What to Look for in a Treatment Center When Doing an Intervention for Addiction or Mental Health

Treatment Centers Today vs. Treatment Centers in the Past: What Has Changed and Why

I have contemplated writing this article for the past seven years. The primary purpose of this article is to inform the reader that what you should be looking for in a treatment center is different from what you have been looking for, and you should be aware of what exists. What has happened to healthcare treatment is happening to the treatment of substance use and mental disorders. What was once a caring, individualized healing approach has become a profitable industry being gobbled up by private equity firms. Any internet search will prove there is a race to prevent private equity from buying more healthcare companies. Current restrictions exist in many states where the private equity firm must notify the state of a potential acquisition. 

As insurance companies clamp down on reimbursements to healthcare providers and reduce their ability to treat patients the way they used to, both healthcare and addiction and mental health providers must make up the difference between patient volume and billable mental disorder codes. The more people they have, the more problems they have, the more money they make. With this comes compromised care and a standard curriculum for all. 

 “Those who read this article and are offended are part of the problem. Those who read this and agree understand this is the problem.” 

Unfortunately, most treatment centers today have been bought up by private equity firms and merged with multiple centers, creating a “herd’ concept. Most of these centers are built for thirty days of treatment or less. People who run human resource organizations like widget manufacturing companies put profits before people. Organizations like this know that the funding is in the detox and residential level of care and is far less profitable when the client steps down to a PHP (partial hospitalization) or IOP (Intensive Outpatient) level of care. The model may be complex for some to read and digest, and you are most certainly familiar with changes to your doctor’s office. What was once an intimate relationship with your doctor is now a massive medical building with pools of doctors with less attention to individual care. 

A family member, their loved one, or both will inevitably accuse us or the center of asking them to stay longer so that everyone can make more money. This thought is not only ridiculously wrong; it is not valid. The longer a client stays in treatment, the less money a center makes. It is why most centers discharge clients after detox and residential treatment: the reimbursement drops significantly. You will only find long-term treatment with centers that are self-paying or are still privately owned.

Treatment Center Marketing & Business Development Representatives

When we say marketing, we are not talking about legitimate marketing online. We are talking about business development representatives. We receive about three to five weekly inquiries from treatment centers and business development representatives who want to work with us. They do not want to work with us; they only want us to send them clients. When this occurs, we have a standard response and standard questions. We ask them to send us any possible intervention referrals so we can work with families needing help bringing their loved ones to treatment. I remind them that we will deliver the intended patient back to them so we can see how they treat clients in real-time. 

We seek a strong therapist and clinical team, an extended stay, and collaboration with the treatment center clinical team and our S.A.F.E.® Family Recovery Coaching department. We ask that no cell phones or electronic devices be accessible to clients as they significantly increase the likelihood of clients discharging early against medical advice (AMA). We require all patients to sign a release of information (ROI) for us and their families. Not doing so will cause restrictions and possible discharge. We look for accountability for the client’s behavior and discourage therapists who satisfy their clients who only know how to update families by saying they are doing GREAT! We look at the discharge plan and whether they are told it is OK to return home or if they are discharged to a sober home or alternative. Although this may not be ideal for every discharge, it is for most of them. We look to see if the center holds the patient as a victim of circumstances or if they encourage clients to own the behaviors that led them to treatment. 

Above all, we make sure they regard the family at least as important as the patient. Does the treatment center have a family program, and do they consider the dishonesty and omissions of the client and the honesty of the family insight? Do they allow the family a voice? Do they feel the discharge plans impact the family? If they do not have a family program, are they willing to work with us to ensure all those harmed get well?

So far, only a few have passed the test or can offer anything close to fulfilling the request. Most say, “That is awesome–let me get with my people, and we will get this going immediately!” 

We are still waiting to hear back from them. 

We haven’t heard from them because they don’t care about that. They care about one thing, and this is meeting their sales quota. The honest business development representatives will share with me that all the other business development reps only care about the one-to-one model. I gave you a client, so where is mine? You only get another once I do. It is patient brokering in disguise, and the money goes to the BD rep.

It’s Not Managed Care, It’s Managed Costs

The majority of families that have called inquiring about mental health interventions believe that the problem their loved one is experiencing is primary mental health. Mental health is the new buzzword, and it is profitable. Before we go any further, we are aware of the actual mental disorders and the impact they have on the patient and their family. What we are saying is that the more mental disorder diagnoses, the more billable services to the insurance company. Every clinician read the part in their textbooks that I did regarding mental health disorder diagnoses with an intended patient who is also using substances. 

  “When active substance use coexists with a range of other psychosocial impairments, the clinician should assume that these impairments are related to the client’s substance use until proven otherwise.”

Integrated Treatment for Dual Disorders, A Guide to Effective Practice,
Mueser, K.T., Noordsy, D.L, Drake, R.E, & Fox, L. 2003

The reference above is one of several points made throughout a clinician’s professional studies. The point is that alcohol and drugs, even at minimal levels, can and will exacerbate mental disorder symptoms or cause mental disorder symptoms to present that do not indeed exist. Most people are unaware that psychiatrists do not attend special schools. Psychiatrists attend the same medical schools as cardiologists, dermatologists, orthopedic surgeons, etc. Any psychiatrist, if honest, will concede to the fact that they have zero to minimal training in substance use and mental disorders, not until they get into their profession anyway. In these settings, psychiatrists are primarily used for their ability to prescribe medications. One of the current debates is why Doctor of Psychology (Psy. D.) are not provided prescribing privileges. After all, they are far more educated than psychiatrists when it comes to addiction and mental disorders. If a Psy. D. had prescribing privileges, there would be no need for psychiatrists in the substance use and mental disorder field. 

Unfortunately, the way the system is set up, doctors and treatment centers need mental disorder codes to submit to insurance for reimbursement to keep the client in their care longer. Now, where many of the clients may be presenting with mental disorder symptoms, there is no way for any professional to provide an accurate assessment when someone is fresh in detox or treatment for alcohol or drug use. Professionals, families, and clients then believe the assessments are based on past diagnoses. Although a good theory, who would say those diagnoses were accurate then? What we are saying is when someone is diagnosed with a mental disorder during a time of crisis, untreated trauma or thoughts, alcohol or drug use, or some other misdiagnosed medical problem, it is not always accurate to carry that with them from facility to facility especially when substance use is at an all-time high. 

Insurance companies want to pay as little as possible, and healthcare providers want to be paid as much. Insurance companies also want to tell you where you can or cannot go for treatment. Insurance companies work out predetermined rates with healthcare providers; those who accept the rates get the business. When you call your insurance company, they do not give you referrals based on your needs. They give you referrals based on their actual costs. We understand some people must use their insurance, and when you do, you are being treated based on what your insurance company says is best, not on what the professionals feel is best. The result is people ending up in an ineffective treatment center and being misdiagnosed and over-diagnosed. We are not saying that this is always the case. We are just saying we follow the instructions of the professionals who say you can’t diagnose until the substance use has been in remission for quite some time. There absolutely may be mental disorders that cause one to self-medicate, and more often than not, the problem ends up being drug-induced psychosis, unresolved trauma, an underlying medical issue, maladaptive coping mechanisms, or any other number of reasons not related to an actual mental disorder. The reality is there is no money in following the directions of assuming substance use as the cause of the behaviors, and there is only money in quickly considering it is various mental disorders.  

It’s not more money, more problems, it’s more problems, more money.

Therapist at Treatment Centers (The Biggest Problem with Treatment Centers)

The greatest challenge we face today is therapists in treatment centers. The majority are, unfortunately, ineffective. The way therapists and social workers help people with addiction and mental health is entirely different than it was years ago when successful outcomes were much higher. The same applies to doctors in medical school—the curriculum for doctors previously focused on diagnostics and learning about the body. 

Today, doctors focus on pharmacology. Most medications used to treat mental disorders are prescribed by family doctors who have no training or understanding of mental illness or the drugs they are prescribing. Graduate schools for clinicians and social workers have gone down the same road. We used to learn about the science of behavior and coping skills, and today, it is mainly in part about the disorder and the mental illness, not the reasons for the behavior coming from elsewhere. 

I was fortunate enough to work with substance use and mental disorder clients for a long time before obtaining a higher education, and I am glad that is how it happened. What worked for all the clients I had been working with was the opposite of what I was taught in my institutions of higher learning. Sit around any Alcoholics or Narcotics Anonymous meeting, and they will all tell you how they found sobriety, and it isn’t what they learned from today’s modern approaches. The way of treating addiction had to do with accountability for behaviors, feeling the consequences, looking at what the individual did and not what others did, behavior modification, fresh perspective, addressing past experiences, and seeing things entirely differently. 

Today, it is what is your disorder, you are a victim, relapse is part of your program, roll with the resistance, meet them where they are at, and the scariest one, clinicians are taught that the patient is the most qualified person to know what it is they need to succeed. Success rates in Alcoholics Anonymous before the disease model was introduced in 1960 by Dr. Jellinek were said to be roughly fifty percent. Alcoholics Anonymous is a twelve-step facilitation program, and it is an evidence-based treatment, which you will read about next. Today’s successful outcomes are roughly three percent, including factoring in harm reduction models as successful outcomes. Harm reduction is a reduction in use and not abstinence. It is estimated that today, treatment of addiction has about a one-and-a-half percent success rate for complete abstinence. You can track the decline starting with the medical model shortly after 1960.

 We have a firm policy at Family First Intervention: therapists and clinicians are not allowed to speak to families and provide updates, period. Why do we do this? We do this because there was a scary correlation between therapists telling families that everyone was doing fantastic and families stopping their family programs. As an absolute, every time a therapist told a family their loved one was doing great, the family went back to their old ways of codependency and enabling, believing the problem was solved. Once we pulled therapists from updating families and a case manager was the point of contact, the AMAs stopped, families continued their programming, and their loved ones were held accountable with boundaries. Plenty of therapists will read this, roll their eyes, and disagree. Here is where they are wrong. The therapist at treatment does not see the fallout of their actions after the client leaves; we do. The therapist at the treatment center does not spend time with the client’s family; we do. The therapist at the treatment center does not believe in our approach; the families and the successful outcomes we have do.

Thirty days of treatment or less and clients leaving treatment early against medical advice has never been higher in the history of addiction and mental health treatment, and it is mainly due to the therapists and their approach. Although we can never replace the therapist at the treatment centers, and you can’t avoid their approaches, there are some silver linings. One of them is that there are still great therapists out there. Our vetting system for working with treatment centers finds them. The other factor that puts therapists in their place is our family recovery coaching program. Whether the therapist likes it or not, we force their hand to do their job. When they put together a ridiculous discharge plan for a thirty-day treatment stay, our families will ask if they are coming to live with the therapist because they are not coming back here. The therapist complains about us and then must do their job. Always remember the power of boundaries and accountability delivered by a robust family support system that does not buy into treatment centers that have failed them repeatedly. Our clients do better, stay longer, and have much higher rates of recovery than clients with an unwell family and a weak therapist, period. Before we explain evidence-based treatment, I will share an example with you.

We received a referral from a nationally known treatment center. The intervention was for a mom and dad and their twenty-five-year-old son who needed help. The young man lived with his parents, and they took care of everything by way of enabling and codependency. The young man accepted help and was transported to the facility. Not long after arrival, the family called us to say the therapist at the treatment center asked Mom and Dad to purchase their son a plane ticket and arrange transportation to the airport. 

The family, engaged in our family recovery coaching program, thought this sounded odd and called us. After speaking with the therapist, we realized that the therapist was what we expected: weak and unwilling to do the job effectively. His answer was to follow the guidance of his graduate studies and discharge the unwilling clients as they were not ready, and he was meeting them where they were. Not long after, we put the family, the therapist, and his supervisor on the phone. The family explained how they would not pick him up or purchase a ticket. We suggested they allow the young man to leave against medical advice and let him feel the consequences of his non-compliant behavior. The supervisor overrode the therapist, and the client left. Within four hours and eighty-plus phone calls to his family to plead his case, he returned. He was borrowing cell phones on the street because his parents shut his phone off. So, for all of you afraid to shut your loved one’s cell phone off, now you know why we do that. And for those afraid they won’t be able to make an emergency call, this patient made eighty of them from various stranger’s cell phones. 

Not only did the client return after that, but he also became a model client, and his attitude and demeanor changed. He not only completed nine months of treatment, but he also stayed out where he was and went to sober living. He realized the game was over, and the environment would never be the same again. 

Therapists also forget that part of their textbooks tells us one of the two most significant predictors of outcomes is the environment, yet most are afraid to have that changed. For the record, the other number one predictor of outcomes is the client/counselor relationship. Client/Counselor relationship does not mean being weak and being their friend; it means doing your job. Therapists also forget that for someone to seek help and move past the second stage of change, the client must see the need for change through consequences. The therapist, like almost all of them, was too concerned about diagnosing him with antisocial personality disorder and believing there was a previous diagnosis of oppositional defiant disorder than he was doing what works. 

If this is too much for you, then perhaps you should keep doing what you are doing and keep going to treatment centers with these types of therapists. If you believe this example is an isolated incident, it is not. We do this about twenty times a month for half of our clients, and almost every one of them stays in treatment or returns shortly after we execute this strategy. If the other way worked, we would take that approach. The alternative approach may be more effective on rare occasions, and we will go that route on those occasions. Our job is to save lives and help families, not coddle clients and allow them to believe they are victims and that families should accept that. 

Evidenced Based Treatment 

 “To expedite this process, treatment programs in the United States are being mandated to provide evidenced-based therapies, with funding and insurance reimbursements contingent on them doing so.”

Evidenced-Based Addiction Treatment
Edited By Peter M Miller 2009

You need only hear about treatment centers and their differences; there aren’t. Treatment centers are all doing the same thing; they must be if they prefer to be paid. Even scarier is that the National Registry for Evidence-Based Programs and Practices (NREPP) is determined primarily by the therapist’s submitting data as they see it. We agree that evidence-based treatment, especially twelve-step facilitation, is effective. 

The question is, who is executing the evidence-based strategy and how? It is easy to say that BCT (Behavioral Couples Therapy) is an excellent evidence-based treatment because it is. What if the therapist is executing this strategy by telling the substance user’s spouse they must accept the addiction, love them to death, relapse is part of their program, and not stand up for themselves? Motivational interviewing, one of my favorite strategies, is evidence-based treatment. Does it work if the therapist asks the wrong questions while leading the patient towards a victim mentality, looking for fault in others rather than themselves? Does it work by asking motivational interviewing questions that allow the patient to feel in control of their recovery plan? 

Evidenced-based treatment is only as effective as the therapist or clinician applying them. Since evidence-based treatment is set by clinicians and professionals, which we are, let us explain the evidence-based treatment that has worked exceptionally well for our clients and their families. 

• Holding clients accountable
  
• Challenging clients on their dishonesty and negative behavior
  
• Attending treatment far away from their home, environment, and comfort zone
  
• A Sober, Healthy, and Well-informed Family
  
• No cell phone or electronic devices while in treatment
  
• Not allowing the client to dictate their treatment plan or length of stay
  
• Sober living after treatment (not returning to the environment after treatment)
  
• Discharging a client for non-compliance while a family holds boundaries and does not help them or validate their negative behavior
  
• Family implementing boundaries and consequences to move their loved one out of the second stage of change
  
• Not allowing families of clients to be updated by weak therapists
  
• Refraining from early diagnosing of mental disorders when substance use is present
  
• Minimum of three months of treatment followed by six to twelve months of aftercare, followed by a lifetime of maintenance
  
• Families staying in recovery for their lifetime as well (same as your loved one)

These are just some of the strategies that work exceptionally well. The strategies listed here have names in the evidence-based directory, and the delivery of the strategy makes the difference between success and failure. The part that makes the treatment center different is the therapist, the rules, the ownership, and the length of stay. These strategies are what we call intervention-friendly treatment centers. In other words, they are required for the family and an intended patient who needs an intervention. 

Intervention-Friendly Treatment Centers

Every person with substance use or mental health disorder will have an intervention at some point. 

The definition of intervention per the Merriam-Webster Dictionary is:

“The act of interfering with the outcome or course, especially of a condition or process (to prevent harm or improve functioning).”

Something will cause the intended patient to look at things and possibly do things differently. The second stage of change in the recovery process is the contemplation stage. In this stage, the person acquires ambivalence, the ability to see both sides. For the intended patient to move out of this stage and progress forward, the consequences of staying the same must become more significant than the benefits of remaining the same; the same theory applies to families of intended substance use and mental disorder patients. For many families, societal intervention and daily consequences are enough for the intended patient to see the need for change. Those who are stubborn, intelligent, and determined to succeed at using alcohol or drugs and manage their mental health while tearing their family apart require a professional interventionist to come to the home. Those who need a professional intervention also have one other common denominator: a family who is exhausted and at or near their bottom.

We will preface the following information by saying that when we refer to “an intervention client,” we refer to a client who had a professional interventionist meet with their family and come to the home. When we use the term non-intervention client, we refer to clients with some form of intervention, just not a professional one involving the family.

Intervention clients and their families are not like other clients and families. After all, those made it to treatment without a professional. We are not saying all of them succeeded at treatment or their families got well; we are saying they felt the consequences when the others didn’t, even if they were not sustainable. All clients and families would benefit from an intervention and an intervention-friendly treatment center. Intervention-friendly treatment centers separate your everyday center from doing the same thing and one that knows how to treat clients effectively. Intervention clients also do better together rather than apart. Having one client in a center from intervention has proven less effective than having several clients from an intervention together. 

There is a different bond and a different flow to the treatment. Intervention clients at treatment improve the outcomes for non-intervention clients because of their behavior. Intervention clients know this is different and understand the families’ boundaries and their recovery engagement. This changes the client’s mindset in treatment and can and will positively affect others. Intervention clients have been brought to their bottom when other clients may not be at their bottom. Non-intervention clients may be there because of legal issues or a recent adverse event that wears off.

“An intervention client’s reason for being there rarely wears off; when they think it has, the family recovery and boundaries remind them it hasn’t.”

Our relationships with treatment centers allow us to help patients and their families. What makes intervention-friendly treatment centers is the ability to collaborate with the patient’s clinical team and Family First Interventions’ ability to collaborate with the patient’s family. Only some treatment centers will allow this, and they should because family counseling and involvement are evidence-based and work. Most don’t because it is extra work, and there are no billable codes because the family is not the client; it’s a true story. That is why you rarely see family programs of any significance in a treatment center. Families who hire Family First Intervention are getting the most comprehensive and effective family program that any treatment center is capable of or willing to provide. 

 We incorporate several evidence-based family therapy strategies in our curriculum, including Behavioral Couples Therapy (BCT), Behavioral Family Therapy (BFT), and Family Role work, also known as Family Behavioral Loop Mapping (FBLM). That is why clients who enter treatment via Family First Intervention stay longer and are less likely to leave against medical advice (AMA), complete treatment, and follow discharge plans. Our process also improves the quality of life for families of substance use and mental disorder patients if the family joins recovery, allows us to lead them, and takes direction and guidance. The centers we work with who have adopted our principles have increased their length of stay, reduced their AMAs, and increased their graduation rates significantly for all their clients; why? Because they are working with us to execute evidence-based family programming in their curriculum.

Families often try to convince us they found the perfect center. As you can see from the information above, they are all doing the same thing. You may have found a shiny website or spoken to someone who knows someone who went somewhere. After being drawn to their findings, it is clear what they were attracted to. The center did an excellent job hitting the people’s hearts in their codependent family roles. Families want their loved ones to be comfortable, close to home, and home soon. Above all, they don’t want their loved ones to be mad at them. None of these is evidence-based treatment, and none increases the likelihood of a successful outcome. 

“Since all the centers are doing the same thing, delivering evidence-based treatment, the difference is the clinicians delivering the evidence-based treatment.”

Questions you should be considering:

• Privately Owned vs. Private Equity – First, you should ask whether the center is privately owned or backed by a private equity company and how many campuses it has. Not all private equity-backed treatment centers have multiple locations yet, but they are working on it.
  
• Quality of Therapists – Will the therapist require the patient to sign a release of information for the family? Will the therapist believe what the patient is saying, or are they willing to hear what the family has to say? Will the therapist make a friend with the patient or be a therapist? Is the therapist always going to assume the patient is doing great?

• JCAHO (Joint Commission on Accreditation of Healthcare Organizations)
  
• CARF (Commission on Accreditation of Rehabilitation Facilities)
  
• Legit Script Certification – A thorough vetting process to determine online advertisement eligibility. To receive this, you must prove you are a legitimate agency.

• Family Program & Involvement – Will the center allow the family a voice? Will the treatment center consider the family in the discharge plan? Will the facility only listen to the substance user and not check their story with the family who has suffered?
  
• ROIs – Does the rehab center require the patient to sign a release of information for the intervention company and their family? Not having an ROI signed allows the patient to be dishonest and omit information. Without an ROI, the center can’t fact-check, and the treatment center will only hear the story as the patient sees it.
  
• Length of Stay – Is the center equipped to treat clients for more than thirty days, and will they keep for longer than thirty days? The NIH, also known as the National Institute on Drug Abuse (also includes Alcoholism), reports that short-term treatment is often ineffective.

“For residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes”.

• Cell phones and electronic devices – Does the center restrict cell phone use, and do they have a blackout period for substance users? The highest risk of leaving AMA (against medical advice) is in the first two weeks. How do they address this?
  
• Accountability – Are they afraid to challenge the substance user and help them see their role in the destruction that has affected their family?
  
• Boundaries – Will they work with clients’ families and encourage them to set firm boundaries on relapses, AMA, and continued recovery efforts? Will they say it is OK for the client to return to their environment?
  
• Consequences – Will they work with the family to help them understand the importance of implementing consequences in the event the substance user relapses or discharges treatment against medical advice?
  
• Discharge planning – Is the treatment center willing to go to bat for others who have been affected by the addiction and mental health, and are they willing to work with the patient to understand the importance of not returning to the old environment too soon?

Family First Intervention has the largest and most comprehensive family program available. Although an intervention company, we are a treatment program for families. We are the piece all treatment centers still need to include. Treatment centers adopting our principles have better results than those that do not. If you choose a treatment center that does little to nothing of what we listed, you reduce the likelihood of a successful outcome for you and your loved one. 

This isn’t the first rodeo for most families and their loved ones. If it is, you can do things effectively the first time. Rather than blame the center for failures, let’s look at what was missed, what can be done differently, and what can be improved upon. The bigger the team, the better the outcome

Choosing what you believe to be the right rehab center to get back the things you lost while not looking at the reasons you turned to drugs or alcohol is mainly, in part, why many people fail after leaving the rehab center. As a result of distorted treatment selection, the first thing the family and substance user do when the substance user resumes consuming drugs or alcohol is blame the rehab center for not working.