Looking for Drug Rehab Online

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(c)2014-2015 Rick Macnamara

Some thoughts about looking for reliable drug rehab information online

As part of the research I am doing for my book on the pitfalls in the Addiction Treatment Industry, I spend a lot of time online using academic databases like OBIS and ERIC.  I also spend part of each day putting myself into the mindset of a family member of an addicted son, daughter or spouse searching for information on the internet, since this is where many people turn for facility information.  What I have discovered is that there is an overwhelming amount of information on line, but may too much of it is unusable.  Some is even laughably awful.

I will not name these laughable websites since I would like to avoid their hate mail, entertaining as I am sure it would be.  The important thing is that these poorly-executed websites clutter up the landscape for people in real need of finding good treatment for their loved one.  I am also not convinced that these junk websites contain errors made by otherwise well-intentioned people because some of their content seems deliberately deceitful.

One example of this is the common marketing practice of establishing a local telephone number or stating in a popup ad or sponsored link on a search engine that they can help a seeker to find a drug rehab right in their own back yard.  This week, one such site popped up when I entered the search term “drug rehab”.  A sponsored ad asked me “Looking for a drug rehab in New Jersey?” and since that is where I live, I clicked on the link.  It brought me to a website that gave me the name of a lumber company called A A Lumber Sales and even showed me where they were on the map, right around the corner from my house.  I have been to that lumber company, but would never confuse them with a drug rehab and I suspect it was the A A in their name that fooled the website’s internal search engine into thinking it had something to do with AA Alcoholics Anonymous.  I explored this website a little further and found dozens of so-called drug rehabs that were actually drug stores, rug stores or just non existent.  Of course, I also found the names of several excellent programs not far away from me, but the entire website did not fill me with confidence.

Next, entering the search term “New Jersey drug rehab” brought me to a website claiming to be a facility located in New Jersey.  The phone number to call, however, was in Hong Kong and as I dug deeper, the site told me about Asian drug abuse treatment facilities.  There were none in New Jersey.

The worst site I visited this week said they were a group practice in New Jersey experienced in drug abuse and mental illness treatment.  There was only one staff member listed, although according to their About Us page, they apparently have other staff working with different demographic groups.  The one person who was listed was featured in a video infomercial embedded on the Home page and he was touting a self-improvement program he created with a name like “The Acme System for Mental Empowerment” (see my effort to avoid hate mail by not giving the correct name?).  I dug into this fellow’s qualifications and he is apparently licensed by the State of New Jersey as a Realtor and Broker, not as a behavioral health professional.  This may explain some of the dead links on the site that brought me to either blurbs about real estate or to “greeked pages”, those pages that feature words like Lorem Ipsum that are put in there by web theme authors as place holders until you enter your own content.

If the needs of family members were not so desperate, these websites would be   funny.  The fact is that family members are often in the middle of a life or death crisis following an overdose or arrest.  Too often, the discharge planner at the hospital is unfamiliar with any but the most local treatment programs, and the court system is less helpful than that.  Where will they find the information they need?  The Yellow Pages?  Friends?  The internet?

There are excellent programs out there, but hacking your way through the thick undergrowth of junk websites and misinformation to find them is overwhelming under normal circumstances and near impossible in the middle of a crisis.  These junk sites may only exist because of greater problem of the lack of regulation over the entire Addiction Treatment Industry, but it points out how important it is for all of us who work with addicts and their families to be as knowledgeable as possible about the really good treatment programs to help our clients in their time of need.

UPDATE:  Today, I found a national directory of addiction providers website in the top ten of search results that uses an interesting deceptive technique.  Searching by state listings shows a list of facilities with “ratings and comments” by previous clients.  I chose New Jersey and recognized many of the facilities on the list.  The catch is that to find out the facility’s telephone contact number, you need to click a link and the number that comes up is an 800#.  Unfortunately, no matter which facility phone number link you click, the telephone number is the same 800#.  This also happens no matter where in the country you are searching for help.  I tried to register to leave a good review for a program in NJ that I think very highly of and was unable to either register or to leave a comment.  In any case, many of the comments on this site seem very canned and generic so it’s possible that they are just peppered around the site automatically for window dressing.

If I owned any of the facilities listed on that site, I would demand that they stop co-opting my prospective clients’ telephone traffic this way.

 

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To Find a Therapist, Use Your “Gut”

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©2014-2015 Rick Macnamara LCSW

As a therapist in private practice, it is unethical for me to treat friends and family, and so people who know me often ask how someone can find a good provider of counseling or addiction services. It’s an important question and I advise them that there are guides available on line with lists of good questions to ask the prospective provider, but most of these guides don’t point out that the most important consideration is how you react when speaking with them the first time.

In popular usage, how you react to another person is called the “gut feeling”; some people call it the “bullshit detector” or “doesn’t pass the smell test” and if cultivated through self-monitoring, this extra sense tends to sharpen over time. In the helping professions, we refer to this as developing self-regulation or “counter-transference”, referring to the feelings the therapist has toward the client in reaction to the client’s feelings about the therapist. Sometimes it is all the therapist has to work with.

When I first began working therapeutically with clients during my graduate internship, my clientele was very challenging; I was assigned to work with mentally ill chemically addicted homeless men and women in an urban homeless shelter system. In addition, many had prison or at least county jail records and had a mistrust of anyone in authority, even a counselor. I recall complaining to my mentor, a former NYPD Detective, “How am I supposed to accomplish anything with these people? They lie all the time.”

His response stayed with me over the years and I paraphrase it here for purposes of brevity. “You’re going to have to work with their lies and your gut. That’s all each of you has right now.”

My mentor and I had many conversations during that internship year about how to use my own reactions to a client to help them to get some positive change in their lives. I discovered, for instance, that whenever a client’s words made me feel really good about the work I was doing with them, I should watch for the other side of the coin when they suddenly hated me. This reaction of my “gut” might be a good indication for me that my client was suffering from what has been called Borderline Personality Disorder and I might then refer them to a program using DBT (Dialectical Behavioral Therapy). In other words, my “gut” was telling me that I really could not work with that client because their best hope was a specialized type of therapy in which I had no training.

Most of us in the helping professions develop these self-regulation skills to a heightened degree; those who don’t can run into serious trouble like “falling in love with” their client, misdiagnosing, subconsciously keeping clients dependent on them, and other pitfalls of our professions. And those who encounter the helping professions as clients can, over time, develop a similar “gut” sense if they did not have one before from their life experiences.

So when someone asks me how they can find a good provider, I tell them that through their life experiences they already have abilities to make good decisions and to detect BS. I give them this simple guide:

  • Have a phone conversation with the prospective provider about the issue that brings you to therapy and see how they react. And, even more importantly,
  • See how you react to their reaction or lack of reaction. Don’t accept a prospective therapist telling you to save your explanation for the first session. I routinely give a free fifteen minute session to all my new clients to give us both the opportunity to see if we have a good fit; don’t let a provider rob the both of you of that opportunity.
  • If something in your “gut” is telling you this may not be the right person for you, tell them that and see how they react. If they seem interested in discussing your “gut” feeling with you to help you clarify what it is you are feeling, they may be exactly the person you need. But if they react by saying, “Well, maybe I’m not the therapist for you” without any further discussion, they may not be the person.

Most guides to finding a therapist will tell you to ask about their years of experience, their license, their treatment philosophy, etc. and these are all good things to know. But paying attention to your reactions to each other in the beginning of therapy makes an important human connection that is much more important to resolving your issue than the provider’s curriculum vitae.

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Is TeleCounseling the Next Big Leap Forward for the Helping Professions?

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(c)2014-2015 Rick Macnamara LCSW

Many social media sites allow us to use the phrase “It’s Complicated” next to our relationship status and for many of us, that is no exaggeration. All the modern conveniences that were supposed to make our lives simpler and more empowered just seem to add extra layers of complication and frustration. Even finding nurturing and healing time for ourselves between caring for others can be almost impossibly complicated and so we put our own self-care on a back burner. But now, thanks to improvements in technology, access to a healing professional can be as close as your laptop, tablet or smart phone.

In the 1960’s, NASA commissioned a study of what became known as telemedicine to reach patients in rural areas or who were otherwise isolated by disability. Telemedicine allows a clinician to speak over a video chat program with someone many miles away from their hospital, even someone on the other side of the world. Typically, their medical information is displayed on the screen and it enables the practitioner to provide ongoing health coaching and assessment to persons who otherwise would not have access. In New Jersey and other areas, telemedicine is also used by psychiatrists working in one hospital who can interview patients at another hospital and make recommendations for treatment.

As telemedicine technology has improved, it is increasingly used by counselors and therapists who “meet” with patients over a secure connection rather than the patient having to travel to the professional’s office. This means that a patient can easily fit in a 45-minute counseling session after the kids are in bed or before picking them up at soccer practice, right from their own couch or easy chair with a hot cup of tea right next to them.

This same technology can easily be adapted to other types of professional practices. Job coaches, spiritual counselors, even energy workers may find this to be a new way to connect with clients who might otherwise not have found the time to travel to their office for a session.

Setting up a therapy session is the easy part. There are a number of excellent software platforms that provide a virtual waiting room, instant payment by PayPal, even the ability to send helpful written materials in real time. The software is fast and easy to install.

Just as you would during an initial phone contact or first office visit, you should always make sure that the professional is properly credentialed and, if required by State law, has a current active license. Another consideration for this new way of meeting with a helping professional is that the Video chat used should be HIPPA-compliant so that your personal and health information is safe and secure. It was recently discovered, for example, that Skype does not provide this sort of confidentiality and many professionals are now moving to services such as SecureVideo and Vsee that uses military-grade encryption.

Technology may be part of the complication of our lives, but Online Therapy technology could become part of the solution. A quick search on the internet can show you a new world of convenient connections with someone who will listen to you and help you find ways to reduce your stress and make your life less complicated.

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The Big Casino: Defining Addiction Treatment Success

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©2014 Rick Macnamara, LCSW

At the heart of decision-making about any healthcare treatment is the success rate. Americans like to know their odds of survival. Readers may recall that Uncle Junior on the HBO series The Sopranos referred to his cancer as “The Big Casino” and in one sense that is very descriptive of how we view our disease survival rates. If one treatment has a 95% survival rate after five years and another treatment has only an 87% survival rate, we’ll put all our chips on the first treatment and spin the Wheel of Fortune in “The Big Casino”.

Studies of treatment effectiveness are common in the medical field and often enough, those studies are reported in the news media. It is encouraging to see that new surgical techniques based on technological advances can allow us and our loved ones to spend many more years together than their particular illness might have allowed even as recently as ten or fifteen years ago.

In the Addiction Treatment Industry, there are studies of the effectiveness of treatment but the results are unclear. Controlled studies of specific treatment centers are rare; any that were conducted by the facility and not by an independent research organization have a self-serving air about them so that even those using credible methodology may not inspire confidence in prospective clients. Over my career, I have heard wildly different success rates for addiction treatment ranging from about 50% to an astounding 95%. If the rate is 50%, you’re playing in The Big Casino at a rate only slightly better than the payoff on a typical Las Vegas Strip slot machine; that’s not encouraging. If the success rate was truly 95%, I would love to review their data because I have a hard time accepting that any treatment center anywhere can “cure” 95% of the people who walk through their doors.

It is dangerous for clients and families when a facility does its own success rate studies. Here in New Jersey, where I am based, Dr. Henry Cotton, a former director of the Trenton State Hospital, claimed 85% cure rates for such serious illnesses as schizophrenia by pulling all of the patient’s teeth and performing dangerous exploratory abdominal surgeries looking for “focal infections”. Sadly, many patients were mutilated and almost as many died before independent analysis indicated that Dr. Cotton’s statistical methodology may have been spurious, leading to his own subsequent breakdown and removal from the hospital staff.[1]

The value of independent review of disease outcomes cannot be overstated and anyone considering laying out tens of thousands of dollars to a rehab (Promises Malibu charges a reported $48,000 for 28 days, for instance) should question the source of any reported success rates.

During my time in a leadership role for a large behavioral health managed care company, we began compiling information on readmission rates for a number of high volume facilities over a 30-day and 60-day period. We were in a good position to conduct this research and publish it to the facilities as a value-added service because we knew when an insured member was discharged from one facility only to readmit to another. Facilities would only have access to readmission date for readmits to their own shop, which could give a misleading picture. When considering admission to a facility, ask if they have any such independent data.

Alcoholic Anonymous, by far the most pervasive influence in American addiction treatment, occasionally reports success rates, but some critics point out that most AA studies are based upon self-reports by their members, which is hardly a representative sample. A study conducted in 1996 called Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) seemed to indicate that most therapies for alcoholism, including participation in AA, had roughly equivalent results. [2] Follow up studies questioned the methodology and the results of what was at the time the largest and most expensive study of alcoholism ever done.[3]

St Jude Retreat is one of the few treatment centers that use an independent research company called Clearwater Research to study their effectiveness. In November 2005, they reported that the average success rate across the three St Jude Retreat was 68.24%. St Jude does not utilize the 12-step model; instead, they use Cognitive Behavior Education (CBE). I have not had the opportunity to review the complete report including data and methodology, but this figure is probably closer to the reality of addiction treatment outcomes. [4]

In my career, I have answered questions about success rates this way: “There is no magic program and no credible guarantees in addiction treatment. When you decide that having a steady job, a nice family, and a real future is more important to you than whatever you’ve been addicted to, your success rate will be 100%.” In the rooms, people talk about becoming “sick and tired of being sick and tired” and that is really where it’s at. And at that moment of clarity, finding effective treatment, whether it is to treat an underlying depressive disorder or a physical problem like diabetes, is the most important thing you can do.

[1] Madhouse: A Tragic Tale of Megalomania and Modern Medicine, Andrew Scull, Yale University Press, 2005. ISBN 0-300-10729-3
[2] Alcohol Clin Exp Res. 1998 Sep;22(6):1300-11. Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes.
[3] BMC Public Health 2005, 5:75 Are alcoholism treatments effective? The Project MATCH data by Robert B Cutler and David A Fishbain
[4] St Jude Retreat website: http://www.soberforever.net/program_success1.cfm

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Sobering Up About Sober Living Houses

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©2014 Rick Macnamara LCSW
Sober Living Homes are a great idea and the vast majority of persons who have stayed in one report positive, life-changing experiences. However, consumers should exercise caution and, as with many things in the addiction treatment industry, not take claims and promises at face value. In this week’s blog, I will point out some of the problems surrounding these establishments and ways you can protect yourself and your loved ones.

Sober Living Homes have been around since at least the 1970’s when it began to be recognized that the living environment for a person recovering from addiction is vitally important to treatment outcomes. It was during this time that residential treatment centers and other inpatient facilities emerged that sought to take the addict out of her destructive living situation and place her in an environment where she could build new support systems and learn new ways of living without the use of substances. [1] A recent article published in the Journal of Psychoactive Drugs compiled the results of several studies of Sober Living Homes that affirmed the hypothesis that a sober living environment and social interactions with other sober individuals led to better outcomes for individuals studied over a three year period. [2]

Several recent articles in local newspapers around the country and reports on local TV stations, however, point out some of the systemic problems of sober living homes as they currently exist. The authors of the Journal of Psychoactive Drugs article acknowledged some of these shortcomings, as well. Taken as individual incidents, they appear to only cause local interest, but in the aggregate, they show a need for national attention.

First, there is the lack of oversight by any state or federal agencies for the majority of Sober Living Homes. In the absence of strong self-governance of a home, things can get out of control as they did in October 2013 in Rumson, New Jersey, when a 25 year old man died of a heroin overdose in a sober living group home. [3] The parents of the young man learned that the home, and many others like it, was not licensed by the State of New Jersey even though in some cases sober living homes are reported to receive state and federal money.
In February of 2014, Channel 7 News Miami Investigative Reporter Carmel Cafiero reported on some disturbing deaths at sober houses, which she described as ‘popping up all over” in south Florida. It was not apparent what, if any, role the sober living homes had in the deaths, but as in the New Jersey case, it raises serious questions about how safe they are and who is watching out for the rights and safety of recovering addicts. [4]

Most other facilities that provide a safe environment must follow licensing requirements and be subject to periodic, often unannounced, inspections. In the late 90’s, I was a Case Manager at a residence for Mentally Ill Chemically Addicted (MICA) homeless adults called the Warner House in Hackensack, New Jersey, a former single room occupancy hotel in a 150+ year old building. We were licensed under the Division of Consumer Affairs and could look forward to an inspection at any time. The three people who operated the Warner House program day to day, two case managers and a building operator, were highly motivated to provide a safe environment for our twenty two residents, but we were very aware of similar residences within a few blocks of us that cut corners and put residents at risk.

In most states, it is possible to access the inspection reports for hospitals, nursing homes, and other care facilities to see if there have been any deficiencies. These reports, many of which are freely available online, judge facilities on an array of criteria, including food, activities, safety, etc. But in nearly every state I have reviewed so far, sober living houses operate in a grey area outside of government scrutiny.

This week, five southern California cities filed a friend of the court brief to ask the Supreme Court to review restrictions on local ordinances governing sober living homes. This action was apparently prompted by local residents’ complaints of noise, cigarette smoke and a transient population at these homes. Local ordinances were over ruled as unconstitutional [5], but it’s important to remember that a well-run and accountable facility would not have these problems in the first place. I can sympathize with these cities, which are only reacting to the lack of uniform regulations and the negative environmental issues that rose as a result.

Also this past week, FBI and IRS agents raided a sober living condo in West Palm Beach, Florida, as part of an insurance fraud investigation.[6] It’s not possible to draw any conclusions regarding whether better state regulations could have prevented this, but the legal vacuum surrounding regulation of these facilities could be attractive to persons looking for illicit opportunities. Reports are that local treatment centers applauded the raid on the described dilapidated condo. As a Clinical Supervisor for a large behavioral health managed care organization, I routinely heard reports from reviewers in south Florida and elsewhere about relapses that occurred in so-called sober environments.

Sober Living Homes and similar establishments have done a lot of good for a lot of recovering addicts. Most are staffed, like the Warner House where I worked, by dedicated professionals serious about the safety and wellbeing of their residents. But in light of recent revelations regarding a lack of oversight on these facilities, consumers would do well to be very careful selecting a sober home and remain vigilant while you or a loved one is living there.

[1] White WL. Slaying the dragon: The history of addiction treatment and recovery in America. Chestnut Health Systems; Bloomington, IL: 1998.
[2] J Psychoactive Drugs. Dec 2010; 42(4): 425–433.
[3] The Record (New Jersey): Sober House Rules September 16, 2014
[4] Sober House Deaths WSVN Miami/Fort Lauderdale Carmel Cafiero, Investigative Reporter February 25, 2014
[5] Costa Mesa supports Newport in sober-living case The Daily Pilot September 12, 2014
[6] FBI raid targets sober home owner in West Palm Beach The Palm Beach Post September 11, 2014

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