About 2.5 million people received mental and/or substance use disorder treatment last year, according to the Substance Abuse and Mental Health Services Administration.1 Of those, a small but significant percentage chose support from a luxury type facility. This article intends to provide clinicians with guidance in addressing medically supervised luxury detox and/or rehabilitation programs for drug and alcohol abuse.
We recommend that individuals entering substance abuse services pursue these treatments with “eyes wide open.” A vast amount of literature indicates a rise in programs designed to attract vulnerable clients seeking treatment.2 They offer an array of luxury services such as equine, massage, and yoga therapy, as well as holistic approaches. These services are all packaged in a five-star hotel–like environment in a desirable area (by the sea, mountains, etc.).
The guidelines that we are presenting do not take into account the diversity of regulations across the country that allow programs to avoid maintaining the appropriate rate of minimal clinical environment that is ideal.
The question is whether a $50,000-per-month treatment center is better at keeping its clients in remission than a facility that charges a fraction of the price per month. We believe that success rates may be less a function of financial cost and more a function of evidenced-based treatment strategies that are specific to recovery.
We would like to advise individuals to look for the following elements when reviewing a potential treatment center:
• Accepted by major insurance companies such as Blue Cross/Blue Shield and United Healthcare, to name a few.
• No cookie-cutter approaches: Programs allowing for inter-individual flexibility regarding length of stay (not specifically 21, 30, or 45 days), as well as flexibility of services.
• Group therapy should have no more than 15 clients. Some individuals may not be appropriate for group therapy or may have a strong aversion to this modality.
• Licensed and/or certified staff (not peer coaching and/or paraprofessionals alone).
• Minimum of 20 hours per week, per client, of clinically supervised evidence-based methods, techniques, and/or practices including individual counseling, group therapies, and family involvement.
• Staff-to-client ratio of no more than 10 clients per one staff member, especially if the length of stay exceeds 21 days.
• If the length of stay is longer, fewer staff members may be more appropriate.
• Availability of higher level of professional staff, psychologists, psychiatrists, and other physicians to address all comorbid concerns.
• Adequate aftercare treatment.
After reviewing social media that rate treatment facilities, one common thread we noticed was the total absence of aftercare services.3 Aftercare services were something that clients may not think of at the initial intake.
Lastly, another often overlooked but important component of treatment is family support and/or direct involvement. Provision for child care may be a concern and necessary for some. Given the distant and isolated locations, this support is many times denied to the prospective client. As in other areas of life, “caveat emptor” (let the buyer beware). One should also be aware that many online searches for substance abuse facilities lead consumers to click on website ads paid for by the facility. As reported in the New York Times,4 companies paying for the most ads are the ones most likely to be seen in online searches. Nevertheless, we are seeing efforts by Google to set limits to these practices.
1 Substance Abuse and Mental Health Services Administration ( SAMHSA ). “Behavioral Health Treatments and Services.”
2 The Verge, Sept. 6, 2017
4. The New York Times, Sept. 14, 2017
Dr. Lesser is executive director of RANE, Medical & Mental Health, in New York City. In his recent positions as medical director for New York City and State, he was instrumental in developing and implementing nationally recognized emergency and response programs. Dr. Brenner is chief of Behavioral Health Service Line for Catholic Health Services of Long Island, in New York. He is a clinical professor of psychiatry for the State University of New York, Brooklyn, and medical director and CEO of Neurobehavioral Research Inc. Dr. Ferber is a licensed psychologist in New York and California. He has been the director of Behavioral Health Central Intake at Catholic Health Services of Long Island for the last 2 years. Dr. Ferber specializes in addiction treatment. Ms. Howard is a psychologist in training with specialization in clinical psychology. She currently treats numerous dual-diagnosed patients with comorbidities on an acute psychiatric ward.