Little Evidence that Costly Treatment Programs Work
It has become fashionable again for celebrities to check into exclusive and high-priced addiction treatment programs, but there's little data to prove that these programs promote long-term recovery, the New York Times reported June 17.
Stars like Lindsay Lohan have drawn extensive media coverage when they have checked in and out of posh rehab programs in Malibu and other California enclaves. Programs like Promises in Malibu charge up to $49,000 per month for a treatment regimen that includes massages and fine dining by the sea.
However, there is little concrete evidence that addiction treatment in general -- or these expensive programs in particular -- are effective. About 80 percent of addiction patients will relapse, studies suggest, and long-term success rates for treatment are estimated at 10-30 percent.
"The therapeutic community claims a 30 percent success rate, but they only count people who complete the program," noted Joseph A. Califano Jr., of the National Center on Addiction and Substance Abuse at Columbia University. "Seventy to eighty percent drop out in three to six months."
"There is not a large body of research on the effectiveness of 12 steps [programs]," added Timothy P. Condon, the deputy director of the National Institute on Drug Abuse.
"Setting up a program, making it luxurious, using things that are not rigorously tested, I don't know the benefit of that. If I was going to spend a lot of money, I'd want to see outcomes."
Richard Rogg, owner of Promises, stated, "There's no way to effectively measure success rates. Any program bragging of a success rate is not telling the truth."
While estimates of success at low- and high-priced treatment programs are similarly imprecise, the latter are called out for criticism for their comparatively permissive attitudes toward clients.
Whereas manual labor and Spartan conditions are sometimes associated with traditional therapeutic communities, programs like Promises and Wonderland emphasize comfort for their exclusive clientele.
Moreover, patients are often allowed to leave the program before their stay is concluded -- Lohan famously left Wonderland to go shopping earlier this year -- something that doesn't happen in most other residential rehab programs.
"Recovery does not need to isolate you from your friends, family or career," the Wonderland website says. "Recognizing the necessity of performers fulfilling preexisting commitments when they are in need of treatment, Wonderland has developed a working solution to this all too familiar problem."
"If you spend your whole time at a treatment center, when you leave you're not prepared for the stresses and anxieties on the outside," said program director Howard Samuels.
Clair Waismann, executive director of the Domus Retreat in Anaheim, Calif., said the more lenient approach to treatment is "not a good thing or a bad thing; it's uncharted waters. They're trying new approaches. You can't tell Lindsay Lohan she can never have a beer again or she's failed. She will fail."
"These [traditional] treatment centers have worked in the same manner for 40 years, and the success rate has been extremely low," added Waismann.
"For business reasons, most of these rehabs are trying to adapt to the new starlets and their needs, allowing them to go to work and come back, go shopping, use their cellphones. This is all new for the 12-step world. They're pretty much the guinea pigs of change in the rehab world."
One program that doesn't shy away from claims of success is Passages in Malibu, which rejects the 12-step model and the disease model of addiction. Owner Chris Prentiss claims an 84.4 percent success rate. The program costs $67,550 per month.
"[12-step programs] believe that alcoholism is a disease and an incurable one, and the same for addiction," Prentiss said. "That's a dirty trick. At Passages we reinforce a person's ability to completely cure themselves of dependency. The first thing we give them is hope: 'You're going to be fine.'"
Treatment as Passages focuses on individual therapy and medical supervision. The program's high success-rate claims are based on phone interviews with 1,000 graduates.
"That's ridiculous," said Promises' Rogg. "Believe me, he doesn't have an 84-percent success rate. Nobody does. Part of the problem in talking about a success rate is you're talking to an alcoholic to gather that information, who is ready to lie and not give you accurate facts."
Califano said that a proper outcome analysis would involve "knowing everything that is done with that person in rehab, and following them for six months to a year, and do an actual urine or hair test. No one lets us do that."
Related book: High Society: How Substance Abuse Ravages America and What to Do About It by Joseph A. Califano
Photo by Dan Chavkin for Newsweek: Renaissance Malibu is one of a new generation of holistic, residential healing centers that can cost between $40,000 and $100,000 for a 30-day stay.