Choosing a drug or alcohol rehab center for yourself or for a loved one can feel overwhelming. Unfortunately, with the rise of the opioid epidemic, the addiction treatment field has seen an influx in deceptive marketing and unethical practices by drug rehab "providers" whose only concern appears to be monetary gain. This leaves many consumers confused and distrustful about where and how to find effective treatment options.
Today, more than ever, consumers need to know what to look for in a rehab center. As you research treatment centers and speak with rehab providers, here are important questions to ask and topics to cover.
Reputable drug rehab centers are accredited by The Joint Commission or the Commission on Accreditation of Rehabilitation Facilities (CARF®). Both the Joint Commission and CARF are independent, nonprofit organizations that base accreditation on industry performance standards and demonstrated results, quality and value. State licensing is not the same as accreditation given the fact that states vary widely in their licensing requirements.
In addition, drug rehab centers need to be certified in order to advertise their programs and services on Google and Facebook via a third-party provider called LegitScript. This certification ensures that, through a rigorous vetting process, only legitimate, quality treatment centers can advertise their services on these channels. It's a process that provides a level of protection for consumers.
Credentials and licensure indicate whether the individuals who provide drug rehab programming and services meet nationally recognized standards for professional practice. If clinical staff are not licensed or accredited, they may not have the training and experience needed to provide the most-effective care. Specific credentials held by addiction treatment professionals may include LADC (Licensed Alcohol and Drug Counselor), LPC (Licensed Professional Counselor), CAC (Certified Addictions Counselor) or CCDP (Certified Co-occurring Disorders Counselor).
The highest quality inpatient substance abuse treatment programs involve a multidisciplinary care team who, collectively, are equipped to address all aspects of the disease—mind, body and spirit. This means your rehab program should include a mix of professionals who work together to create an individualized treatment plan. All team members should be licensed to practice in their particular discipline. Be wary if one staff member wears several different hats. A multidisciplinary treatment team typically consists of:
The most effective treatment programs rely on evidence-based practices that have been proven through science-based research. Examples of evidence-based practices include Twelve-Step Facilitation, Cognitive Behavioral Therapy, Medication-assisted Therapies and other treatment models.
Many people who struggle with alcohol or drug addiction also have a co-occurring mental health condition such as anxiety or depression. In order to provide the right treatment, an accurate diagnosis is needed. For patients with a dual diagnosis, the most promising treatment approaches incorporate care for addiction and the co-occurring mental health disorder at the same time. If an addiction treatment program doesn't provide mental health services, be sure to ask how these services are coordinated with other providers in the community.
Too often, treatment outcomes are not measured by rehab providers—or they're measured inconsistently. Even the definition of treatment "success" can be very different among providers. Be wary of rehab facilities who claim to have "the cure" or “100% success” rates. If rehab success rates are quoted, the data should be collected using research-based methods or be published in peer-reviewed journals.
Treatment for substance abuse can be expensive, so look for rehab facilities that are in-network with your insurance. Being in-network also means the program has met the quality standards of the insurance companies. Some treatment providers will say they "work with your insurance" company, but that doesn't mean they're in-network. If in doubt, check with your insurance provider.
Medical detoxification services can be provided by your hospital or health care clinic before you enter a treatment program, but going through medical detox on site allows you to begin the rehab process at the same time. The medical staff of a detox unit should include both nurses and physicians who have expertise in easing the discomfort of alcohol or drug withdrawal and reducing drug cravings. Ongoing monitoring of your physical health is an important part of your recovery process.
Quality treatment providers do not take a cookie-cutter approach to care. It's important to find rehab programs where care is individualized and tailored, whether that means providing gender-specific programs, targeted treatment for teens, young adults or other specific populations, or other types of specialized rehab. Many issues discussed during rehab can be difficult to have when in mixed groups.
The length of time spent in treatment is best determined by your progress rather than a specified number of days. Some substance abuse programs give an estimated time frame, but if progress isn't made during that period, the length of time in treatment could be extended. Look for programs that provide multiple levels of rehab so that, as progress is made, you can step into a less-intense level of care.
Addiction treatment typically involves a high level of clinical care and support. When drug rehab ends and you're on your own, it's important to have a support system in place to help prevent the risk of relapse. Quality treatment centers offer a variety of post-treatment options including phone-based coaching, apps to build and strengthen recovery, continuing care groups and other resources and support.
Addiction is often referred to as a family disease because it's a condition that affects the entire family. Families need to heal and recover from addiction, too, by learning to work through the chaos they've experienced, set healthy boundaries and rebuild trust. Treatment patients tend to have better recovery rates when the whole family is educated about addiction and involved in the recovery process.
With the passing of the Affordable Care Act, more Americans have access to health insurance to help cover the cost of drug rehab. While this is great news for people who need treatment but were unable to access care in the past, there's been a rush of companies eager to get into the addiction treatment business. Most rehab programs provide quality care, but do your research and remember the test of time: treatment providers who've been around for a long time have established their credibility.
Depending on your specific needs and situation, there are a multitude of additional questions to ask treatment providers when you are trying to select the right drug rehab center for yourself or a loved one. Be sure to read reviews on Google, Yelp, Facebook and other sources of consumer feedback.
Conduct your own web search to find more information about specific drug rehab centers. Here is a list of questions to assist in your research:
What type of accreditation or licensing does your facility have?
What credentials or licenses does the clinical staff hold?
Is treatment provided by a multidisciplinary team?
What is the patient-to-counselor ratio?
Do you use evidence-based practices?
Do you have gender-specific programs?
How successful is your treatment program?
Are you in-network with my insurance?
Do you provide mental health services?
Do you offer medical detox or other medication-assisted therapies?
Do you offer treatment specific to teens, young adults, older adults or other populations? (as it applies to your situation)
How long does the program last?
What kind of post-treatment support do you provide?
Do you offer family support?
How long have you been providing addiction treatment?
Addiction treatment marks the beginning of a new way of living. The insights you gain and the changes you make during rehab will become the foundation for your recovery throughout the challenges life brings. Keep this in mind as you choose a treatment center. It will help you determine a good fit and identify the best treatment approach for build a solid foundation for lifelong recovery.
Learn more about Hazelden Betty Ford, the efforts we've taken to become a premier addiction treatment center of choice, and how we can help you reclaim your health and your life from addiction.
Determining the characteristics of a COE requires identification of the minimum standards necessary to deliver outstanding quality of care. In other words, an obvious starting point is to define the characteristics and practices that are minimally required in order for a provider to demonstrate it is delivering adequate services. This section of the paper will list and describe each of these criteria.
The first essential characteristic is receiving and maintaining accreditation from external regulatory organizations, such as the Joint Commission (JCAHO) or the Commission on Accreditation of Rehabilitation Facilities (CARF). It is also important to maintain a state license and meet the expectations at the highest standard of care. Hazelden Betty Ford and Caron are accredited and licensed facilities. Surprisingly, many addiction treatment providers throughout the United States have not received accreditation, and there is no mandate in the field requiring providers to have accreditation in order to operate. Because accrediting agencies are vital in establishing rigorous standards for quality of care, organizational performance, and evaluating whether providers meet these standards, accreditation should be a "minimum requirement" of any organization offering addiction treatment.
Well-trained and credentialed clinicians are critical to providing quality care. COEs hire and retain clinicians with the appropriate degrees and licenses, such as addiction medicine physicians, doctoral-level psychologists, and licensed or certified addiction counselors. As the field of addictions counseling has increased in complexity and sophistication over the past decades, so too have the licensing and certification requirements across the United States. At present, few states will license counselors at the associate's level. COEs hire addictions counselors that have, at a minimum, a baccalaureate degree from an accredited institution with a preference for those prepared at the master's level. COEs also implement clinical training programs that keep clinicians up to date in their fields and continuously advance their clinical skills.
COEs use state-of-the-art tools for conducting all aspects of business, including clinical operations. These include a well-designed, integrated electronic health record that allows information to be shared across all stakeholders, including direct providers of care. Organizations should have solid Information Technology (IT) platforms, case management systems and other data systems that facilitate care and allow quick and seamless communication among staff and stakeholders. It is also important for these platforms to provide accurate and reliable data that can be used for benchmarking and quality performance assessment. Advances in technology have led to its use during treatment. Both Caron and Hazelden Betty Ford utilize technology as part of their treatment. At Caron, the IT team worked with the clinical team to develop a program called Passport. This program is electronic and allows the patients to interface with their patient-centered treatment plan, track progress, keep their treatment homework, work on their treatment work digitally, interface with their addiction counselor when not in group or individual sessions, and be part of a peer community. At Hazelden Betty Ford, the My Ongoing Recovery Experience (MORE) web-based program helps discharged patients track their recovery process, interact with recovery coaches, and participate in a peer community of support.
Clinical services offered to patients should be "evidence-based," serve as "practice-based evidence" and/or be rooted in research and aimed at establishing new innovations in practice. In addition, the treatment provider should have a hard-wired process for routinely reviewing the ongoing research literature and exploring ways to incorporate new practices and methods as the evidence base for these develops. Hazelden Betty Ford and Caron both have robust training programs and affiliations with leading universities to ensure employees are knowledgeable and trained in current trends in the industry, age and gender specific treatment issues, along with recognized evidenced-based practices such as Motivational Interviewing and Dialectical Behavioral Therapy.
It is well known that the majority of individuals with a substance use disorder also have a co-occurring mental health condition or other co-existing addiction. An addiction treatment provider should therefore offer formal treatment for these co-occurring disorders (in addition to treatment for the substance addiction) and do so using evidence-based practices. To ensure proper treatment of co-occurring disorders, addiction treatment providers should have medical or psychiatric staff available to treat the presenting co-occurring disorder and clinical staff trained in the treatment of these disorders. An integrated approach to treatment is the best practice. At Caron and Hazelden Betty Ford, there is a comprehensive behavioral health team bolstered by full-time medical, psychiatry and psychology staff.
Another area vital to a COE is performance measurement. Increasingly, substance use treatment centers are being called to task to provide measurable outcomes demonstrating the success of their programs. At the industry level, addiction treatment centers are facing a rapidly expanding competitive environment and increasing pressure from government and health care insurance industries to show demonstrated success. Individuals seeking treatment are also becoming progressively savvy in their search for a treatment center that will give them the best possible outcome. A COE should have formalized, proven methods for measuring several aspects of organizational performance, including patient outcomes.
While there appears to be field-wide acknowledgement that such measurement is important, addiction practitioners and scholars have yet to agree on the precise metrics that should be collected and reported within the addiction treatment field. If outcomes are collected at all, most treatment centers rely solely on patient self-reporting without methods and structures in place to reduce bias and demand characteristics. Centers of Excellence have robust measures, which include reports from families, information from other professionals and science-based, physical measures, such as urine drug screens in addition to self-reports. This is an area where both organizations have been pioneers. For decades, Hazelden Betty Ford and Caron have collected patient self-report, but recognized the limitations of distal-outcomes measurement and designed programs to manage and monitor patients during treatment and after discharge for a year or more. It is not uncommon to find providers with little to no evidence of measuring patient outcomes or organizational performance as it relates to the quality of services provided. Centers of excellence pave the way toward standard outcome measures for the addiction treatment field, so that one day all programs can be compared based on the same measures – a development strongly urged and supported by both Caron and the Hazelden Betty Ford Foundation.
A first-class addiction treatment provider must engage in quality and process improvement, and have reliable, valid measurement systems to track improvement efforts and demonstrate quality of care. After much-needed industry-wide consensus around measurement has been reached, a COE would lead this effort and encourage peers to adopt and share metrics results. In this way, national benchmarking can occur, which is currently lacking in addiction treatment but vital in terms of demonstrating accountability for care quality. A few examples of benchmarking criteria include satisfaction rates, average length of treatment, successful treatment completion, abstinence rates, re-engagement rates, and integration of family into treatment.
At a minimum, a COE needs to participate in national benchmarking efforts and help drive adoption and compliance with such activities throughout the field. Both Caron and Hazelden Betty Ford participate in a national benchmarking group where they are measured against other treatment centers. Both have also agreed to participate in a first of its kind pilot study through NAATP (National Association of Addiction Treatment Providers) which has the goal of setting the standard of practice for collecting outcomes.
There should also be transparency in sharing information regarding the quality of care and outcomes, and educating the consumer about services and expected results. It is important for this information to be valid, so the use of outside agencies to evaluate the data is essential. Both Hazelden Betty Ford and Caron collaborate with leading university-based researchers in the field to create measurement systems, analyze data, and publish them in peer-reviewed research journals. Data should be displayed in a forthright, appropriate way so they are not misinterpreted.
Regarding service offerings, a COE must offer a full continuum of care that provides a complete range of services that offer the patient an array of treatment opportunities based on acuity level and need. These services span a wide range of areas, including prevention and education, formal treatment and management of addiction issues, and post-treatment services, tools and resources that support ongoing recovery. Caron and the Hazelden Betty Ford Foundation believe that not all of these levels of care need to be offered by a single addiction treatment provider. Rather, some services can be offered through strategic affiliations with other providers that are transparent with their clinical outcomes and business practices, operate ethically, and are committed to providing quality care.
Treatment is only one component of a continuum of care. A COE should have services offered to the patient and family prior to admission to treatment. Examples include education, intervention, and supports for families in the community and in the schools. COEs have extensive programming for families, which includes education, support and referrals to professionals for their own treatment when warranted. The continuum of care should continue post treatment. Both patients and families require additional support as they navigate early recovery. Transitional recovery care programs based on physician monitoring programs have been shown to be highly successful. Both the Hazelden Betty Ford Foundation and Caron offer ongoing monitoring of patients post discharge for 1 year or longer. Caron’s program, My First Year of Recovery, and the Hazelden Betty Ford Foundation’s program, Connection, focus on recovery transitions, overall wellness, monitoring through random urine drug screens, and assisting families with their own transition issues when their loved one returns home. The goal is not only promoting continuous abstinence, but swiftly re-engaging the individual back on the recovery path if a relapse occurs.
Student Assistance Programs, whether delivered in schools or in the treatment setting, provide resources to children impacted by a parent's or sibling's addiction. School-based programs can also be a great support when an adolescent patient returns to school after the completion of treatment.
An addiction treatment provider that aims to be a COE should also engage in ongoing education and scholarship through collaboration with local academic centers and universities and the delivery of educational programs, fellowships, internships and opportunities for further professional development (such as continuing medical education offerings). Scholarship and research are both important and can be accomplished through collaboration with other institutions. A COE should also conduct primary, prospective research on the topic of addiction and publish findings in peer reviewed scientific journals.
To the extent possible, a COE in addiction treatment should engage in advocacy efforts and be a leading voice in the field. Some of this activity can be accomplished through membership with national trade associations. A first-class provider can educate people in local communities by hosting and sponsoring events and conducting interviews with the media.
Though it may sound obvious, Hazelden Betty Ford and Caron believe the core business practices of a provider should be sound and ethical. Marketing, advertising and promotional activities should be ethical, truthful and legal. Paying organizations for patient leads is highly inappropriate, as is presenting misleading data or results. Regarding financials, a world-class provider should also be well-capitalized.
Lastly, the reach of services should be extensive in order for a provider to qualify as a COE. Compared to acute care providers, the addiction treatment industry has been slow to serve underprivileged individuals who do not have economic resources. To the extent possible, services should be available to people of all socioeconomic backgrounds. COEs like Hazelden Betty Ford and Caron offer extensive scholarships and patient aid programs to ensure access for all. A first-class treatment center also practices diversity and inclusion, including having culturally appropriate symbols and employing staff who are diverse and bilingual.
A COE should also be invested in the development of staff, which creates a pipeline for growth within the organization. Growing staff from within is not only cost effective for the organization, but allows individuals to expand their leadership skills, creating a staff better equipped to meet the needs of an ever-changing and complex healthcare system. It also creates a loyalty to the organizational mission.
These characteristics represent, at a minimum, what is needed for an addiction treatment organization to consider itself a Center of Excellence. With the ever-changing landscape of the American healthcare system, providers are challenged to meet evolving expectations, which will continually increase over time. As an industry, addiction treatment centers are in a position to set the highest standard of care for clients. This is accomplished with accreditation, performance management, and evidence-based care with the capacity to treat co-occurring illnesses, an investment in education and research, transparent and ethical practices and marketing, availability to all individuals, and advocacy in the field.
It is time for accountability in the addiction field. It is time to set standards that all treatment organizations should strive to meet. While Caron and Hazelden Betty Ford uphold the highest standards required to be a Center of Excellence, both organizations call upon others to adopt similar standards which promote overall quality of care.