Who is accountable for the treatment services addicts receive?

It’s not often that I let my opinions out freely rather than letting the data do the talking, but this issue’s been making me mad for a while and now it just has to come out. As part of our work on the A3 rehab-finder we’ve been trying to get some measure of standardization into the system so that when we match those looking for treatment with provides we get a good fit. The problem is that when SAMHSA collects this data there is essentially no oversight whatsoever regarding the services addiction treatment providers report and their actual capabilities for providing those services.

One of the most obvious examples of this has to do with providing services for clients who suffer from both mental health issues and drug and/or alcohol problems. This happens often and SAMHSA has a few specific fields that ask providers if they can handle these more difficult cases. Over 50% of addiction treatment providers claim they can, but since no one ever checks up on them, it’s just their word we’re supposed to count on. Well, as far as at least some of them are concerned, having a psychiatrist come by once a month for a few hours is enough, still other providers offer even less in terms of mental health provisions. Believe it or not, some who claim to offer mental health services do not allow the use of any psychiatric medication… I think that actually qualifies as negligence.

There is some research looking into this sort of stuff, including work from Dartmouth (and Dr. Mark McGovern) using an instrument called the DDCAT (Dual Diagnosis Capacity in Addiction Treatment). Unfortunately, as usual, the findings aren’t making it into the actual field. I think it’s due time that we hold providers accountable and set some sort of standard for each of these services that they claim to provide.

I mean seriously, could you imagine gynecologists being able to provide post-mortem examinations without training? Oh, I guess that’s happening too… Nevermind.

4 responses to “Who is accountable for the treatment services addicts receive?”

  1. Besides a lack of oversight regarding whether or not a treatment facility provides acceptable care for more difficult cases, there’s a lack of standardization about what constitutes acceptable care.

    But worse, there’s no decent way to judge effectiveness of different treatment plans. How many of their graduates are sober or doing really well after a year? 5 years? Imagine a cancer treatment that couldn’t answer those questions!

    • Hi Gentle,
      You’re certainly right although as a researcher I can say that at least measuring success is difficult and there really isn’t an agreed-upon way to assess it (quality of life improvement or abstinence only?). The thing about specific services is that we could make specific requirements like having a psychiatrist on staff for a certain number of hours, getting specific COD training for a certain portion of clients (one of which is always on staff), and let’s say… assessment of MH disorders as part of intake? Each of these is a common sense sort of regulation, and there are many more evidence based options.

  2. Personal experience time…

    When I was in rehab I went to a well-known rehab in Ireland with a claimed 80% success rate (how can you claim that?

    I had been on psych.med for 12 years prior to this but was told I could only go to this facility if i stopped taking my med. Why? because it would interfere with the recovery process..what..and depression wouldn’t?.

    This was a 12 step recovery center. This philosophy of no meds for those in the program is prevalent in many meetings and, in my opinion, plain wrong. I think these people believe that you are not truly feeling the slings and arrows of outrageous fortune if you take psych. meds., that you are replacing alcohol with another substance.

    Grow up, it’s not an iron man competition.

    Anyway I am rambling here, to cut a long story short I cam off my tablets and proceeded to go into massive depression and had to be hospitalized. Now, that is negligent.

  3. This is a very touchy subject for many of us loved ones who try to trust, and spend enough money to buy new houses in hopes rehab will “take”. Of course, the first thing they say when you bring someone in is there are no guarantees. I get it. In my experience it is even less than that sometimes. For instance, in two different situations, with 2 different loved ones, at two different rehabs, the same thing. The addict wasn’t “behaving” or sticking to the rules so they got kicked out. Well, if they had been behaving and sticking to the rules in our home environment why would we take them to a rehab in the first place!!! We took them to “experts” for a reason. So, they keep the big bucks, the addict goes out and makes us crazy, we take them back to that rehab or another and spend more big bucks. We are not so trusting this time when we speak with most families whose loved ones are there multiple times. I understand the “no guarantee” part, but why should they have any incentive when, in reality, they make a ton more money off of the despair of loved ones, by not having any responsibility?
    Anyway, it became so disconcerting that this is my attitude.
    One day a termite inspector came to our house for our annual termite inspection. He said there is a small area that should be treated. So I asked how much it would cost and he gave this huge price and said that he couldn’t guarantee anything and it might just have to be done again for more money. My answer to him was “gee, it sounds just like rehab!”.

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