Let the buyer beware about addiction treatment

Let the buyer beware about addiction treatment

A. Tom Horvath, Ph.D., ABPP
The Latin phrase caveat emptor (“let the buyer beware”) suggests that sellers may not inform buyers of everything buyers might want to know about the purchase they are considering.  Caveat emptor certainly applies when considering services from the highly competitive addiction treatment industry.  This multi-billion dollar industry divides into two primary parts: government funded treatment (about 75% of treatment) and private pay treatment.  Private insurance may pay a portion of private treatment, but typically only a small portion.  Government funded treatment centers do not compete so much for clients as for contracts.  If you attend one of these centers you may simply feel fortunate that you have the opportunity to do so!  Work hard to derive what you can from the experience.
If you are considering private pay treatment, your situation is more complicated.  You will need to make sense of a barrage of marketing claims.  An internet search for treatment facilities (“alcohol treatment”) will reveal that treatment is an “essential” ingredient in beginning recovery, and that there are centers which are “effective and nationally recognized,”  “the leading and most effective,” “proven x times more effective,” “the best type of treatment you can get,” “one of the nation’s most elite treatment centers,” “premier treatment [by] world-renowned providers [providing] the finest clinical care anywhere” and “the world’s premier treatment center for curing all forms of dependency.”
Let us assume a benign explanation underlying some of these (outrageous) claims: the staffs at all of these centers work hard, are proud of what they do, have seen many successes associated with their work, would love to help others, and are willing to “toot their own horns” a little if it helps prospective clients feel confident about choosing them.
But what about claims that one facility is significantly better (is more effective, has a higher success rate) than another?  Such claims should be ignored, because they are probably not backed up by solid evidence.  The crucial question:  Is the claim based on studies published in the scientific literature?  To my knowledge, no center’s effectiveness is established by multiple studies published in the (peer-reviewed) scientific literature.
Reading about treatment outcome in the scientific literature is quite different than reading treatment center websites.  “Success rate” is a term not typically used, because actual treatment outcomes usually range from very poor to very good, even with the most effective treatments available.  It is not sensible to divide that range into just two possibilities, success and failure.
Most scientific studies will therefore report the outcome range in at least several groups, such as: worse, not improved, slightly improved, significantly improved.  Even individuals in the improved groups are not necessarily abstaining.  In the largest study ever conducted of alcohol treatment (Project MATCH) the two outcome measures—the numbers they looked at to decide how effective the treatments were—were PDA (percentage days abstinent) and DDD (drinks per drinking day).  Furthermore, in scientific studies client self-reports about progress are usually confirmed by drug testing and reports by a family member (collateral reports), and outcomes may be measured long term (years).
The financial reality for treatment centers is that they cannot afford to conduct their outcome studies according to these scientific standards (drug testing, collateral reports, long term follow-up, plus many other standards not mentioned here).  If they could conduct their outcome studies according to currently accepted scientific standards, you would see their claims of success actually published in scientific journals—but they are not there.
A treatment center that claims high success can still be good, but you’ll need to look beyond the success rate to know.  It would be unwise to go to a center simply on the basis of a claim that its success rate, effectiveness, or outcomes are better than other centers.  The most important ingredient in treatment outcome remains the client and the client’s motivation.  Pick a treatment center that seems well-suited to you, and then work on creating your own recovery.