People recovering from substance use disorders require more than just a bed in a residential treatment center. Quality health care, medication-centered treatment, homes, and jobs are essential for their recovery. In a medical training experience, a young woman named Cara, who was struggling with opioid addiction, was started on methadone, which is known to be one of the most effective treatments for opioid addiction. However, Cara was also waiting for a bed in a treatment facility, as suggested by a hospital case manager.
The idea of getting a rehab bed being Cara’s only chance at recovery raised some questions among the care team. Would inpatient treatment facilities accept individuals using effective medications like methadone or buprenorphine? What would happen after completing treatment? Most importantly, what did Cara want for herself? The focus on building more addiction treatment beds as a solution is seen as a temporary fix to a larger issue.
With the alarming number of overdose deaths in the U.S. each year, it is crucial to reevaluate the country’s inpatient addiction treatment system. The approach needs to shift towards investing in expanded access to medication, behavioral therapies, harm reduction interventions, and affordable housing for individuals dealing with both addiction and homelessness. It is essential to involve individuals in their treatment plans rather than imposing specific types of care on them.
In the past, opioid addiction was treated in federally run facilities known as “narcotic farms.” These facilities resembled prisons and focused on labor as a form of treatment. Over the years, therapeutic communities (TCs) became popular, but they often lacked medical professionals on staff and enforced strict rules that could be dehumanizing. Today, while some TCs still exist, they are mostly court-mandated and may not align with a patient-centered medical model.
Data on treatment outcomes within residential treatment facilities are limited, but outpatient treatment with medications like methadone or buprenorphine has shown to significantly reduce overdose rates and recurrence of opioid use. However, only a small percentage of residential treatment programs in the U.S. offer these medications. Many treatment facilities focus on 12-step programming, which may not be suitable for everyone, especially those who do not align with the spiritual focus of such programs.
A recent audit study revealed exploitative practices in some addiction treatment facilities, such as offering spots without proper evaluation, requiring upfront payments, and turning down individuals with psychiatric comorbidities. This highlights the need for a more comprehensive and evidence-based approach to addiction treatment that addresses the diverse needs of individuals seeking help.
Residential addiction treatment beds are not a one-size-fits-all solution to the addiction crisis. It is crucial to integrate addiction treatment into mainstream medical practices, providing evidence-based care while addressing social determinants of health. Individuals like Cara do not always require residential treatment; they may benefit more from stable housing, employment, and ongoing support.
In conclusion, improving addiction recovery requires a holistic approach that goes beyond building more treatment facilities. By focusing on individual needs, evidence-based treatments, and addressing social determinants of health, we can better support individuals on their path to recovery. Ultimately, the goal should be to provide comprehensive and personalized care that empowers individuals to take charge of their recovery journey.