Virtual Drug Rehabs. They’re Coming.

Alcoholic avatars and penny pinching insurance companies – a match made in heaven.

None of us would complain about less time spent wasted in doctor’s waiting rooms, or better and more affordable healthcare! Emerging internet based interactive platforms promise to increase our access to health information and healthcare participation, while allowing a finite number of doctors to treat as many patients – more comprehensively and effectively.

We are not the same group of patients we were 15 years ago. Who goes to the doctor now before taking a self diagnostic tour of internet medical sites? We often scare ourselves with misdiagnoses of terrible diseases, but we endeavor to get informed and by doing so we participate better in the healthcare process – and at its best, healthcare is not passive, but interactive.

The potential for positive change is great – but will the pendulum swing too far? As interactive net based communication between patient and provider improves, will financial pressures compel the e-sourcing of things that just don’t make sense? Will we soon see virtual drug rehabs?

The Good – Where E-Care Makes Sense

Simple and effective online pain management platforms where patients can communicate their symptoms in real time, and longitudinally, to their doctors. Pain patients can create what is essentially an online pain diary – and as they experience pain on a day-to-day basis, they can record information about their symptoms in their diary.

It’s collaborative too. Doctor’s can log on, and given permission, access a patient’s diary, see what’s really happening, and even write notes to the patient in their diary – on a day-to-day basis. Great stuff – It just makes sense. No need to try and explain a history of pain in a 15 minute office appointment, that’s a pretty tough thing to do. Doctors get to see what’s really happening, can make better diagnosis’s and can react to changing symptoms in real time. It provides a way for more accurate information sharing, it saves money and everyone’s time, and it allows doctors to treat their patients more effectively.

That’s the kind of stuff we need. Platforms that improve healthcare efficiency while at best also improving the standard of care, or at the very least – not reducing it.

Except for the very rich, in any country you can name, healthcare systems are overburdened. Resources are finite and never enough to provide optimal care to all that demand it. It’s a fact of life, and for now, it’s just a case of managing the shortfall.

Internet healthcare systems could free up such enormous resources of time and money – ensuring that those that need a hospital bed and a doctor’s care get it – and those that don’t, stay home. How many parents, after some deliberation, make a midnight trip to the emergency room in search of treatment for something that they are 99% sure is not serious? For parents, a 1% chance of tragedy is more than enough to justify a few hours of inconvenience and 99 wasted trips out of a hundred.

On an individual basis, this makes perfect sense – but systematically, it strains resources – and strained resources mean lessened care for everyone.

E-based diagnostic platforms, staffed by doctors and nurses, serving as a front line operation would make sense, and in some jurisdictions, already exist. Get on the video phone, explain the situation, and a lot of the time, they are going to be able to tell you with certainty that there is no need to go to the hospital.

How about on the back end? How many hospital beds stay filled each year by doctors pretty sure that the patient could go home, but wanting one more day of observation – just to be certain. What if those patients that doctors were almost sure were going to be OK – were released one day earlier, but remained linked via web based diagnostics tools? The doctor could still monitor the symptoms in real time – could get someone back to the hospital if needed, but tens of thousands of beds a year would be free to people waiting for them. Better health care for all. Some people would die, but many more people would live – saving more lives for the same expenditure.

The Bad & When Only Face-to-Face Will Do

In the short to mid range future, you need not be terribly imaginative to envision the sort of benefits that interactive net based healthcare services could result in – the two suggested above are only the tip of that iceberg. But there are certain services that do not lend themselves well to distance interaction. Poisoning, trauma, pancreatitis – you can name thousands of conditions that, if you had one, you’d probably want in-person and face-to-face medical care for.

What about addiction counseling? I’d argue that although less obvious and dramatic, it also requires in-person treatment for any real odds of success. I’m not talking about detox, which obviously demands medical supervision; I’m talking about the nuts and bolts of long term treatment – group therapy, cognitive therapy, psychotherapy, etc. A case could be made that such forms of counseling could be provided more cheaply, and with little loss in efficacy, using internet communication technologies. Actually, a case will be made, and e-rehabs are likely on their way.

Addiction though, is tricky. It’s a gestalt kind of disease, in which the sum of the parts never seem to equal the whole, and a disease that demands treatment of a psychological intensity that matches the cognitive manipulations of the disease.

You could arrange for an internet based group therapy session. It would be cheap and easy, but it wouldn’t work very well. Group therapy works when participants are fiercely and honestly involved. You don’t get that when tuning out is as easy as checking your email as you sit in therapy; and manipulations don’t get spotted as they do when you squirm, lying, in person to a group.

You could conveniently get individual therapy at home, over the internet; but the trust building needed for effective counseling takes time in the best of cases, and a situation where the patient is miles removed from the therapist – is not the best of cases for relationship formation. And forget about what our non verbal communication would otherwise reveal.

Could you learn how to make sober friends again, online? Would you really do that yoga – if no one could see what you were up to? Would you tune out, when you didn’t like what you were hearing – sometimes people need a little push to make a breakthrough, but it’s a lot easier to close your browser window than it is to walk out of a therapy session.

Logistically, online addiction treatment is a cakewalk – online addiction treatment that works may be another story.

The Ugly & Financial Pressure

Interactive net communication will create savings opportunities. Ideally, healthcare e-sourcing never harms patient care. The selective application creates a higher standard of individual care in certain areas, and areas unsuited to the application of the e-sourcing benefit from increased funding from the savings – An opportunity for better healthcare, for all.

But if the potential savings in any area become significant enough, there will undoubtedly exist pressure to accept an erosion of healthcare quality in the face of savings – or to put it more bluntly – profit.

Already, consumers with excellent private health coverage who want to get residential drug treatment find that they are obliged to try outpatient first, for a long while, before their insurance company will fund a residential stay. Once insurance companies have an even cheaper option, it’s hard to foresee how they won’t compel us to use it first.

Addiction treatment isn’t like a lot of other disorders. If you had cancer, and the insurance company forced you to try a less expensive procedure first, prior to allowing the more intensive treatment – if that first one didn’t work, you’d be ready that next day to sign up for the better one. Alcoholics and drug addicts are more easily discouraged (or their disease is better at manipulating their behavior) and if the first treatment doesn’t work, odds are it will take a while (if ever) before they approach a second round. A very cynical person might suspect that insurance companies are counting on this…

It will be interesting, and great changes in healthcare over the next decade are a certainty. Most will be positive. The potential for great advances in systematic levels of care exists through the selective application of resource saving distance treatments. There will, I suspect, be an ugly side to it though, and I’d wager virtual drug rehabs will be at the head of that, unfortunate, pack.

I hope I’m wrong though.

“The lost decade” The average period between onset of dependency and treatment…and how we can do better

The average gap between alcohol abuse onset and treatment is actually a decade, while for dependency it is about 8 years, with the average alcoholic succumbing to dependency at the age of 22 and not attempting first treatment until the age of 29. A long and destructive time!

And that’s only for the 25% who ever initiate any form of treatment…and treatment was defined in very broad terms, including any form of intervention from a doctor or psychologist, any inclusion in group support meetings or any participation in 12 steps meetings such as AA.What we know is that the longer alcohol dependency is allowed to progress, the worse the eventual prognosis, and that those people that do ever seek out treatment endure many years of deepening addiction before doing so, and most never even try to get better.

Better public awareness about intervention strategies that work

The agency calls for better public and professional education as to the signs and symptoms of alcohol abuse and dependency, and education about how families and medical care workers can apply intervention strategies to both decrease the average length of alcohol abuse or dependency before treatment, and even more importantly, to increase the total percentages of alcoholics initiating any form of treatment.

Let’s focus on the intervention part of that…

And while educating about the signs of alcohol abuse and dependence is maybe a beneficial thing, it’s hard to imagine that for those 25% who (after 8+) years seek out treatment, that people didn’t notice the emergence of the alcoholism.

I think that instead of teaching people about the signs of alcoholism, we need to be teaching them what to do when they do see it. People can always spot a drunk, and its not as if family doesn’t notice when a loved one passes out drunk every night. The problem is that too many people mistakenly believe that only alcoholics themselves can decide when to initiate treatment, and that only after hitting rock bottom can alcoholics really decide to get help.

We need public campaigns that educate people of influence (anyone!) about effective strategies such as interventions that do prove very successful at influencing changes in behaviors and in forcing an acceptance of a need for treatment.

We need to educate people that by doing nothing to intervene they remain complicit in the levels of abuse and the destruction of the disease, and that when the damage of alcoholism starts to migrate through the family, the workplace or the community, it becomes everyone’s business to intervene for the individual and the common good.

The average gap between alcohol abuse onset and treatment is actually a decade, while for dependency it is about 8 years, with the average alcoholic succumbing to dependency at the age of 22 and not attempting first treatment until the age of 29. A long and destructive time!

And that’s only for the 25% who ever initiate any form of treatment…and treatment was defined in very broad terms, including any form of intervention from a doctor or psychologist, any inclusion in group support meetings or any participation in 12 steps meetings such as AA.What we know is that the longer alcohol dependency is allowed to progress, the worse the eventual prognosis, and that those people that do ever seek out treatment endure many years of deepening addiction before doing so, and most never even try to get better.

Better public awareness about intervention strategies that work

The agency calls for better public and professional education as to the signs and symptoms of alcohol abuse and dependency, and education about how families and medical care workers can apply intervention strategies to both decrease the average length of alcohol abuse or dependency before treatment, and even more importantly, to increase the total percentages of alcoholics initiating any form of treatment.

Let’s focus on the intervention part of that…

And while educating about the signs of alcohol abuse and dependence is maybe a beneficial thing, it’s hard to imagine that for those 25% who (after 8+) years seek out treatment, that people didn’t notice the emergence of the alcoholism.

I think that instead of teaching people about the signs of alcoholism, we need to be teaching them what to do when they do see it. People can always spot a drunk, and its not as if family doesn’t notice when a loved one passes out drunk every night. The problem is that too many people mistakenly believe that only alcoholics themselves can decide when to initiate treatment, and that only after hitting rock bottom can alcoholics really decide to get help.

We need public campaigns that educate people of influence (anyone!) about effective strategies such as interventions that do prove very successful at influencing changes in behaviors and in forcing an acceptance of a need for treatment.

We need to educate people that by doing nothing to intervene they remain complicit in the levels of abuse and the destruction of the disease, and that when the damage of alcoholism starts to migrate through the family, the workplace or the community, it becomes everyone’s business to intervene for the individual and the common good.

The truth about rehab recovery statistics… and why you should make your own evaluation of a facility

I read a lot of rehab centers boasting of some pretty astonishing recovery rates, and while I can’t say for sure that these numbers are not accurate, understanding the nature of addiction as I do all too well; I can’t help but be a little skeptical…

Recovery is a process, and part of that process is sometimes a slip back into use and abuse; and a needed second…third….even fourth crack at the lessons of rehab. Just because a drug rehab doesn’t offer every person that passes through its doors a miraculous recovery doesn’t mean that it’s not a quality and beneficial facility; and perhaps we should look more favorably at facilities that do release more realistic figures of relapse and recovery, more in line with nationally released relapse rates as compiled by agencies such as NIDA.

Statistics can be a marvelous and powerful tool to mislead and to dissuade from a thorough and comprehensive look at the realities of the programs as offered. What does a relapse or abstinence statistic as issued by a drug rehab center really mean anyways?

  • I mean, how are they checking sobriety?
  • How long does sobriety need to occur for them to recognize a success?
  • Do they only consider people that have remained in aftercare as a part of their statistics and most importantly, is there any form of independent confirmation of the statistics as released?

Narconon facilities boast of incredible success rates, but whenever anyone wants to take a look at how these stats are compiled they clam up in a hurry? If there’s nothing to hide, why not be transparent? I don’t know whether they really cure up to 85% as advertised…but I can’t help but be skeptical when no one has ever been able to independently confirm their reporting.

While controversial narconon programs report oddly high stats, they are not alone in this regard, and some of the nation’s most expensive and exclusive facilities will also boast of astonishing success rates, with little real proof backing up very impressive sounding figures. It may well be that some drug rehab programs have no real desire to gain an accurate accounting of actual sobriety rates, and much prefer to use an occasional phone call with a recovering alumni as a basis for the compilation of statistics; and when they are looking for your treatment dollars as a private enterprise, I think it makes sense to take their released numbers with a bit of a grain of salt.

Forget the numbers, and look at the programs, the facilities and the ideology. To get the most of a rehab experience, you have to be compatible to the methods and programming used, and the rehab should offer comprehensive and intensive methods to give you the relapse prevention strategies you’ll need. Hoping for a guaranteed recovery isn’t practical, and even if drug or alcohol treatment doesn’t take completely the first time, it always imparts beneficial tools and strategies towards relapse avoidance; and brings you one step closer to an ultimate goal of sobriety and a life of happiness without substance abuse.

Recovery is possible, and it’s even probable with determination and professional support, but forgets the numbers, and concentrate on getting a great program well suited to your needs and wants.

I read a lot of rehab centers boasting of some pretty astonishing recovery rates, and while I can’t say for sure that these numbers are not accurate, understanding the nature of addiction as I do all too well; I can’t help but be a little skeptical…

Recovery is a process, and part of that process is sometimes a slip back into use and abuse; and a needed second…third….even fourth crack at the lessons of rehab. Just because a drug rehab doesn’t offer every person that passes through its doors a miraculous recovery doesn’t mean that it’s not a quality and beneficial facility; and perhaps we should look more favorably at facilities that do release more realistic figures of relapse and recovery, more in line with nationally released relapse rates as compiled by agencies such as NIDA.

Statistics can be a marvelous and powerful tool to mislead and to dissuade from a thorough and comprehensive look at the realities of the programs as offered. What does a relapse or abstinence statistic as issued by a drug rehab center really mean anyways?

  • I mean, how are they checking sobriety?
  • How long does sobriety need to occur for them to recognize a success?
  • Do they only consider people that have remained in aftercare as a part of their statistics and most importantly, is there any form of independent confirmation of the statistics as released?

Narconon facilities boast of incredible success rates, but whenever anyone wants to take a look at how these stats are compiled they clam up in a hurry? If there’s nothing to hide, why not be transparent? I don’t know whether they really cure up to 85% as advertised…but I can’t help but be skeptical when no one has ever been able to independently confirm their reporting.

While controversial narconon programs report oddly high stats, they are not alone in this regard, and some of the nation’s most expensive and exclusive facilities will also boast of astonishing success rates, with little real proof backing up very impressive sounding figures. It may well be that some drug rehab programs have no real desire to gain an accurate accounting of actual sobriety rates, and much prefer to use an occasional phone call with a recovering alumni as a basis for the compilation of statistics; and when they are looking for your treatment dollars as a private enterprise, I think it makes sense to take their released numbers with a bit of a grain of salt.

Forget the numbers, and look at the programs, the facilities and the ideology. To get the most of a rehab experience, you have to be compatible to the methods and programming used, and the rehab should offer comprehensive and intensive methods to give you the relapse prevention strategies you’ll need. Hoping for a guaranteed recovery isn’t practical, and even if drug or alcohol treatment doesn’t take completely the first time, it always imparts beneficial tools and strategies towards relapse avoidance; and brings you one step closer to an ultimate goal of sobriety and a life of happiness without substance abuse.

Recovery is possible, and it’s even probable with determination and professional support, but forgets the numbers, and concentrate on getting a great program well suited to your needs and wants.

Take a month and get back your life!

I’ve been in detox twice; once for booze and once for pills, and while both were hard, I’d take the physical pain of detox any day over the emotionally difficult days of therapy and recovery that need to follow to really beat any addiction.

Getting the physical metabolites of a drug out of your system needs to happen before you’re clear headed enough to start real treatment; and as such the first few days of any rehab program are almost always spent under medical supervision, and are not really all that intensive. You tend to be in a bit of a fog from the discomfort and the medications, and are certainly in no real position for any self reflection or soul searching. That’s why I always wonder at the claims made by places offering detox only, or week long rehabs…how can they possibly offer anything of value? I know they can be tempting, and a week’s disruption seems a lot easier to accept than a month or more out of a busy life; but recovery is too important, and the process is too tough to give it anything less than 100%.

An addict entering rehab needs to heal the void that leads them back to abuse, and this doesn’t ever happen during the dark days of rehab. Only after, when the mind is clear, and the spirit is able, does the journey to real recovery begin. Through rehab, I learned why I turn to drinking and drugs, and while you can’t expect to solve all of your problems in a month’s session, gaining awareness into yourself and the things that lead you to abuse is a very powerful thing, and can really help you get back on a different path in life.

Through rehab I learned the tools I needed to minimize the temptations to abuse in my life, and to deal with things without abuse when temptation did arise. Your life is never going to be stress or problem free, and you need a new set of skills to cope with the bumpy road that is life. Rehab won’t work for everyone, and I was surprised to find myself back in a program a few short years after "successfully" graduating from one. But recovery is a process, and it continues for life, and a few bumps in the road are OK as long as we deal with them appropriately, and get back on our feet and back to sobriety.

I don’t think that I’ll need to go back to rehab ever again…but I’ll be back in a heartbeat if I find myself again using and slipping back into addiction. A month is nothing when compared to the years of suffering that further abuse will bring, and taking the time away from the triggers to abuse gives you a chance to start again, and relearn why sobriety is important to you. My family means everything to me, and yet I’ve put them through the trials of addiction more than once. I now know that I am powerless over my addiction, and my disease can only be controlled, and never cured. I learned what I needed to know to live without abuse at rehab, and I’ve never regretted investing the time in my own, and my family’s, future health and happiness. If a month can give you your life back, isn’t it worth it?

I’ve been in detox twice; once for booze and once for pills, and while both were hard, I’d take the physical pain of detox any day over the emotionally difficult days of therapy and recovery that need to follow to really beat any addiction.

Getting the physical metabolites of a drug out of your system needs to happen before you’re clear headed enough to start real treatment; and as such the first few days of any rehab program are almost always spent under medical supervision, and are not really all that intensive. You tend to be in a bit of a fog from the discomfort and the medications, and are certainly in no real position for any self reflection or soul searching. That’s why I always wonder at the claims made by places offering detox only, or week long rehabs…how can they possibly offer anything of value? I know they can be tempting, and a week’s disruption seems a lot easier to accept than a month or more out of a busy life; but recovery is too important, and the process is too tough to give it anything less than 100%.

An addict entering rehab needs to heal the void that leads them back to abuse, and this doesn’t ever happen during the dark days of rehab. Only after, when the mind is clear, and the spirit is able, does the journey to real recovery begin. Through rehab, I learned why I turn to drinking and drugs, and while you can’t expect to solve all of your problems in a month’s session, gaining awareness into yourself and the things that lead you to abuse is a very powerful thing, and can really help you get back on a different path in life.

Through rehab I learned the tools I needed to minimize the temptations to abuse in my life, and to deal with things without abuse when temptation did arise. Your life is never going to be stress or problem free, and you need a new set of skills to cope with the bumpy road that is life. Rehab won’t work for everyone, and I was surprised to find myself back in a program a few short years after "successfully" graduating from one. But recovery is a process, and it continues for life, and a few bumps in the road are OK as long as we deal with them appropriately, and get back on our feet and back to sobriety.

I don’t think that I’ll need to go back to rehab ever again…but I’ll be back in a heartbeat if I find myself again using and slipping back into addiction. A month is nothing when compared to the years of suffering that further abuse will bring, and taking the time away from the triggers to abuse gives you a chance to start again, and relearn why sobriety is important to you. My family means everything to me, and yet I’ve put them through the trials of addiction more than once. I now know that I am powerless over my addiction, and my disease can only be controlled, and never cured. I learned what I needed to know to live without abuse at rehab, and I’ve never regretted investing the time in my own, and my family’s, future health and happiness. If a month can give you your life back, isn’t it worth it?