06/10/2022
REHAB TREATMENT OR REHAB TOURISM
On the 12th May 1935, a meeting occurred between two alcoholics who realised the benefit of mutual support. From this meeting grew the AA fellowship and with the passage of time, it was noted that previously hopeless alcoholics were miraculously finding sustainable sobriety through their participation in this organisation. 15 years later, a group of treatment pioneers located in Center City, Minnesota extracted the core tenets of what was now called the 12 Step programme and used it as the basis of a non-profit treatment facility - the origins of the so called Minnesota Model and possibly the birth of the modern day addiction treatment industry. Their success then sparked the interest of the psychiatric community, which had previously abandoned alcoholics as untreatable and not worth the effort but now a source of additional income.
To make it official, alcoholism was introduced into the first DSM in 1952 as a Sociopathic Personality Disorder, (a first cousin to a Psychopathic Personality Disorder) which gave the condition some academic (and billable) credence. In the meanwhile, the Minnesota Model treatment programme had gained further respect and was exported internationally. The addiction treatment industry proliferated and in the USA today, it is estimated to be worth in excess of 46 billion dollars annually with about 15 000 treatment facilities and growing.
So what is the problem?
The problem is that an initiative that commenced as a worthy attempt to help “the still suffering alcoholic” find a sustainable sobriety has transformed into a very lucrative industry, intent on maximising profit and often based on questionable treatment practices. The demand for treatment has increased as both the drug distribution and drug treatment industry has become more slick and sophisticated. With this growing demand and the low-level entry requirements, the industry has become very competitive attracting all sorts of operators, ranging from venture capitalists to newly sober patients with no other career options.
The greatest irony of all amongst this industrial mayhem is that there is still no consensus about how to treat addiction effectively, despite claims of evidence-based treatment modalities. In fact, there is very little consensus about anything in addiction, including whether the condition exists at all. The desperate alcoholic who was finally ready for help has become the desperate alcoholic ripe for exploitation by predatory service providers.
Addiction treatment remains a grudge purchase, like the dentist – people need it but don’t really want it. In the competition for customers, the packaging has become more attractive and we now have bespoke treatment in private villas, cordon bleu catering, soothing massages, surfing lessons and whale watching outings – all sorts of optional extras. The chase is on for the rehab dollar. The Internet has contributed dramatically to the bun fight with its capability for deceptive marketing and patient brokering.
So what is my concern? There is no harm in making a profit!
This is the critical point: to invest sobriety and recovery with a value such that it becomes a precious commodity in the hands of an addict or alcoholic which they will nurture like a piece of valuable jewellery, the patient has to make some sort of sacrifice. There has to be a transcendent moment for treatment to be successful. Sobriety has to cost something more than just money, otherwise people squander it and relapse very quickly. In a climate of increasingly indulgent treatment facilities that pander to their clients purses and not their problems, a sacrifice becomes less and less likely and rehab treatment runs the risk of becoming thinly disguised rehab tourism.
