An Addiction Science Network Resource

Treatment Resources

(This is currently an online draft document subject to frequent revisions. It is provided as a courtesy to those who wish to track the progress in developing this resource.)


Treating drug addiction is big business and the potential patient and those making treatment referrals such as heath-care providers have a daunting range of facilities from which to choose. Although selection of a treatment facility is often best made considering the individual needs of the client, there are certain guidelines that can be used to help make an informed decision. Adherence to certain standard treatment procedures and utilizing the state-of-the-art methods maximize the chance of a successful treatment outcome. These “best practices” can be applied to rank the various treatment options, and different facilities adhere to these practices to varying degrees. This guide is provided as one resource for those seeking treatment to use at their discretion.

 

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Criteria for Ranking

Treatment Facilities

Ranking for Best Practices

 

 

Treatment facilities for drug detoxification and rehabilitation are listed here for various locations around the United States and Canada. They are grouped under four types of headings: Alphabetical Listing, Geographic Location, Primary Treatment Approach, and Ranking for Best Practices. This information is provided as an educational resource for those seeking treatment and for health-care providers advising treatment for drug addiction and related problems. Inclusion in the listings is provided free of charge to any vetted facility that appears to meet minimal standards for treatment effectiveness. To be considered for listing here, send your request along with the URL for both your facility’s home page and the page(s) describing your primary treatment approach to webmaster@AddictionScience.net.

Listing Criteria

The criteria used for the four classifications schemes are briefly described below. The data used for the classifications are publically available from the facilities themselves and are not subject to onsite verification unless noted. Treatment facilities that do not provide enough details regarding their primary treatment approach to be evaluated are given a negative rating for their lack of transparency. Finally, the information contained herein is subject to revision as more data are available and as the exact criteria are further refined and reconsidered.

Alphabetical and Geographic Classification

The first two are the easiest classifications, by common name used for the treatment facility and by their geographic location(s), respectively. The listings for geographic location include satellite facilities that provide inpatient treatment. Geographic location is often considered important for two very different reasons; some feel that close proximity to family and friends provides a support network that facilitates treatment, while others believe that the patient should be as far as possible removed from the influences that encourage their problem drug use. Each orientation has some merit and the final decision is best made considering the treatment approach and the policies of the specific treatment facility.

Primary Treatment Approach

The second classification scheme is considerably more difficult and somewhat subjective in nature. Data are obtained from public disclosure and evaluated for application of the various treatment approaches. Some treatment approaches yield a negative impact on the ranking but these are not tabulated for programs that simply offer these methods without relying upon them for their primary treatment effectiveness (e.g., many programs will provide supplemental treatments that while lacking proven effectiveness similarly lack a noted detrimental effect).

 

Special note on data collection: Both survey-based and public-source data were considered for summarizing the treatment approaches used by each facility. The latter method was chosen because it is part of the public record easily verified. That is not to say that these methods are actually used by the facility or that they are employed properly. However, information obtained through ‘private’ survey techniques would seem to be even less reliable. Unscrupulous treatment facilities could easily falsify responses to correspond to therapeutic approaches that receive a high rating in this analysis; of course this is also true for the online information provided by each facility, but at least there the claims are subject to public (as opposed to private) disclosure.

Criteria for Best Practices Ranking

The last classification involves a subjective ranking based on what is considered by the leading ‘expert organizations’ (e.g., NIDA) to be among the best approaches for treating drug addiction. It should be noted that what constitutes the best approach for treating an addiction (i.e., “best practices”) is debatable and even the adherence of any specific treatment program to the prescribed best practices is open to subjective interpretation. Nonetheless, the facilities listed here are not only vetted as reputable treatment centers but also ranked by the likely effectiveness of their treatment programs.

 

Several treatment approaches yield a negative impact factor. These treatments when used as the primary method of treating drug addiction have an overall detrimental effect on the outcome. Most notable is the denial that addiction involves important disturbances in brain chemistry (i.e., Denial of Brain Disorder) and the insistence that addictive behavior is the result of some past traumatic experience or other psychodynamic process related to developmental psychology or to the individual’s personality. Acknowledgement that addiction is a brain disorder does not mean that the treatment must be chemical involving medication or nutritional supplements, however. The single most effective approach for treating addictive disorders is cognitive-behavioral therapy. Other psychological treatments follow roughly the order of effectiveness shown in Table 1 and only methadone/buprenorphine (and to a lesser extent naltrexone) are designed to directly affect brain chemistry. Effective treatment of addiction often demands consideration of many aspects of the client’s life, including psychosocial adjustment, stress management and coping skills, and even vocational rehabilitation. Nonetheless, to focus primarily on psychodynamic or psychosocial processes unrelated to drug addiction is detrimental to treating the addiction and hence the large negative impact factor for facilities that rely primarily on this method of treatment.

 

 

Table 1: Criteria and Point Values for Ranking1

Cognitive-behavioral therapy (CBT)

+10

Selling marijuana addiction

Follow-up treatment after discharge (FTD)

+9

Detoxification/stabilization (DS)2

+7

Methadone/buprenorphine maintenance (MBM)3

+7

Motivational interviewing (MI)

+6

Comprehensive psychiatric screening (CPS)

+5

Individual counseling (IC)

+5

Group counseling (GC)

+4

12-step program (12S)

+2

Meditation/yoga/other spiritual focusing (MYS)

+2

Exercise/nutritional programs (ENP)

+2

Message therapy (MT)

+1

Sauna/other body cleaning (SBC)

0

Snake oils and other elixirs (SOE)

-1

Beating on a drum (BD)

-2

Aroma therapy (AT)

-3

Copper bracelets/magnets (CBM)

-6

Denial of brain disorder (DBD)

-10

 

 

Although the tactics are seemingly more subtle today, misinformation continues to exploit the fears and ignorance of people regarding drug abuse and addiction as depicted by this mid-20th Century film promotion.(From the Beaux Arts USA collection.)

 

 

 

1 Programs often have a combination of treatment approaches including some that have little or no demonstrated effectiveness. Point values are only assigned when the treatment facility reports that a major component of their program involves a specified treatment method (see text for details). Also, these point assignments are preliminary and subject to revision pending further study on the effectiveness of some of the methods listed here.

2 Detoxification/stabilization are only applicable for drugs that produce strong physical dependence such as the opiates, alcohol, and the barbiturates.

3 Methadone/buprenorphine maintenance are only application for treatment of opiate addiction. Experimental use of these treatments for other addictions are not rated here.

Copyright 2009 www.AddictionScience.net

 

 

Statistics reported by these facilities for their reputed effectiveness are not considered in the rankings. Such data are not subject to independent verification and thus duly dismissed. Claims of high success rates involve manipulation of the statistics in a manor that makes the program appear inappropriately superior to all of the others. For example, careful selection of patients (e.g., not including patients with severe drug addictions who are less likely to remain drug abstinent), short follow-up period (e.g., evaluating treatment effectiveness a month or two after dismissal when even placebo treatments can show substantial ‘effectiveness’), and excluding individuals who fail to complete the program from the analysis (i.e., probably the most common method of inflating the statistics) all yield meaningless outcome statistics. Unfortunately drug addiction treatment is a competitive business and even honest treatment facilities are de facto ‘forced’ into inflating their treatment success statistics to remain competitive with their less scrupulous peers. Therefore, these data are omitted from consideration here except in the case where programs claim a 90% or higher success rate where this statistic produces a negative impact on ranking for deliberately misleading potential clients and health-care providers and promoting unrealistic expectations for treatment effectiveness.

 

Facilities that do not provide sufficient information online to evaluate and who apparently prefer to ‘hide’ the details of their specific treatment approach are ranked on the bottom of this listing. Some of these facilities are undoubtedly very good, but others may be hiding details of their treatment programs to avoid public scrutiny and scientific evaluation (e.g., magic is best performed in the ‘dark’). Secrecy in the actual methods of treatment even plagues many government-sponsored treatment facilities, indeed, keeping addiction treatment within realm of the “black arts.”

 

Cognitive-behavioral therapy (CBT) is demonstrably the single most effective approach to treating drug addiction and therefore receives a +10 rating for its impact on treatment effectiveness. The overall rating of facilities using this approach is boosted even further by the explicit application of specific methods such as motivational interviewing and individual counseling which are often components of this approach. This functionally raises the impact factor of facilities focusing on this technique well above the “10” assigned to this category.

 

Follow-up treatment after discharge (FTD) is extremely important in treating addiction and correspondingly receives a +9 impact factor. Even facilities with relatively low ratings derived from their general treatment approach receive a significant boost in the overall rating by providing follow-up treatment services.

 

Detoxification/stabilization (DS) is not applicable for many drugs but can be particularly important for the opioids and in some cases for alcohol. The +7 impact factor might seem high to those who understand that physical dependence is not the cause of drug addiction (see A Primer on Drug Addiction), but programs only providing detoxification services will obviously still rank low in the listings. In addition, programs that do provide detoxification/stabilization or methadone/buprenorphine maintenance services for applicable substances (e.g., opioids) in addition to cognitive-behavioral therapy or other evidence-based treatments will not benefit from the combined efficacy of these treatments for opioid addicts.

 

Methadone/buprenorphine maintenance (MBM) is really only applicable to opioid addiction but has also been employed with alcohol and even cocaine addiction with some reports of success. Although results from these preliminary reports are unsubstantiated by formal scientific study, the use of adjunct methadone or buprenorphine in the treatment of these non-opioid addictions does appear to merit further exploration. 

 

Exercise/nutritional programs (ENP) are given a +2 rating because they can help provide focus that distracts from drug-related cognitions and external stimuli and because the general health-promoting feature of such intense programs can contribute significantly to stress relief and an increase in the general feeling of well-being. Such programs do not contribute demonstrably to treatment for the reasons often given such as “detoxifying the body” and “cleansing the system.” And although there are reasons to suspect dietary supplements might help restore perturbed neurophysiological function reliable scientific evidence for such an effect from any currently available formulation is lacking.

 

Massage therapy (MT) is given a +1 rating because it can contribute to a general sense of well-being and the stress-relieving effects can often be beneficial. It is, of course, not really a drug treatment approach per se but still merits consideration as an ancillary treatment and hence its positive contribution to the overall treatment program. Therefore, like exercise/nutritional programs, massage therapy can make a small contribution to a program’s overall rating.

 

Sauna/other body cleaning (SBC) approaches receive a neutral rating because they neither help nor hinder real drug addiction treatment. When used as the sole method of treatment they are about as close to a true placebo as can be found.

 

Snake oils and other elixirs (SOE), better known scientifically as orthomolecular psychiatry, have no demonstrable effectiveness in treating drug addiction. Yes, there are chemical imbalances that have been identified through scientific research and yes, some of the “medicines” touted to help remedy these imbalances underlying addiction do contain chemical precursors and other compounds related to the disturbed brain, but unfortunately it’s a whole lot more complicated than suggested by companies pedaling these products. For example, the catecholamines dopamine and norepinephrine are lower during drug abstinence but the biosynthesis precursor tyrosine or even L-dopa fail to boost dopamine levels significantly in most studies. This is because feedback inhibition limits synthesis of these neurotransmitters and the disturbance in brain chemistry caused by drug addiction is not easily remedied by such macro-nutrient treatments.

 

Beating on a drum (BD) has no demonstrable therapeutic effect. Indeed, this is the first of the “treatment” approaches that have a negative impact on the facility’s overall rating. There is no scientific evidence for synchronizing the brain waves with the rhythmic pulse of beating, jumping, or other repetitions behaviors. Similar methods that hypothesize neurorythmic integration are also ineffective. The -2 rating is given because of the headaches such useless loud racket can cause in the participants and bystanders alike.

 

Aroma therapy (AT) moves even deeper into the realm of charlatans and deservingly receives a -3 rating.

 

Copper bracelets/magnets (CBM) received a -6 rating because it implies a totally passive solution to an active problem which is even worse than the beating-on-a-drug and aroma therapies described above. Beating-on-a-drug is obviously an active practice requiring a certain amount of energy and focus. Aroma therapy usually involves trying to achieve a semi-meditative or other tranquil state. Either approach acknowledges that addictive treatment is an active process requiring some degree of effort on the part of the patient. Copper bracelets and magnets declare “slap it on and let the copper or magnetic field cure your addiction by realigning the endorphins while you sleep or carry-on your normal daily routine.”

 

Denial of brain disorder (DBD) is perhaps the single worse impact on treating drug addiction and therefore receives a -10 rating. It is a common misconception that recognizing addiction as having a biological basis necessitates treatment using chemical solutions—this is not the case. As noted above, the single most effective treatment for addiction involves cognitive-behavioral therapy and other treatment approaches can have a positive impact on treating addiction. The denial of addiction as a ‘brain disorder’ fails to recognize the very nature of addiction and moves the focus away from the actual problem.

 

The facility doesn’t have to ‘treat’ addiction as a biological disorder—there are no effective biologically based treatments that reverse the effects of drug addiction or that singularly improve drug abstinence except for the detoxification/stabilization and methadone maintenance programs noted above. The treatment facility need only recognize the nature of this disorder and then address the program with whatever marginally effective treatment means they have available. “Marginally effect” sounds bad and it’s unfortunate but it’s the reality—get over it!

 

There is no uniformly effective treatment for ‘curing’ drug addiction, only various treatments that increase the chances of the addict remaining drug abstinent and thereby appear to ‘cure’ some. Treatment approaches that consistently show the greatest effectiveness rate the status of being “evidence-based” treatments, and the rankings for the various treatment facilities listed here are based on an evaluation of best-practices deployment. Facilities that deny the biological nature of addiction often reply on quasi-psychoanalytical methods (usually with staff having little or no formal training in actual psychoanalysis or other schools of dynamic psychology) spending much of the time trying to uncover deep seated feelings of hostility towards ones parents or early childhood traumatic events. Unfortunately, what makes good copy for a novel or makes a talk show lively doesn’t have ANY effectiveness in combating drug addiction. (There are, of course, many cases of illicit substance use where an individual is only abusing the substance and not actually addicted to it. In such cases [as in some cases of apparent addiction to substances or other rewarding events that are not generally considered addictive] a ‘soft psychology’ approach focusing on these types of factors can be effective in remediating the problem which is not really centered on the substance. See Distinguishing Drug Abuse from Drug Addiction)

 

Composite Scores are computed by simply summing the numeric values assigned to each treatment approach for each treatment facility. The only way to obtain a high rating is to include evidence-based treatment approaches such as cognitive-behavioral therapy. The use of ineffective treatments to supplement evidence-based treatments does not generally negative the effectiveness of the evidence-based treatments. Therefore, facilities incorporating some components on the approaches assigned a negative score are not penalized as long as the ineffective “treatments” are not deemed to be the primary method of treatment. The -20 impact factor associated with denial-of-brain-disorder is, however, assigned even to facilities that inadvertently employ some treatment approach with demonstrated effectiveness such as cognitive-behavioral therapy or methadone maintenance.

 

Finally the rankings displayed here actually represent what is termed an ordinal scale despite their numeric values that might to appear to suggest some precise quantitative difference among the rankings (cf., interval scale data). More realistically, the differences may actually be more categorical with facilities grouping according to top, middle, and bottom tiers. To emphasize this nature the treatment facilities are listed alphabetically within each tier. Actual selection of a treatment program should focus more on the individual program elements listed for treatment facilities grouped in the top and middle tiers in consultation with a qualified health-care professional.

 

Treatment Facilities

 

Table 2: Treatment Facility Approaches

 

Rating

CBT 

FTD

DS

MBM

MI

CPS

IC

GC

12S

MYS

ENP

MT

SBC

SOE

BD

AT

CBM

DBD

Betty Ford Center

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BryLin Hospitals

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CARE Florida

 

 

 

 

 

 

 

 

 

 

Hazelden

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Holistic Addiction Treatment Center

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Horizon Corporations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Last Resort—Panama

16

 

 

 

 

 

 

 

 

 

 

 

 

 

Meditox — At-Home Drug Detox Programs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Narconon Drug Rehabilitation Center

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Orchid Recovery Center for Women

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passages Malibu 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phoenix House

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

US Detox Treatment for Opiate Addiction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

See Table 1 for abbreviations. A large check mark indicates that this is a primary treatment approach at the named treatment facility; a small check mark indicates that this is an optional or supplemental method at the facility and therefore can add but not subtract from the facility’s overall ranking.

 

(preliminary listings only)

Geographic Location

 

Table 3: Geographic Location

Alaska & Hawaii

(Outside of USA)

North East States

North West States

Middle States

Atlantic Seaboard States

South West States

Southern States

South East States

 

 

 

(Table 3, in progress)

Primary Treatment Approach

(Table 4, in progress)

Ranking for Best Practices

The various facilities are listed below in actual numerical order but are best considered as upper tier, middle tier, and lower tier facilities. The actual differences in numerical rankings are likely to be much smaller than implied by the numbers, and the list should be viewed more categorical than as an actual rank order of facilities. Most importantly, selection of a treatment facility will depend on the needs of the individual client. The listing provided here is strictly intended to guide this selection and help match the client’s needs with the appropriate treatment facility.

 

Table 5: Ranking for Best Practices

Treatment Facility

Location

Cost (Duration)

Top Tier Facilities

CARE Florida

North Palm Beach, FL

not specified but luxury setting

The Last Resort—Panama

David, Panama

$7,500-$15,000 (28-90 days)

 

 

 

 

 

 

Middle Tier Facilities

 

 

 

 

 

 

 

 

 

 

 

 

Bottom Tier Facilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(section in progress)

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Disclaimer:  The information presented on this page is provided as a public service for educational purposes. Selection of a treatment center, approach to treatment, and even whether treatment is appropriate should be made in consultation with a qualified health-care provider trained in substance abuse and addiction science. No liability is assumed by the Addiction Science Network or by any of its agents for use of this information nor is this information warranted in any way. The information provided here is deemed accurate to the best knowledge of the information provider.

 

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