The deeper that we dig into the opioid crisis every week on Last Day, the more we realize how completely fucked up every aspect of it is.
Rehab, for example. Families of those with opioid use disorders are often relieved when their person agrees to go to rehab for the first time (or second, third, sixth, tenth, etc.). Finally! They will crack the code. They will figure out how to fix this. But here’s the truth: It’s not a quick fix or a permanent fix or even a “fix” at all, really. There’s so much more to the sobriety equation than rehab.
“Most of the general public thinks you should go to rehab if you have opioid addiction,” says Adam Bisaga, a professor of psychiatry at the Columbia University Medical Center, about medication-assisted treatment (MAT) written for The Atlantic. “But 70 percent of the success is giving [patients] the medication.” (We’ve written about MAT before.)
The maddening truth is that the medications needed to treat people with opioid use disorders are locked behind layers of bureaucracy and stigma. So, people either continue to use, or they head to a rehab center, most of which cannot treat the disease. Compare this plan to cancer: If you contract lung cancer from smoking, you will be treated with medicine, not a program to “change your behavior.”
That’s just the first hurdle, and it’s a GIANT hurdle. But let’s say a person with an opioid addiction does manage to receive MAT and get into a good rehab program, where they can improve their chances of recovery through therapy and behavior training.
Rehab facilities are poorly regulated and standards vary state-to-state. From Mother Jones: “[R]ehabs themselves exist in a quasi-medical realm where evidence-based care is rare, licensed medical staffers are optional, conflicts of interest are rampant, and regulation is stunningly lax.”
In a piece for Wired Magazine, Zachary Siegel writes about his own rehab experience at “one of the oldest and most reputable treatment institutions in America:”
“This confrontational circle felt more like gaslighting than therapy. Bill’s voice filled with anger when he called me selfish, a liar, a junkie: all the words I called myself. I tried to tell the therapists that my whole body hurt and that I didn’t think my addiction was a ‘spiritual malady,’ like they’d suggested. Bill kept at me. He poked fun at my withdrawal symptoms. He insisted I was arrogant and intellectualizing; I needed to feel the gravity of my situation. Toward the end of the session, I looked up at the other therapists. Their eyes were aimed at the floor.”
Next, consider that rehab—like every other part of the U.S. medical system—is a for-profit business. If your business is to profit off of vulnerable people, guess what? There are others who will prey on the vulnerable to make a profit of their own. Per the Mother Jones article:
Mergers and acquisitions related to drug and alcohol addiction programs doubled between 2013 and 2016, according to the Braff Group, and 48 private equity firms entered the market over the last five years. With more people heading to rehab and more money to pay for it, the investment community noticed.
All this activity has funneled billions of dollars into an addiction industry dominated by small providers that are mostly disconnected from traditional medical institutions. The roughly 14,000 licensed addiction treatment facilities in the United States each serve, on average, fewer than 100 patients at any given time. They include detox centers, where patients go to agonize through withdrawal; residential facilities, where patients stay a month or more as they receive treatment and attend group meetings; and outpatient facilities, whose patients tend to live in group sober homes and go to classes and appointments during the day. The programs vary wildly in approach.
Searching Google for articles on revolutionizing rehab shows many people asking the question, “should we rethink rehab?” and they’re from years ago.
It is beyond time to rethink the rehab system in America. In the meantime, if you are trying to get a loved one into a treatment program, try to find one that is based on medical practices and employs board-certified addiction medicine doctors. The most important thing is to know in this situation is that your person cannot think or talk their way out of this disease.
We wish it were the case. We wish there were easier solutions. But we have a long way to go.
Lemonada is tackling opioid use disorder on Last Day. Subscribe now.