US state and federal governments spend $15 billion per year on substance abuse treatment programs and private insurers drop $5 billion more.
Yet few rehab programs have data showing they work. The high-end private clinics generally do not permit investigators to validate their claims, and publicly supported programs don’t have the time or money to undertake verification studies.
It’s not like we don’t know which approaches are effective. Prescription drugs like naltrexone and buprenorphine can help people shake alcohol and narcotic addiction, for example.
Certain behavioral techniques including intake interviews that galvanize patient commitment are effective, as are certain counseling and behavioral techniques that help people cope with mood shifts, promote self esteem and promote healthy interests and creativity.
In 2003, Oregon began requiring that rehab programs use evidence-based practices in order to qualify for state funds. Now, nearly 54% of the state’s $94 million budget goes to programs claiming to use these approaches.
That’s twice as high as before the mandate, but some doubt all those programs are really using proven techniques. Inspection programs don’t have enough resources to monitor the 400 programs receiving state support.
And then there’s the ground war involving rehab counselors who, after devoting 100% effort for years to forge an approach that makes sense for them, don’t want to hear what others may think.
“The challenge is to build a bridge between what the science says is effective and what people are already doing,” according to Brian Serna, director of outpatient services at Adapt.