How to choose a quality treatment program

By: WILLIAM CELIS - Public Access Journalism | Saturday, December 9, 2006 6:33 PM PST ∞

Finding an effective addiction treatment center or program can be a confusing and frustrating process, but if you're armed with the right questions, it doesn't have to be. Here are some questions to ask:

- What type of accreditation or licensing does the program have?

Failure to obtain accreditation may mean nothing, but it could indicate fringe status or, in the worst case, a quasi-cult or an abusive form of "care." Look for accreditation from national programs ---- such as the Joint Commission on Accreditation of Health Organizations, the Rehabilitation Accreditation Commission, the National Committee for Quality Assurance and the All-States ---- that look for effective elements of treatment. Accreditors also require a well-documented patient complaint process. Remember that "state licensing" is not the same as accreditation, since states vary widely in their requirements.

- Have there been studies to measure the effectiveness of the program's treatment methods?

Treatment effectiveness is a new field of study, so it is too early to expect all providers to have done the full research necessary to credibly evaluate their methods. Still, it's not too early for them to be planning these studies. Keep in mind that the most objective evaluations usually come from outside agencies rather than "in-house" evaluators.

- What medications does the program support or prescribe to treat other medical problems?

Many medical symptoms may be complications of addiction and clear up after a period of sobriety, but that's not always the case. Clinical depression or anxiety can undermine chances for recovery. The best programs evaluate patients shortly after admission and offer appropriate care, including medication. Methadone, naltrexone and disulfiram (antabuse) can be effective in helping some addicts. Staff should discuss them with patients.

- What sort of after-care does the program offer?

Short-term treatment by itself is not enough to sustain recovery in most patients. After-care is crucial, preferably at least a year of weekly or biweekly outpatient counseling, plus participation in 12-Step programs such as Alcoholics Anonymous or other addiction self-help groups, like Smart Recovery or Women for Sobriety. A good treatment program will actively help the patient integrate into a self-help group, although patients sometimes have to shop around to find a comfortable fit.

- What does the program do about relapse?

Unfortunately, relapse is a common occurrence in substance abuse treatment, just as it is in treatment for other chronic illnesses. A good program includes prevention classes that teach patients to recognize and avoid or deal with situations and emotional states that could trigger relapse. It should also have a plan for the patients re-entering treatment or support groups to prevent a one-time lapse from becoming a full-blown return to active addiction. Relapse, though demoralizing, can be an important learning experience ---- with the necessary coping skills.

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Other key considerations:

- Does the program accept your insurance? If not, will they work with you on a payment plan or find other means of support?

- Is the facility clean, organized and well run? What is the ratio of clinical staff to patients?

- What is the average length of treatment?

- What is the treatment philosophy?

- Are services or referrals offered to family members to ensure they understand addiction and the recovery process?

- What happens in a typical day or session?

- Does the program encompass the full range of needs, including help in finding a job and child care; dealing with legal problems; parenting?

- Is a mental health evaluation done? Does the program offer individual or group counseling and other behavioral therapies?

- Does the program address sexual orientation and physical disabilities as well as provide age-, gender- and culturally appropriate services?

- Is there ongoing assessment of the treatment plan to meet changing needs?

- Does the program have ways to engage and keep people in longer-term treatment?

Sources: U.S. Department of Health and Human Services, U.S. Substance Abuse & Mental Health Services Administration's Center for Substance Abuse; Public Affairs Television Inc.'s "Moyers on Addiction: Close to Home"; www.drugfree.org/Intervention/Treatment/13_Questions_to_Ask

http://www.drugfree.org/Intervention/Treatment/13_Questions_to_Ask.

Treatment locator guide

The following is only a small sampling of the agencies, providers and services that can help you find, choose and pay for addiction treatment. For a comprehensive list of treatment resources throughout the United States, visit www.silenttreatment.info.

Hotlines and locators

- Substance Abuse Treatment Facility Locator, www.findtreatment.samhsa.gov/facilitylocatordoc.htm: A comprehensive, searchable directory of alcohol and drug treatment programs nationwide from the U.S. Department of Health and Human Services' Substance Abuse & Mental Health Services Administration.

- Buprenorphine Physician Locator, (866) 287-2728; www.buprenorphine.samhsa.gov/bwns_locator/index.html: An online resource designed to assist the states, medical and addiction treatment communities, potential patients and their families locate physicians who can prescribe buprenorphine (SuboxoneÆ and SubutexÆ) for treatment of opioid addiction.

- National Helpline, 1 Choke Cherry Road, Room 8-1036, Rockville, MD 20857, (800) 273-8255; (240) 276-2000; www.samhsa.gov/: A hotline offering confidential information on alcohol and drug use disorder treatment and referral.

- National Committee for Quality Assurance, 2000 L St. NW, Suite 500, Washington, D.C. 20036; (202) 955-3500; www.ncqa.org: The accrediting agency for most managed care companies offers online report cards on health plans that lets you compare hundreds of health plans, Medicare and Medicaid for the best treatment coverage.