tag:theconversation.com,2011:/id/topics/drug-rehabilitation-35825/articlesDrug rehabilitation – The Conversation2022-11-16T13:29:39Ztag:theconversation.com,2011:article/1927882022-11-16T13:29:39Z2022-11-16T13:29:39Z317,793 people were arrested for marijuana possession in 2020 despite the growing legalization movement<figure><img src="https://images.theconversation.com/files/493178/original/file-20221103-24-ztrf84.jpg?ixlib=rb-1.1.0&rect=0%2C31%2C5217%2C2983&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's the first year that most drug arrests were not for marijuana possession.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/passing-the-cannabis-joint-royalty-free-image/1360115234?phrase=marijuana&adppopup=true">Cappi Thompson/Moment via Getty Images</a></span></figcaption></figure><figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/493153/original/file-20221102-12-f92tqx.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/493153/original/file-20221102-12-f92tqx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493153/original/file-20221102-12-f92tqx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493153/original/file-20221102-12-f92tqx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493153/original/file-20221102-12-f92tqx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493153/original/file-20221102-12-f92tqx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493153/original/file-20221102-12-f92tqx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493153/original/file-20221102-12-f92tqx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>More than 300,000 people were arrested for cannabis possession in 2020, FBI records show. Meanwhile, the drug is being <a href="https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx">legally sold for a profit in 19 states</a>.</p>
<p>That arrest number may sound high, but arrests have actually been going down each year since 2010 as more states legalize medical or recreational use of the drug. In 2019, for example, <a href="https://ucr.fbi.gov/crime-in-the-u.s/2019/crime-in-the-u.s.-2019/topic-pages/tables/table-29">more than 500,000 marijuana possession arrests were reported</a>, so the 2020 arrest numbers represent a single-year decline of 36%. </p>
<p>In another sign of change, 2020 – the most recent year for which I consider the data reliable – was the first year that marijuana possession was not the most common cause for a drug arrest. Out of roughly 1.16 million drug arrests nationwide that year, 36% were for possessing “other dangerous nonnarcotic drugs” like cocaine and methamphetamine. Just over a quarter (27.5%) were for <a href="https://crime-data-explorer.app.cloud.gov/pages/downloads">possessing marijuana</a>. </p>
<p>Despite these declines, racial disparities have not changed over the past decade. Black Americans accounted for about <a href="https://crime-data-explorer.fr.cloud.gov/pages/docApi">38.8%</a> of marijuana possession arrests in 2020 despite representing just 13.6% of the U.S. population and using marijuana at the same rate as white Americans, <a href="https://www.samhsa.gov/data/report/2020-nsduh-detailed-tables">according to the National Survey on Drug Use and Health</a>. </p>
<p>There are some caveats to consider when looking at 2020’s figures. Safety measures taken to limit the spread of COVID-19 – like lockdowns, school closures and work-from-home mandates – resulted in <a href="https://safetyandjusticechallenge.org/wp-content/uploads/2021/07/The-Impact-of-COVID-19-on-Crime-Arrests-and-Jail-Populations-JFA-Institute.pdf">fewer police-citizen contacts</a>. The number of arrests for all drugs fell by 25% compared with 2019, even though no other drugs were legalized that year. Still, arrests for marijuana declined at an even steeper rate.</p>
<h2>New data reporting problems</h2>
<p>Arrest data for 2021 is also problematic, but for different reasons.</p>
<p>Since the 1920s, the FBI has published crime statistics reported by local law enforcement agencies using the <a href="https://www.fbi.gov/news/stories/five-things-to-know-about-nibrs-112520">Summary Reporting System</a>. This system always had limitations, notably only counting only the most serious offense even when an arrest involves more than one charge. To improve data collection, the FBI created the <a href="https://bjs.ojp.gov/national-incident-based-reporting-system-nibrs#:%7E:text=As%20of%20January%201%2C%202021,reporting%20in%20the%20United%20States">National Incident-Based Reporting System</a> in the 1980s. The new system, NIBRS, collects much more detailed data. </p>
<p>The FBI has been trying to get law enforcement agencies to use NIBRS for years. Because the transition has been slow, the FBI has continued reporting crime data from the old system, too. <a href="https://www.leafly.com/news/politics/the-fbi-doesnt-know-how-many-marijuana-arrests-were-made-in-2021-and-its-their-own-damn-fault">Advocates</a>, <a href="https://www.marijuanamoment.net/new-fbi-marijuana-arrest-data-riddled-with-inconsistencies-as-agency-touts-changes-to-reporting-system/">journalists</a> and <a href="https://www.bakerinstitute.org/expert/katharine-neill-harris">researchers like me</a> relied on the old system because more police departments used it. </p>
<p>But on Jan. 1, 2021, the FBI started reporting only NIBRS-collected data. The <a href="https://www.fbi.gov/news/stories/five-things-to-know-about-nibrs-112520">agency insists</a> this is not a serious issue, but only <a href="https://www.cnn.com/2022/10/05/us/fbi-national-crime-report-2021-data/">52%</a> of agencies fully reported data last year. Two of the nation’s largest police departments, New York City and Los Angeles, did not report at all. </p>
<p>The low rate of agency participation suggests the FBI’s 2021 estimate of <a href="https://crime-data-explorer.fr.cloud.gov/pages/explorer/crime/arrest">170,856</a> marijuana possession arrests is a big undercount. For instance, in 2020, Florida reported <a href="https://crime-data-explorer.fr.cloud.gov/pages/explorer/crime/arrest">68,614 total drug abuse violations</a>. In 2021, it reported 104 – even though there were no changes to drug laws in the state between those two years. Though growing pains are expected with a major data collection transition, as a researcher I find it concerning to have such low confidence in the numbers meant to capture how laws are enforced. </p>
<h2>Other measures to consider</h2>
<p>Arrests for cannabis possession are dropping, but that doesn’t necessarily mean that the legal consequences of marijuana use are disappearing.</p>
<p>Courts often require people to go to treatment for cannabis use. The legal system has been the largest referrer to treatment for <a href="https://www.icpsr.umich.edu/web/ICPSR/series/56">cannabis use since 1995</a>. In 2019, courts, probation and parole offices and diversion programs referred more than <a href="https://www.samhsa.gov/data/sites/default/files/reports/rpt35314/2019_TEDS_3-1-22.pdf">100,000</a> individuals for cannabis use treatment. That accounts for roughly half (49.2%) of all cannabis treatment admissions to publicly funded facilities. Roughly 30% of these justice system referrals came from states in which marijuana use and sales are legal.</p>
<p>In research currently under peer review, my colleague <a href="https://www.bakerinstitute.org/expert/christopher-f-kulesza">Christopher Kulesza</a> and I show that legalization is not associated with a significant decline in justice system referrals to cannabis treatment. Black and Latino adults and juveniles are more likely to be referred to treatment by the justice system than their white counterparts in both states in which marijuana is legal and those where it isn’t.</p>
<p>Failure to comply with mandated treatment programs can result in the same negative consequences as an arrest and conviction, including detrimental effects on an individual’s <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305464">health</a>, education and <a href="https://www.bakerinstitute.org/research/case-marijuana-decriminalization#:%7E:text=Decriminalization%20would%20result%20in%20a,arrests%20following%20the%20policy%20change">employment prospects</a>. Our findings, along with <a href="http://doi.org/10.1080/10826084.2019.1593007">other</a> <a href="http://doi.org/10.1001/jamahealthforum.2021.3435s">research</a>, suggest that policymakers who want to reduce these consequences must find ways to root out arrest practices that unfairly target minority users and pay more attention to who is being referred for treatment.</p><img src="https://counter.theconversation.com/content/192788/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katharine Neill Harris received funding from Ohio State University's Drug Enforcement Policy Center for the research project discussed in this article. </span></em></p>Arrest numbers reflect a nearly 40% decline from 2019, but the statistics come with some caveats.Katharine Neill Harris, Fellow in Drug Policy, Rice UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1809462022-05-30T01:22:12Z2022-05-30T01:22:12ZAlcohol problems aren’t for life, and AA isn’t the only option. 8 things film and TV get wrong about drug and alcohol treatment<p>Drug use and addiction are popular themes in movies and television, but they often get things very wrong. Here are eight common myths about drugs you’ll see on the silver screen.</p>
<h2>1. Rehab goes for 28 days</h2>
<p>In the movie 28 Days, Sandra Bullock is given a choice between prison and 28 days in a rehab centre. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/y7RXmrlGe-k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>The 28-day program, popular in the United States, actually has nothing to do with the optimum treatment period.</p>
<p>Health insurance companies in the US <a href="https://www.npr.org/sections/health-shots/2016/10/01/495031077/how-we-got-here-treating-addiction-in-28-days">are only prepared to fund</a> 28 days in rehab. So the 28-day rehab model was developed around funding, not effectiveness.</p>
<p>We now think <a href="https://psycnet.apa.org/record/2016-46667-001/">about three months of treatment</a> is optimal. <a href="https://pubmed.ncbi.nlm.nih.gov/21997500/">Treatment completion</a> may be as important as treatment length. So completing a shorter treatment is better than dropping out of a longer one.</p>
<h2>2. Rehab is a luxury retreat</h2>
<p>In the Netflix series Cobra Kai, Shannon is in residential drug rehabilitation. It’s a luxurious vacation retreat with art and yoga classes, wide open spaces and Michelin-starred food.</p>
<p>Some luxury private rehabs are pretty fancy, but these can <a href="https://www.smh.com.au/lifestyle/escape-to-rehab-20130708-2pl0x.html">cost A$35,000 a week</a> or more, which is out of reach for most people.</p>
<p>The public residential rehabilitation system is is far less glamorous because it is <a href="https://ndarc.med.unsw.edu.au/resource/new-horizons-review-alcohol-and-other-drug-treatment-services-australia">severely underfunded</a>, resulting in long waiting lists and little money to spend on pleasant surrounds.</p>
<p>There is no evidence the more you pay the better your success in treatment. And yoga and a private chef won’t solve your drug problem. What’s important is developing specific skills that can help prevent going back to problematic drug use. For that, you need trained professionals and good supports.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7S_e_OPgj9c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p><a href="https://theconversation.com/drug-rehab-what-works-and-what-to-keep-in-mind-when-choosing-a-private-treatment-provider-95431">Take care</a>, because currently the <a href="https://10play.com.au/theproject/news/2022/allegations-against-rehab-centre-granted-government-funds/tpv220403azpxd">private rehab sector is unregulated</a> so anyone can set up a rehab without the knowledge, skills or experience to do so.</p>
<h2>3. ‘Once an addict, always an addict’</h2>
<p>In the original Sherlock Holmes books, Holmes used morphine and cocaine (legal at the time) whenever he was bored between cases, without any problems. In the TV series, Sherlock, he is shown as an “addict”, always on the edge of relapse. Watson starts out as his “sobriety coach”.</p>
<p>The idea that alcohol and other drug use is an incurable disease comes from <a href="https://theconversation.com/does-alcoholics-anonymous-actually-work-179665">12-Step programs</a>. It has been a widely held view, especially in the US, for many decades, <a href="https://theconversation.com/viewpoints-is-addiction-a-disease-63113">despite evidence against the idea</a>.</p>
<p>Many people return to “<a href="https://pubmed.ncbi.nlm.nih.gov/33188563/">controlled drinking</a>” or move from problematic to low or moderate illicit drug use, especially if they access help early. It’s just as realistic as abstinence-based recovery.</p>
<p>There’s also no such thing as an “<a href="https://www.scientificamerican.com/article/the-addictive-personality-isn-t-what-you-think-it-is/">addictive personality</a>”.</p>
<p>But for many people, a period of abstinence (sometimes a year or more) may help them gain the skills they need to go back to moderate use and to understand the reasons behind their use. For some it is easier to be abstinent for life, but that’s not universal.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462186/original/file-20220510-21-na1qn3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sherlock Holmes book" src="https://images.theconversation.com/files/462186/original/file-20220510-21-na1qn3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462186/original/file-20220510-21-na1qn3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462186/original/file-20220510-21-na1qn3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462186/original/file-20220510-21-na1qn3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462186/original/file-20220510-21-na1qn3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462186/original/file-20220510-21-na1qn3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462186/original/file-20220510-21-na1qn3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">While Sherlock Holmes was a functional user in the original texts, the show portrayed him as a problematic addict.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>4. Recovery only comes after ‘rock bottom’</h2>
<p>Movies, like Requiem For A Dream and Trainspotting, often show people at their lowest point as a turning point for recovery. But the idea that someone has to hit “rock bottom” before they will seek help is not true.</p>
<p>First, it’s impossible to know what “rock bottom” is for any one individual. Potentially, aside from death, there is always something worse. Second, many people successfully change their alcohol or other drug use early, even after the very first signs of a problem.</p>
<p>If someone isn’t ready to go into rehab it’s not because they’ve not yet reached their lowest point. People tend to seek help when something else outweighs the importance of using alcohol or other drugs, such as family, friends or career.</p>
<p>The “rock bottom” idea can be dangerous because people may delay treatment until things are really bad. But <a href="https://www.nps.org.au/australian-prescriber/articles/brief-interventions-for-alcohol-and-other-drug-use#r7">the earlier someone seeks support, the better the outcome</a>.</p>
<h2>5. ‘Tough love’ works</h2>
<p>Tough love is acting harshly with the aim of helping a person in the longer term. This might include locking them out of the house if they refuse to go to rehab, refusing money for food if they are still using, or refusing to pick them up if they are intoxicated.</p>
<p>In <a href="https://en.wikipedia.org/wiki/Four_Good_Days">Four Good Days</a>, Glenn Close’s character shuts the door on her distressed daughter, played by Mila Kunis, telling her she can come back when she is “clean”.</p>
<iframe width="100%" height="315" src="https://www.youtube.com/embed/5voLuLNv2WA" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe>
<p>There might be good intention behind tough love, but not only does it not work, it often makes things worse. Leaving someone homeless or starving or in a dangerous situation when they are intoxicated or dependent on alcohol and other drugs may be harmful.</p>
<p>There are better ways to <a href="https://www.fds.org.au/coping-tips/setting-boundaries/">set clear and consistent boundaries</a> and still maintain relationships that can provide support for recovery.</p>
<h2>6. Addiction happens after one use</h2>
<p>The main character tries a drug for the first time and then spirals into unbridled drug use. This dramatic shorthand saves time in the plot, but gives the impression that anyone trying a drug will become dependent on it instantly. </p>
<p>In the 1991 movie <a href="https://en.wikipedia.org/wiki/Rush_(1991_film)">Rush</a>, Jennifer Jason Leigh is an undercover cop who has to use heroin to show a dealer she is for real, then spirals into a well of addiction.</p>
<p>But dependence (the more technical term for “addiction”) is a <a href="https://www.youtube.com/watch?v=HUngLgGRJpo">gradual process</a> in which your brain and body get used to having a drug regularly.</p>
<p>It’s impossible to become dependent after a <a href="https://drugpolicy.org/drug-facts/can-using-heroin-once-make-you-addicted">single use</a> of any drug. This is evidenced by the fact nearly half of Australians have <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary">tried an illicit drug</a>, but only a minority of those are dependent.</p>
<p>What might happen is the first time someone tries a drug they might like it. A lot. Then they might use it frequently over time until they become dependent.</p>
<h2>7. All drug use is to ‘self-medicate’</h2>
<p>Some people use alcohol or other drugs to help manage the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jts.22521">difficult emotions</a> they experience as a result of trauma or other mental health issues – like Rue in the television series <a href="https://en.wikipedia.org/wiki/Euphoria_(American_TV_series)">Euphoria</a>, who descends into drug problems after the death of her father.</p>
<p>There is a much <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1465-3362.2011.00314.x">higher rate</a> of alcohol or other drug use among people with mental health problems. But even among <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/">people with mental health problems</a>, around two-thirds <em>don’t</em> have an alcohol or other drug problem.</p>
<p>Most people use alcohol or other drugs because it makes them feel good and is fun. Most typically <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary">use occasionally</a> for a short period in their lives, never experiencing significant problems.</p>
<h2>8. ‘Interventions’ help</h2>
<p>Picture this scene: a character returns home only to be greeted by family and friends sitting in the living room to confront them about their drug use. This popular trope was brought to life by the show “<a href="https://7plus.com.au/intervention">Intervention</a>”. </p>
<p>When family and friends raise their concerns, it <a href="https://onlinelibrary.wiley.com/doi/abs/10.1080/09595230500302356?casa_token=nJFn27G1zKIAAAAA:-gmK0nibKiuSJc6KemEELS4ys-23OT8kjVzEkQyxwWjDsnVtYwGfVnunKHQ2RUBzgVHvJmc9caw7tQ">can influence</a> a person’s decision to get help. But taking a confrontational approach will probably backfire. Confronting a person is likely to make them feel embarrassment and shame, both <a href="https://pubmed.ncbi.nlm.nih.gov/27736680/">key barriers</a> to entering treatment. </p>
<p>Taking a supportive approach or seeking <a href="https://pubmed.ncbi.nlm.nih.gov/16113616/">family therapy</a> usually results in better outcomes.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/v4np7L0aJd0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<hr>
<p><em>If you are worried about your own or someone else’s alcohol or other drug use, you can contact the National Alcohol and other Drug Hotline on 1800 250 015 for free, confidential advice.</em></p><img src="https://counter.theconversation.com/content/180946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Jarryd Bartle is a consultant for a drug and alcohol consultancy.</span></em></p><p class="fine-print"><em><span>Paula Ross is a guest lecturer at Australian Catholic University and a psychologist consultant for a drug and alcohol consultancy. </span></em></p>We might think we know a lot about drug and alcohol treatment, as it’s so often depicted on the silver screen. But there’s a lot film and TV get wrong.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityJarryd Bartle, Sessional Lecturer, RMIT UniversityPaula Ross, Sessional psychology lecturer, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1188222019-07-04T07:06:44Z2019-07-04T07:06:44ZHow rehab helps heavy drug and alcohol users think differently<figure><img src="https://images.theconversation.com/files/282639/original/file-20190704-126391-11u9iqh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Living in a group environment is part of learning how to manage without using drugs.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Around 16,700 Australians stay in residential rehabilitation centres each year, most commonly for problems with alcohol, amphetamines <a href="https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/aodts-2017-18-key-findings/contents/treatment">and opiates</a>. </p>
<p>Rehab is a structured, drug- and alcohol-free environment. Residents participate in the same daily and weekly routines and activities, including educational and therapeutic groups and individual counselling sessions. Household chores, cooking, exercise, education and recreational activities fill the time. </p>
<p>Some rehabs have as few as 12 residents at one time, others have as many as 60. Programs last from six weeks to 18 months, with eight weeks the average in Australia.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/30925888">Our recent study</a> of 12 rehab residents in Australia found the safe, structured environment and the support of others going through the same experience were key to helping residents change their thinking about drug and alcohol use. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-rehab-what-works-and-what-to-keep-in-mind-when-choosing-a-private-treatment-provider-95431">Drug rehab: what works and what to keep in mind when choosing a private treatment provider</a>
</strong>
</em>
</p>
<hr>
<h2>Safety and routine</h2>
<p>We asked people what program elements they thought were important. They most often talked about the safe environment, structured routines and staff support. As one woman explained, “I love my room, it’s my space. I am safe there.”</p>
<p>Living in a group environment with strangers while fighting mood swings and cravings is tough. The staff maintained the routines and monitored the group dynamics but they also responded to individual needs for support: </p>
<blockquote>
<p>I’ve had down days and they’re (staff) pretty quick to pick it up. I’m not the sort of person that likes to talk about emotions and let it out, but they’re pretty quick. The times I’ve been down, they pick it up pretty quick.</p>
</blockquote>
<p>Living in a group environment is part of learning how to manage without using drugs. Critical changes that study participants attributed to the program were about dealing with their own and others’ emotions:</p>
<blockquote>
<p>I think, what I’ll take away is to understand that that’s the person I am and I’ll manage it. To understand my feelings, like when I am angry, to get away from the situation and take a breath and understand my feelings, I guess. Just understand what I’m feeling. If I’m angry, I know there’s other options than to go use, or drink.</p>
</blockquote>
<h2>A new way of living</h2>
<p>Most participants described the shared experience of everyday life without drugs or alcohol for an extended period as particularly important. One woman said:</p>
<blockquote>
<p>we’d sit around laughing our heads off and actually we’d say we’ve probably never laughed so much in our lives. We were just sitting around with no alcohol, no drugs and just making do with what we’ve got.</p>
</blockquote>
<p>For many, that change was unexpected: </p>
<blockquote>
<p>There was no drugs or alcohol involved and pretty much the first time since I was a young teenager, I realised you can be happy. I don’t know. It was just a bit of a change in life. </p>
</blockquote>
<p>Rehab programs are not usually designed around a specific type of drug or individual. The same therapies are applied to everyone. </p>
<p>The group content used in the rehab we studied included health and well-being education and psychological therapies intended to help people deal with triggers and make decisions around drug use. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-rehab-and-group-therapy-do-they-work-65413">Drug rehab and group therapy: do they work?</a>
</strong>
</em>
</p>
<hr>
<p>However, the most important thing for most people was a daily, group-based reflection on personal values which helped create a different view of themselves as, say, a mother or friend. As one man said:</p>
<blockquote>
<p>so it makes me look at myself, like I’m forgiving and humility, and really looking at me and going, okay, well, I’m not such a crap person, because I’m an addict. I’ve got some good values there.</p>
</blockquote>
<h2>Possibility of relapse</h2>
<p>Fear and anxiety about relapse after leaving rehab were common. People felt vulnerable to resuming drug use despite gains made during the program and their desires to remain substance-free:</p>
<blockquote>
<p>I’m getting a bit anxious, knowing that I’m going. I’ve been here, wrapped in cotton wool for two months, and being released back into the big, wide world, I’m scared that I’m going to relapse.</p>
</blockquote>
<p>Few study participants had support to cope in the future. Friends and social groups were limited because past connections usually involved drug use: </p>
<blockquote>
<p>That’s going to be the hardest thing for me, seeing old mates and them asking if I want some. That’s the hardest part. You are who you hang around. It’s sad to say, but I’ve started hanging around some pretty ordinary people. You think they’re your friends but they’re not.</p>
</blockquote>
<p>Maintaining change after rehab is a challenge and few supports are available. </p>
<p>Relapse rates are high. Most people use drugs in the year after treatment. Between 40% and 60% <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fadb0000386">return to substance dependence</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-success-in-drug-rehab-programs-need-more-than-just-anecdotes-to-prove-they-work-76081">What is 'success' in drug rehab? Programs need more than just anecdotes to prove they work</a>
</strong>
</em>
</p>
<hr>
<h2>The downsides</h2>
<p>Several people described being fearful of what would happen when they got there. Others described conflicts between residents and lack of contact with children as challenges they faced.</p>
<p>Cost can also be an issue. The centre we studied charged A$240 a week for all facilities including therapeutic programs. But private rehabs are also available and can cost as much as A$30,000 a <a href="https://www.smh.com.au/national/money-makes-all-the-difference-when-it-comes-to-tackling-ice-addiction-in-victoria-20150210-13b2ic.html">month</a>.</p>
<p>Rehab fills the day and provides intensive support for people but that doesn’t exist when they go home. </p>
<p>Community support programs like counselling, employment and drug-free social and recreational programs, which bring safe family members and friends back into the picture, could reduce relapse.</p><img src="https://counter.theconversation.com/content/118822/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julaine Allan has received funding from NHMRC, ARC, Ian Potter Foundation, NSW Health to conduct research on services for people who use drugs. Julaine has worked for Lives Lived Well, a not for profit drug and alcohol service provider.</span></em></p><p class="fine-print"><em><span>Dr Alice Munro receives funding from NSW Health. </span></em></p><p class="fine-print"><em><span>Susan Collings receives funding from NSW Family and Community Services</span></em></p>Residential drug rehab programs usually last for around eight weeks and include everything from counselling sessions to household chores, which help build connections and support between residents.Julaine Allan, Senior research fellow, Charles Sturt UniversityAlice Munro, Conjoint Research Associate, National Drug and Alcohol Research Centre, UNSW SydneySusan Collings, Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/954312018-05-01T20:16:56Z2018-05-01T20:16:56ZDrug rehab: what works and what to keep in mind when choosing a private treatment provider<figure><img src="https://images.theconversation.com/files/216935/original/file-20180501-135840-1stdofd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In alcohol or drug rehabilitation, much of the day is spent in either group or individual therapy.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>The public alcohol and drug system is <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/New%20Horizons%20Final%20Report%20July%202014.pdf">chronically underfunded</a>. About 200,000 people receive treatment for alcohol or other drug problems each year in Australia, but the demand is estimated at closer to 500,000. The result is long waiting lists for some publicly funded treatment, or people <a href="https://www.theage.com.au/national/victoria/desperate-families-exploited-by-drug-and-alcohol-detox-operators-20180421-p4zaxy.html">choosing private services</a> to fill the gap.</p>
<p>But there is currently no overarching regulation of private alcohol and other drug treatment. This means anyone can set up private rehabilitation services, regardless of whether they have the skills, experience or qualifications to do so.</p>
<p>There are many good private alcohol and drug treatment providers, but lack of regulation means some <a href="http://www.abc.net.au/4corners/rehab-inc.-promo/7827128">unethical practices</a> are being uncovered. So, if you’re looking for private drug treatment for yourself or a loved one, here are some things to keep in mind. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-rehab-and-group-therapy-do-they-work-65413">Drug rehab and group therapy: do they work?</a>
</strong>
</em>
</p>
<hr>
<h2>Types of rehabilitation</h2>
<p>When people hear “rehab” they usually think of residential rehabilitation, but rehabilitation options are much broader.</p>
<p>Treatment types vary by state, but the main ones are residential rehabilitation, day rehabilitation and outpatient treatment. The public and private sector both offer these treatment types.</p>
<p><strong>Residential (live in) rehabilitation</strong></p>
<p>Residential rehabilitation is the most intensive of the three, and requires a high level of commitment. It can go from a few weeks to a year or more, and much of the day is spent in either group or individual therapy, or working in the centre.</p>
<p>Some people may be ready for treatment but not for the level of intensity that requires them to live and negotiate interpersonal relationships with people they don’t know; and to be without the day-to-day support of family or friends.</p>
<p>Residential rehab can be a good option for people who don’t have a stable home situation, or who need a complete break from their environment, or as a step up when less intensive treatments have not been effective.</p>
<p><strong>Day rehabilitation</strong> </p>
<p>This is where a person lives at home but attends treatment typically three to five days a week, for around six to eight weeks. The program is usually similar to residential rehabilitation, except you go home in the afternoon.</p>
<p>This can be a good option when someone doesn’t need or want the intensity of residential rehabilitation, has commitments that make it difficult to be away from home for long periods (such as kids), or as a step down when residential rehabilitation has finished.</p>
<p><strong>Outpatient treatment</strong></p>
<p>The most common outpatient treatment is counselling (group or individual talking therapy, typically occurring once a week for an hour at a time, for six to 12 weeks). It may also include case management (help with accessing other services such as housing, medical or mental health services) or pharmacotherapy (prescribed medicine, such as methadone for opiate dependence).</p>
<p>Outpatient treatment can be a good option for people who don’t want or need intensive treatment, have daytime commitments (such as work), or as a step down when day or residential rehabilitation has finished. </p>
<p>People with quite severe and complex problems can still do well in outpatient counselling, especially when they have good professional, community or family support. Severity of dependence isn’t a consistent predictor of <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/Mono.45.PDF">treatment outcome</a>.</p>
<p>The exact nature of these treatment types may differ between providers, whether they are in the public or private sector. So it’s worth knowing what evidence shows works when making a choice of treatment type and provider. </p>
<h2>What we know works</h2>
<p>It may take a few attempts, but with the right treatment, <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/C51C9F3326D93748CA258082001232CB/$File/Patient%20Pathways%20National%20Project.pdf">most people recover</a> from an alcohol or other drug problem. </p>
<p>An average of about <a href="https://www.ncbi.nlm.nih.gov/pubmed/16445550">three months of residential treatment</a> seems to be effective. The optimal <a href="https://www.ncbi.nlm.nih.gov/pubmed/10617094">treatment time</a> seems to be similar in non-residential treatment, suggesting a combination of residential and non-residential treatment might be effective over that time. But <a href="https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=120787">completing</a> the treatment program and actively <a href="https://www.ncbi.nlm.nih.gov/pubmed/7655308">participating</a> seem to be more important than treatment setting or length.</p>
<p>The <a href="https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/aodts-2016-17-key-findings/contents/agencies">completion rate</a> for all treatment types among publicly funded services is about 65%, and the relapse rate after treatment of about 50% is similar to that of other types of <a href="https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment">chronic health conditions</a>, such as asthma, high blood pressure and diabetes. </p>
<p>Independent data from private agencies are not collected or published so we don’t know their completion or success rates.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/216936/original/file-20180501-135840-1p7bdxm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/216936/original/file-20180501-135840-1p7bdxm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216936/original/file-20180501-135840-1p7bdxm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216936/original/file-20180501-135840-1p7bdxm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216936/original/file-20180501-135840-1p7bdxm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216936/original/file-20180501-135840-1p7bdxm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216936/original/file-20180501-135840-1p7bdxm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216936/original/file-20180501-135840-1p7bdxm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We know with the right treatment, drug rehabilitation does work.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Programs that are <a href="https://theconversation.com/what-is-success-in-drug-rehab-programs-need-more-than-just-anecdotes-to-prove-they-work-76081">one-size-fits-all</a> or have overly punitive rules are less likely to be successful. </p>
<h3>Program content</h3>
<p>A small number of therapies have been well researched, so we know they are effective in alcohol and other drug treatment. These include <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive behaviour therapy</a>, which helps to strengthen skills to manage cravings and difficult situations or emotions that might trigger a relapse and <a href="https://www.psychologytoday.com/us/therapy-types/motivational-interviewing">motivational interviewing</a>, which helps to develop and strengthen the motivation to change, is also effective. </p>
<p>These interventions have been tested hundreds of times in different groups of people with good outcomes, so we have some confidence when a service uses these strategies that they will be effective.</p>
<p>If a program doesn’t include these type of approaches, or claims to use “new” strategies, ask to see an independent evaluation of their <a href="https://theconversation.com/what-is-success-in-drug-rehab-programs-need-more-than-just-anecdotes-to-prove-they-work-76081">program outcomes</a>. An evaluation should measure whether the service has had a positive impact (on drug use, dependence or mental health) and what the completion rates are. It can be conducted by independent specialists, or sometimes by the service itself.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-success-in-drug-rehab-programs-need-more-than-just-anecdotes-to-prove-they-work-76081">What is 'success' in drug rehab? Programs need more than just anecdotes to prove they work</a>
</strong>
</em>
</p>
<hr>
<p>There should be regular individual counselling available, even when the program is primarily based on group therapy. Individual counselling is associated with <a href="http://eprints.whiterose.ac.uk/8718/1/meierps5.pdf">better retention</a>.</p>
<p><a href="https://theconversation.com/how-does-ice-use-affect-families-and-what-can-they-do-41186">Involvement of families and partners</a> in a person’s treatment generally results in better outcomes, so look for a program that has a well developed and integrated family program, beyond just information sessions and visits for family members.</p>
<p>Twelve-step groups like <a href="https://aa.org.au">alcoholics anonymous</a>, and more modern alternatives such as <a href="http://www.smartrecovery.org">SMART Recovery</a>, are peer support groups. They aren’t considered a treatment, and don’t need to be a compulsory part of a program. But they may be offered as <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/C51C9F3326D93748CA258082001232CB/$File/Patient%20Pathways%20National%20Project.pdf">additional support</a>, which can be helpful when treatment is finished.</p>
<h3>Accreditation</h3>
<p>Publicly funded services are required to adhere to certain standards that private providers are not. Publicly-funded services need to maintain health <a href="https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/">accreditation standards</a> and are externally assessed regularly. </p>
<p>Private hospitals, which sometimes offer drug rehabilitation, need to be registered with the appropriate <a href="https://www2.health.vic.gov.au/hospitals-and-health-services/private-hospitals/registration">state authority</a> and meet specific hospital standards.</p>
<p>Some individual private health professionals, including psychologists, medical practitioners and nurses, are required to register with the <a href="https://www.ahpra.gov.au">Australian Health Practitioner Regulation Agency</a> (AHPRA). The relevant board of APHRA sets ethical and practice standards and hears complaints against registered practitioners. </p>
<p>Others, including social workers and counsellors, have no requirement for registration, but some professional bodies may set voluntary standards of practice and the Health Complaints Commissioner in each state may deal with complaints.</p>
<p>However, beyond these, registration and accreditation is optional for other alcohol and drug providers, like private residential or day rehabilitation. Ask to see their current accreditation endorsement and evidence of staff qualifications and registration with professional bodies. </p>
<p>You can then check directly with the accreditation or registration body they say they are endorsed by to confirm these details yourself.</p>
<h2>Cost</h2>
<p>As a baseline, when the government funds residential treatment, the cost has been estimated to be around <a href="https://www.pc.gov.au/inquiries/completed/not-for-profit/submissions/sub066-attachment2.pdf">A$117 per day</a>. Plus people are usually asked to contribute to their day-to-day living costs (usually A$200-300 a week) through their government benefits or other income.</p>
<p>In Australia, private residential rehabilitation can cost from A$7,000 to A$30,000 per month. Private hospital-based rehabilitation can cost around A$800 a day. You can expect to pay between A$150 and A$250 per session for counselling. Some costs for hospital stays and private counselling with some health professionals, such as registered psychologists, may be recoverable through private health insurance or Medicare.</p>
<p>Some overseas residential facilities are less expensive, but the same considerations about program content, accreditation and cost apply. Effective and ethical treatment is the same whether it’s offered in Brisbane or Bali.</p>
<p>There’s no evidence that a higher cost of treatment leads to better outcomes, so there is no need to re-mortgage your house or take out large loans to pay for expensive rehabilitation when a more affordable evidence-based option is available.</p><img src="https://counter.theconversation.com/content/95431/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, NHMRC and other public funding bodies for alcohol and other drug research. She is a member and past President of the Australian Association for Cognitive and Behaviour Therapy. She is a registered Psychologist who has previously worked in private practice.</span></em></p>There are many good private alcohol and drug treatment providers, but lack of regulation means some unethical practices are being uncovered. Here’s what you should know about treatment.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/851312017-10-05T13:35:32Z2017-10-05T13:35:32ZUnless prisoners have a good place to live after release, prison drug rehabilitation won’t work<figure><img src="https://images.theconversation.com/files/188782/original/file-20171004-6757-1g84i6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A far larger proportion of prisoners have histories of dependent substance use than the general population.
</span> <span class="attribution"><span class="source"> Anthony Devlin/PA Wire/</span></span></figcaption></figure><p>Drug recovery work in prison is largely futile unless suitable accommodation and support are available to prisoners upon their release. That is the finding of <a href="https://www.york.ac.uk/media/healthsciences/documents/research/mentalhealthresearch/DRWsFinalPublishedReport.pdf">newly published research</a> I have led that analysed the effectiveness of ten pilot projects within prisons aimed at getting prisoners off drugs and alcohol and reintegrated into communities. </p>
<p>Our research showed that some of these pilots, known as Drug Recovery Wings (DRWs) showed promise, involving dedicated staff and highly motivated prisoners. But too often these prisoners faced a “cliff edge” of support on release. Many became homeless or resorted to living in chaotic, “crackhead” hostels, bed and breakfasts and night shelters. There is a pressing need to identify new approaches that can link effective treatment in prisons with proper, well-funded support on release.</p>
<p>The ten pilot DRWs were set up during 2011 and 2012 and, with £30,000 each to cover initial costs, they were given considerable license to develop their own models to reflect local needs. The resulting pilots were very varied: capacity ranged from 20 to 140 beds and therapeutic content from structured full-time programmes to the basic support offered elsewhere in the prison. Some were run by uniformed prison officers, others by third sector treatment professionals, and some were carefully segregated from the rest of the prison while others shared the wider regime.</p>
<p>My colleagues and I were funded by the National Institute of Health Research to undertake a substantial evaluation of these pilots. We found that some of the DRWs were promising, with prisoners expressing strong motivation to make changes in their lives and survey data showing a significantly higher quality of life on the wings compared to other locations in the prison. Key to their success appeared to be a mixture of physical separation from the rest of the prison and protection of beds in the wings only for prisoners engaged in the programme. A strong sense of community and good relations between prisoners and staff who were strongly committed to the programme were also important.</p>
<h2>Life after release</h2>
<p>We surveyed 109 prisoners after they had been living back in the community for six months. Comparing the six months prior to custody with the six months following release, there were considerable reductions in drug and alcohol use, and self-reported offending. However, as we did not have another group of prisoners to compare these to, these reductions cannot be attributed to DRWs. </p>
<p>We also interviewed a group of 36 prisoners six months after their release from a DRW, which gave us a more detailed picture of the lives they were leading outside prison. We found that a major obstacle to prisoners’ continuing recovery was the absence of acceptable accommodation. Most commonly, they had been released to a hostel or local authority-funded bed and breakfast. These were almost universally described as deeply unpleasant environments. One man from Manchester told us:</p>
<blockquote>
<p>There were a lot of drugs. It was a horrible place. It was worse than jail.</p>
</blockquote>
<p>Others were released homeless. One man from Brixton told us:</p>
<blockquote>
<p>Nothing. Nothing. I came out with 50 quid in my pocket, street homeless. No hostel, no night shelter, nothing. I was down housing every day looking for a place, but nothing come up. </p>
</blockquote>
<p>Where we could, we also interviewed people providing support to the ex-prisoners, usually their partners or parents. These interviews often elicited the most poignant narratives. One woman from Swansea, the parent of an ex-prisoner, told us:</p>
<blockquote>
<p>Well I suppose it’s just continuously feeling for years that you’re not getting anywhere. And always keep on going in spite of having police in the house and raiding the house… And sort of breaking your heart seeing his life is going by and no changes for him, you know?</p>
</blockquote>
<h2>Support on the outside</h2>
<p>We concluded that while some DRWs offered promising approaches inside prison, without continuing help on release, such efforts were often in vain, with prisoners’ plans for making radical changes to their lives swiftly evaporating upon release. Much more needs to be done to help such prisoners on release from prison, linked more effectively to therapeutic work in prison.</p>
<p>This study has also led us to question what is really meant by the use of the word “recovery” in a prison setting. Two influential American researchers in the drug recovery field have pointed to the importance of <a href="https://nyupress.org/books/9780814715826/">“recovery capital”</a>, which they define as: “The sum total of one’s resources that can be brought to bear in an effort to overcome alcohol and drug dependency.” </p>
<p>Imprisonment inevitably erodes people’s recovery capital by reducing contact with family and friends, lessening the chances of finding suitable accommodation and employment, and exacerbating mental health problems. Prison “recovery” programmes may therefore best be aimed at limiting this damage: by working to maintain links with families and gain employment skills while inside. They can also provide an environment that can foster and support a commitment to moving on from drug use and offending – as the best DRWs did. Yet, everything depends on what then happens when they walk through those prison gates.</p><img src="https://counter.theconversation.com/content/85131/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlie Lloyd has received funding from the National Institute of Health Research Policy Research Programme for the research discussed in this article. The views expressed are solely those of the author and do not represent those of the government or any other agencies.</span></em></p>New research has analysed the effectiveness of ten Drug Recovery Wings piloted in British prisons.Charlie Lloyd, Reader, University of YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/760812017-04-12T20:14:53Z2017-04-12T20:14:53ZWhat is ‘success’ in drug rehab? Programs need more than just anecdotes to prove they work<figure><img src="https://images.theconversation.com/files/164988/original/image-20170412-26720-ylk07s.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Peter Lyndon-James turned his life around and went on to establish a private rehabilitation service in Perth.</span> <span class="attribution"><a class="source" href="https://www.youtube.com/watch?v=kfYB_OixLY0">YouTube screenshot</a></span></figcaption></figure><p>This week’s <a href="http://iview.abc.net.au/programs/australian-story/NC1701Q010S00">Australian Story</a> was a compelling narrative of redemption. After a long history of problem drug use and related crime, Peter Lyndon-James’s life was turned around and he went on to establish a private rehabilitation service in Perth, <a href="http://www.shalomhouse.com.au/">Shalom House</a>.</p>
<p>Shalom House <a href="http://www.abc.net.au/news/2017-04-10/shalom-house-inside-australias-strictest-rehab-centre/8397570">calls itself</a> the “strictest drug rehabilitation centre in the country”, portrayed as a military-style boot camp with a strong Christian focus. But evidence of its so-called “success” is anecdotal at best and warrants analysis. </p>
<h2>Anecdotes and evidence</h2>
<p>Monday’s program about Shalom House presented a number of convincing stories to demonstrate the success of the program, but anecdotes are not evidence.</p>
<p>When treatment is said to be “evidence based”, this means it has been subjected to rigorous scientific trials that show it works, not just for a small number of people, but for the majority of those with a particular problem.</p>
<p>Imagine you are sick and you go to your GP. They say “I can give you this treatment that has been researched and is known to be effective for about 70% of people; I’ve had good success with it”. Or, “I have this new treatment that hasn’t really been tested, but I gave it to a couple of people yesterday and they said they felt better”. </p>
<p>Which would you choose?</p>
<p>It’s important to have both experience and evidence to inform treatment services, but we need to be careful not to confuse a few positive anecdotes with real outcomes. </p>
<p>Evidence tells us what works. Anecdotes give us a richer understanding of the problem and how treatment can be adapted and applied for individuals. Both are important, but they are not interchangeable.</p>
<p>Treatment services should provide options based on the <a href="https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment">best available evidence</a> and be able to demonstrate outcomes with data.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/164989/original/image-20170412-26720-1szui6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/164989/original/image-20170412-26720-1szui6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/164989/original/image-20170412-26720-1szui6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=809&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164989/original/image-20170412-26720-1szui6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=809&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164989/original/image-20170412-26720-1szui6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=809&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164989/original/image-20170412-26720-1szui6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1017&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164989/original/image-20170412-26720-1szui6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1017&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164989/original/image-20170412-26720-1szui6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1017&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Unfortunately, the most common outcome of treatment is relapse.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Success rates</h2>
<p>There are a number of documented <a href="https://theconversation.com/you-dont-have-to-go-off-the-grid-to-get-treatment-for-drug-dependence-50075">evidence-based interventions</a> for people experiencing substance-use disorders. </p>
<p><a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/%24File/Patient%20Pathways%20National%20Project.pdf">Effective treatments</a> include <a href="http://www.guilford.com/add/miller2/biblio.pdf">motivational interviewing</a> that facilitates motivation in the client, the psychological technique of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/?_escaped_fragment_=po=6.25000">cognitive-behaviour therapy</a> and <a href="http://jamanetwork.com/journals/jamapsychiatry/fullarticle/1839290">mindfulness-based relapse prevention</a>.</p>
<p>There is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266078/">little evidence</a> that hard-line confrontational approaches, such as bootcamp style rehab and the much popularised “intervention”, are effective. They may even be harmful to some people. </p>
<p>The drug treatment field moved away from these types of interventions more than 30 years ago because we realised they just don’t work.</p>
<p>The reality is the reported 40% dropout rate at Shalom House is no better than any other drug treatment service. In fact, it’s slightly worse. <a href="http://www.aihw.gov.au/publication-detail/?id=60129554768">Data collected</a> from drug treatment services in Australia for over a decade shows, on average, around 35% of people drop out of mainstream treatment unexpectedly, or are discharged before completion. </p>
<hr>
<p><strong><em>Further reading - <a href="https://theconversation.com/drug-rehab-and-group-therapy-do-they-work-65413">Drug rehab and group therapy: do they work?</a></em></strong></p>
<hr>
<p>Shalom’s unsubstantiated 50% “success” rate (80% of the 60% that didn’t drop out) is no more successful (in fact slightly worse) than any other available service in Australia. On average, <a href="http://www.aihw.gov.au/publication-detail/?id=60129554768">65% of people</a> who enter alcohol and other drug treatment complete it.</p>
<p>And without proper follow up of participants after they leave, there is no way anyone can say what the success rate really is. To be honest, most people find it relatively straightforward to get off and stay off drugs while in a contained environment like residential rehabilitation. </p>
<p>The real test is after treatment. When you go back to the real world with its endless temptations, pressures and frustrations. Unfortunately, the most common <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/study-of-patient-pathways-in-alcohol-and-other-drug-treatment">outcome from treatment</a> is <a href="https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment">relapse</a>, with 40 to 60% of people returning to drug use.</p>
<h2>Finding effective treatment</h2>
<p>One of the biggest issues in the alcohol and other drug sector is the lack of regulation of treatment services. There is no way of knowing exactly how many private services are operating, and no systematic monitoring of what they do or their outcomes.</p>
<p>Government-funded alcohol or drug treatment services, and public and private hospital services, are at least required to maintain <a href="https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/hospital-accreditation/nsqhs-standards">quality standards</a> through established health accreditation processes.</p>
<p>But anyone can set up a private rehab clinic, and the ABC has previously reported how some <a href="http://www.abc.net.au/4corners/stories/2016/09/12/4535254.htm">unscrupulous operators</a> prey on people who are desperate for help and unable to access the <a href="http://www.vaada.org.au/wp-content/uploads/2017/02/SUB_state-budget-submission_19122016.pdf">overstretched, underfunded public system</a>. </p>
<p>Accreditation protects consumers and their families by ensuring the treatment they receive is evidence-based and underpinned by best practice.</p>
<p>Until the government establishes accreditation requirements for private drug treatment services, if you are looking for treatment, check whether the service is accredited through a recognised health accreditation standard, such as those developed by the <a href="https://www.iso.org/news/2001/10/Ref802.html">International Organisation for Standardisation</a>. </p>
<p>These standards cover a range of quality indicators including staff training, consumer input and use of evidence-based practices. Alternatively, ask to see published evaluation data that has been independently reviewed. </p>
<p>If you are concerned about a service, there is a health complaints commissioner or health ombudsman in every state that can hear your concerns and act on them.</p>
<p>It’s important to remember there is no “one size fits all” in health care. Like any other health problem, not every treatment will suit every person, and it might take a few attempts to find what’s right for you.</p><img src="https://counter.theconversation.com/content/76081/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Stephen Bright is a member of the Victorian Alcohol and Drug Association's board. He is also a member of AOD Media Watch, a site that monitors reporting on alcohol and other drug issues in the media. </span></em></p><p class="fine-print"><em><span>Nicole Lee works as a paid consultant to public, private and not for profit services to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research. She is a member of AOD Media Watch, a site that monitors reporting on alcohol and other drug issues in the media. Nicole was interviewed for the program. </span></em></p>Shalom House calls itself the ‘strictest drug rehabilitation centre in the country’ but evidence of its so-called success is anecdotal at best.Stephen Bright, Senior Lecturer of Addiction, Edith Cowan UniversityNicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/727192017-02-13T19:09:24Z2017-02-13T19:09:24Z‘Ice Wars’ message is overblown and unhelpful<figure><img src="https://images.theconversation.com/files/156503/original/image-20170213-23342-10nqphj.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ice Wars invokes fear and stigma - both of which are very unhelpful in battling drug dependence.</span> <span class="attribution"><a class="source" href="https://tv.press.abc.net.au/ice-wars-coming-to-abc-on-february-7">Screen Shot/ABC website</a></span></figcaption></figure><p>Without doubt, crystal methamphetamine, or ice, is capable of causing immense harm. That’s true for many drugs, including alcohol. But when facts are distorted to create fear and stigma it helps no one. Not the people who use ice. Not their families. Not the health professionals supporting them. Not the police who enforce drug law.</p>
<p><a href="http://iview.abc.net.au/programs/ice-wars/DO1501H001S00">Ice Wars</a>, airing over the next few weeks on ABC, shows the dark side of crystal methamphetamine use. It shows the great, but difficult work that police, mental health and substance use treatment professionals do every day. </p>
<p>It carefully explains some of the commonly misunderstood effects of the drug. It shows the breadth of the ice problem across police, treatment services and individuals. And it shows how people are suffering and the compassionate response that is possible from health workers and police.</p>
<h2>There’s no ‘ice epidemic’</h2>
<p>Most of what is reported in this four-part documentary is not incorrect, but it lacks nuance and context. It makes entertaining television, but it contains the type of sensational language that can create community fears leading to the stigmatisation of people who use drugs and knee jerk responses from policy makers.</p>
<p>We are not “under siege”, or “at war” with ice. There is <a href="http://www.abc.net.au/radionational/programs/allinthemind/why-no-australian-ice-epidemic-counselling-treatment/7235576">no ice epidemic</a>. Ice is not “tearing apart the fabric of our community”.</p>
<p>Crystal methamphetamine, commonly known as “ice”, is one form of methamphetamine. The other main form is a powder, commonly known as “speed”. They are the same chemical, but ice is more pure and therefore much stronger. </p>
<p>We have seen a consistent <em>decrease</em> over the last 15 years in the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/">percentage of the population</a> using methamphetamine, but a large proportion of the group who previously used speed are now using ice. From our <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/about-ndshs/">best available data</a>, 2.1% of Australians over 14 years have used methamphetamine in the last year and about half of those prefer ice over speed.</p>
<p>It’s <em>close</em> to the truth that 1.3 million people have <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/"><em>tried</em></a> crystal methamphetamine – the figure is probably more like 850,000. It sounds like a lot of people, but it’s around 5% of the population over 14 years old. </p>
<p>The vast majority of these people have tried the drug not more than a handful of times and <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/">are not regular users</a>. Around 1% of the Australian population have used ice in the past year. Around <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/tables/">three quarters of that 1%</a> have used not more than 12 times in the past year. That means only 0.25% of the population use more than once a month.</p>
<p>Yes, there is an increased risk of <a href="http://jamanetwork.com/journals/jamapsychiatry/fullarticle/1555603">psychosis</a> among people who use methamphetamine, but 75% of people who use it regularly never have any type of psychotic experience. Yes, there is an increased risk of agitation, aggression and violence among people who use methamphetamine, but 75% of people who use it regularly never become <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12474/abstract">aggressive</a> while using it.</p>
<p>Clearly ice is capable of causing significant harm to the person using it and to others, and significant distress to their families and friends. It’s a drug that when it is bad, it can be very bad.</p>
<p>But we already know the best, most <a href="http://www.drugpolicy.org/docUploads/ndny_costeff.pdf">cost effective</a> way to reduce drug use in the community is to reduce demand through effective treatment. Interventions as brief as <a href="https://www.ncbi.nlm.nih.gov/pubmed/15733250">two sessions</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/18368613">counselling</a> and longer term <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">rehabilitation</a> are all effective, and people who use methamphetamine do <a href="http://journals.sagepub.com/doi/abs/10.1177/0004867415625815">as well, or better, in treatment</a> than people who use other drugs.</p>
<h2>Fear and stigma help no-one</h2>
<p>There is one significant thing we have learned from hundreds of sessions of community education, thousands of hours of worker training and many sessions of treatment with people who use ice and their families: it is counterproductive and distressing for people who are affected when the media makes exaggerated negative claims, showing only the ugly side of drug use.</p>
<p>One of the greatest harms to people who use drugs is the fear and stigma generated by exaggerated images, out of context “facts”, and name calling - “monsters”, “junkies”, “addicts”, “zombies”. We see it every day - fear drives good people to lock their doors and close their hearts. Families and individuals become isolated as a result, and communities outcast those who need to be pulled closer.</p>
<p>Our research has found it takes on average five years for someone to <a href="http://www.emeraldinsight.com/doi/abs/10.1108/17570971211225145">access treatment</a> after they first experience problems with methamphetamine. We know the earlier someone gets treatment, the better the <a href="https://www.ncbi.nlm.nih.gov/pubmed/12778840">outcomes</a>. Continued stigmatisation of people who use ice and their families only serves to prolong the time to treatment by making it less likely those who need help will <a href="http://www.psychologicalscience.org/publications/mental-illness-stigma.html#.WJ0_vxA3kgA">ask for it</a>.</p>
<p>Fear and stigma also make it hard for families to have an <a href="https://theconversation.com/how-does-ice-use-affect-families-and-what-can-they-do-41186">open discussion</a> about drugs, which is crucial in prevention efforts. <a href="https://theconversation.com/ex-ice-users-lecturing-school-kids-isnt-the-answer-to-preventing-drug-use-64753">Talking early</a> and openly about drugs in an age-appropriate way is one of the best protective factors for kids.</p>
<p><a href="https://theconversation.com/ex-ice-users-lecturing-school-kids-isnt-the-answer-to-preventing-drug-use-64753">Fear messages don’t work</a> on young people, and they don’t work on the people at highest risk of using. They just make those who would probably never try the drug more determined not to. Sometimes these approaches can even <a href="https://theconversation.com/ex-ice-users-lecturing-school-kids-isnt-the-answer-to-preventing-drug-use-64753">increase</a> young people’s interest in using. Kids see the world differently from adults. When we use scare tactics on kids, if it doesn’t fall within their sphere of experience they switch off.</p>
<p>Fear drives poor policy, policy that focuses on “crackdowns”, “zero tolerance” and scare campaigns. None of these things is effective. We know what reduces drug related harms in the community is a focus on support, on keeping people alive and on access to treatment.</p>
<p>So watch Ice Wars with interest. But question, reflect, look for the good news. Remember it’s not the whole story. And know the people who use methamphetamine and their families are, first and foremost, people. Compassion and a clear head is going to solve this problem. Not fear and stigma.</p>
<hr>
<p><em>Annie Bleeker from the Alcohol and Drug Foundation co-authored this article.</em></p><img src="https://counter.theconversation.com/content/72719/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant to public, private and not for profit services to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research. She is a member of AOD Media Watch, a site that monitors reporting on alcohol and other drug issues in the media. Nicole was interviewed for the program. </span></em></p>Without doubt, crystal methamphetamine, like many drugs (including alcohol) is capable of causing immense harm. But when facts are distorted to create fear and stigma it helps no one.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.