Bradley S. Caldwell, A.S., B.A., CATC III

Engaging in a program of recovery from substance abuse and addiction can often seem overwhelming to both the one struggling with addiction, and their family members.  Just finding the right help can be fraught with confusion and frustration.  Treatment is often expensive, and knowing just what you can expect from treatment is difficult to understand.  In fact, because the nature of substance abuse and addiction recovery necessarily entails human decision making, and despite whatever claims you may have heard on television or radio ads, there is really never any guarantee that you or your loved one will have the positive outcome you hoped for.  In light of this, what should you reasonably look for in a rehab when considering treatment?  As a California State Certified Addiction Treatment Counselor, I am often asked this question by people I meet.  Thus, to provide a comprehensive answer, I have put together the following list of the three most important components that I believe any effective treatment facility should include:   

  • Qualified counselors and therapists


This may seem like a “no-brainer,” but I actually know of clinics where the only people that are directly working with clients are interns.  While these interns may be overseen by licensed therapists or certified counselors, often no direct care is being provided to the client.   Of course, this doesn’t have to mean that the client is receiving poor or ineffective care, but it may mean that the client is not receiving the best care that is available for the money they are spending.  In my experience, good rehab facilities always provide direct care from licensed or certified staff members—even if it is being supplemented by care from interns. Moreover, drug addiction and alcoholism are deadly conditions; not getting competent treatment could have catastrophic consequences far beyond just the money lost on ineffective treatment stays.  Consequently, I always recommend to anyone thinking of going into treatment to make sure, up front, they will be receiving direct care from a licensed or certified professional.


  • Detox


If you or your loved one is going into treatment for the first time, more than likely a detoxification period will be necessary.  This is a very dangerous time for the alcoholic or addict; for example, sudden alcohol cessation can cause hallucinations, convulsions, and even heart seizure that may result in death. Additionally, the mental anguish of detoxing can lead to self-harm and even suicide.  While many residential rehabs offer medical detox, these facilities (often known as “detox houses”), do not actually have a fully trained medical staff on the property at all times.  Typically, these facilities subcontract to an off property physician that provides remote supervision, and if there is an employed staff nurse, he or she works out of an office that can be miles away from the detox house.  Moreover, such detox houses typically have little in the way of medical equipment and the on-property staff members have only limited medical training.  One facility I worked at actually had a patient go into seizure and pass away one night while waiting for an EMT to arrive!  This being the case, I have always recommended that if you plan to detox at a drug rehab facility, find out whether there is 24-hour medical staff and medical equipment on-sight.  If not, I recommend that your detox be done at a local hospital.  You can always then transfer to a rehab facility once your detox is completed.


  • Family Involvement


I really cannot over emphasize the importance of the non-using family members being involved in recovery.  It has been my experience, in working with both adolescents and adults, that without treating the enabler it is very unlikely that the user will have any long term success in recovery.  Uniquely, addiction is as much of a social condition as it is a medical and psychological condition.  There have been legions of studies done on the subject of addiction that demonstrate how addiction is, necessarily, a symbiotic social relationship between two or more people.  What this means is that wherever you find a “user” (i.e. someone abusing substances), there is a corresponding “enabler” (one or more people in the user’s life that makes it possible for he or she to continue using).  More often than not, the enabler is completely unaware of how their behavior is helping to perpetuate the user’s substance abuse.  In almost every case, the “enabling” is happening within the family dynamic.  Thus, I highly recommend finding a rehab that provides either private family sessions, or a comprehensive family process group, (or both).  (Note: the family component may be less important if the user is returning to treatment for a second or third time, or in an outpatient setting where family issues have been previously addressed in an in-patient treatment setting.  Regardless, the family members still need to be attending Al-Anon, or some other outside support group, as long as the addict remains a part of their lives.)  


Of course, there are many other things that may be considered as well, but in the interest of brevity, I have kept it to the most important three.  Hopefully, this article has been helpful and I invite any comments, questions, or feedback the reader might have.