Fletcher also highlights the exorbitant cost of rehab: one young woman’s treatment drained her parents of ,000. Fletcher presents what works, why, where to find it, and how much it costs. It’s startling, difficult, and important information for those traveling toward recovery, and anyone who wants to help. (Feb.)

Publishers Weekly

Best-selling author Fletcher (Thin for Life; Eating Thin for Life; Sober for Good) traverses and researches the world of addiction and substance abuse rehabilitation. In this extensively researched book, Fletcher recounts her visits to numerous outpatient and residential rehab centers, interviewing dozens of current and former patients to evaluate the nature and efficacy of the facilities and treatment models. Her travels take her to rehabs of every kind: pricey resorts, insurance-subsidized in-patient facilities, and community outpatient clinics. As she compares and contrasts different treatment modalities, her conclusions are alarming. Clearly, recovery itself is a highly individual phenomenon, with varying degrees of success resulting from many types of programs, but many readers may find it disconcerting to discover that the majority of rehab facilities lack professional counselors. Moreover, Fletcher notes that rehab directors ignore scientific evidence that substantiates effective methods for promoting recovery. Helpful checklists for clients shopping for the optimal rehab option are provided. VERDICT An excellent resource for potential patients, doctors, and addiction counselors, as well as for readers interested in a meticulously researched study that exposes the rehab industry. Readers of William C. Moyers's Now What: An Insider's Guide to Addiction and Recovery will appreciate this book. [See Prepub Alert, 9/15/12.]—Lynne Maxwell, Villanova Univ. Sch. of Law Lib., PA

Library Journal

An extensive, critical overview of modern treatment methods for substance abuse. Health and medical writer Fletcher (Weight Loss Confidential: How Teens Lose Weight and Keep It Off--and What They Wish Parents Knew, 2008, etc.) conducted interviews with patients and the administrators and staff of addiction programs, visiting more than a dozen such programs (both residential and outpatient). The author challenges the notion that an addict is powerless to overcome an addiction on his or her own or with minimal professional counseling. She found that little had changed since 2002, when her book Sober for Good was published. At that time, more than 90 percent of U.S. rehab facilities were based on the 12-step method pioneered by Alcoholics Anonymous. Today, the figure is similar, despite evidence that "the twelve-step approach isn't for everyone, and many people overcome addiction using other methods." Even patients who relapse several times are offered no alternative treatment options. Fletcher documents the many difficulties facing addicts in regard to receiving replacement medications, and among other surprising conclusions, she found little significant difference in the quality of care offered at high-end celebrity rehab centers and those at the low end of the economic spectrum. For those looking for a structured program, Fletcher includes tips on how to choose the best fit and check out facilities, including anecdotes and advice garnered from people who report having benefited from programs and others whose experiences were not positive. A valuable guide for individuals seeking help and for their families, as well as for policymakers.

Kirkus Reviews

Eye-opening... Ms. Fletcher’s book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.”
–Jane Brody, The New York Times
 
“The information and perspective Fletcher provides are indispensable. Anyone in the unfortunately position of needing her advice on how to find the best addiction treatment will find this book invaluable, but the rest of us have a lot to learn from it as well.”
–Salon.com
 
“Inside Rehab is an invaluable addition to addiction literature. It is fascinating, insightful, and unafraid to upset the establishment. And Anne Fletcher is a measured, detailed, and insightful reporter. Her book is also a great tool for any family struggling with an addicted loved one. Getting sober is hard. Staying sober is hard. Having more options to get clean just might mean that more people do so.”
–The New Republic
 
“Fletcher presents what works, why, where to find it, and how much it costs. It’s startling, difficult, and important information for those traveling toward recovery, and anyone who wants to help.” –Publishers Weekly (starred review)

"Fletcher’s book has much to recommend it as a layperson’s guide to the way substance abuse is treated in the United States and how this treatment can be improved." –Health Affairs 
“Fletcher... provides answers to fundamental questions: How much does it cost? How long does it last? What do people actually do there? Inside Rehab is a valuable road map for navigating the multiple pathways and programs dealing with the problem of substance abuse.”
            –Booklist (starred review)
 
“An extensive, critical overview of modern treatment methods for substance abuse. A valuable guide for individuals seeking help and for their families, as well as for policymakers.” –Kirkus
 
“With the degree of addiction in this country, cutting across all communities, this book looks to be an important purchase.”
–Library Journal
 
“Like her stunning Sober for Good, Inside Rehab is a transformational read that distinguishes myth from reality in the murky and uncertain world of addiction treatment. This isn’t just a useful guide to addiction treatment, Inside Rehab is landmark: it is a brave, bold and paradigm-shifting contribution to the literature. Inside Rehab is a must read for anyone with a stake in addiction treatment.”
            –Howard J. Shaffer, Ph.D., Director, Division on Addiction, The Cambridge Health Alliance (A Harvard Medical School Teaching Affiliate); Associate Professor, Harvard Medical School
 
“This is an extraordinary book. I know of nothing like it. Objective, informative and extraordinary detailed, this book tells the truth about how addiction treatment measures up to modern science and medicine and how you can find a quality addiction treatment program.”
            –David C. Lewis, MD, Founder, Brown University Center for Alcohol and Addiction Studies
 
“The stigma, desperation, and fear that accompany addiction are so often exacerbated by our ignorance of where to turn for help, what to expect, and what to ask. No longer. This long overdue resource informs and empowers suffering individuals and families to know what effective treatment should look like, to ask the right questions, and ultimately, to obtain the quality care they deserve.”
–John F. Kelly, Ph.D. President, Society of Addiction Psychology, American Psychological Association; Associate Professor in Psychiatry, Harvard Medical School; Director, ARMS Program, Mass. General Hospital
 
“What a great book – so needed and timely! If you’re asking yourself, ‘What should I do?’ for yourself or for a loved one struggling with an addiction, you should read this book. Combining personal stories with in-depth research, Anne Fletcher offers you invaluable inside information about the currently available treatment options. As a professional who has long worked in this field, I learned some useful things that I know I will return to.”
            –F. Michler Bishop, Ph.D., CAS, Director, Alcohol and Substance Abuse Services, The Albert Ellis Institute
 
“Finally, a book that takes an inside look at  addiction treatment by blending an investigative-reporter feel with research-minded rigor—invaluable for patients, policy makers, service providers and program administrators.  It also offers a fresh perspective on the complexities of treating a person suffering from chronic addiction.  To accomplish this with such empathy toward the predicament faced by patients and treatment providers is a real achievement.”
            –Ken C. Winters, Ph.D., Professor, Department of Psychiatry, University of Minnesota Medical School
 
“[Inside Rehab] is carefully researched, draws upon considerable expert opinion and research data, and communicates with compassion, ideas about how to navigate this unnecessarily complex field.”
–Mark P. McGovern, Ph.D., Associate Professor of Psychiatry and of Community & Family Medicine, The Geisel School of Medicine at Dartmouth
 
“Fletcher has written one of the most important clinical books in the past decade. Before spending a dime on rehab, for yourself or a loved one, read this book! Her work may do more to help people get and stay sober than millions spent in high dollar rehab facilities.”
–David Ley, Ph.D., author of The Myth of Sex Addiction
 
“This is the definitive guide to effective rehab – not only a cogent and highly informative summary of what good rehab should look like, but also a bird’s-eye view of what it’s like to get good and bad treatment. Finally, consumers will have a way to know how best to help themselves or their family members.”
            –Michael V. Pantalon, Ph.D., Research Scientist, Yale School of Medicine & CEO of the Center for Progressive Recovery
 
 

From the Publisher