Evaluative Evidence of Rehab/Treatment Programs

[Page 287]The National Institute of Drug Abuse (NIDA), the federal agency responsible for the scientific study of drug abuse and addiction, characterizes drug addiction as a chronic illness that, for many individuals, involves a complex interaction of biological processes (long-term users will experience changes in brain function that will impact their impulse control and inhibit their ability to resist the temptation to use drugs even when aware of negative consequences for doing so), psychological stressors, and social and environmental cues. Given the complex etiology and development of drug addiction, treatment will in all likelihood be a long-term process requiring multiple interventions and long-term vigilant monitoring. The body of research examining the efficacy of drug treatment is vast and has demonstrated mixed results. There is evidence that treatment can be effective, at least when provided under certain circumstances and for certain populations. Greatly complicating the assessment of the outcomes of drug treatment and formulating any general conclusions about its efficacy are myriad complex issues and questions.

First, there is a lack of consistency in both the literature as well as the public policy regarding what constitutes “effective” treatment. Treatment providers view total cessation of drug use among program participants as unrealistic. They urge instead an emphasis on lower relapse rates, reduced frequency of drug use, and longer time span until a first relapse event (as compared to nonparticipants) as more sensible measures of program quality. As many treatment programs must compete for funding and may be required to justify their costs, their effectiveness might also be viewed through the lens of whether there is a cost savings in sending individuals to treatment as opposed to another, perhaps more standard, response (such as incarceration or traditional probation for drug-abusing offenders). An additional possible consideration in determining program efficacy is an assessment of overall quality of life of program participants, including measuring any changes in personal and social costs that were associated with drug use.

Additionally, methodological problems within the treatment literature have made it difficult in some instances to determine to what extent outcomes can be accurately attributed to treatment program participation. One major issue, for example, is the failure by researchers to account for the true extent that program participants might actually receive specific services promised by the program. Another area of interest is whether court-ordered treatment has demonstrated different outcomes among participants than treatment programs that individuals enter voluntarily.

Furthermore, as the etiology of drug addiction is complex and drug abuse can be influenced by multiple factors, drug treatment programs often involve multiple treatment modalities including medical, psychological, and sociobehavioral therapeutic components and, as such, it can be difficult to delineate which specific components are effective, either in isolation or in combination. Additionally, an ongoing challenge is determining what type of treatment programs are appropriate for what type of users, depending on particular risk factors and unique needs of the user. Drug treatment programs designed for adults, for example, may not be appropriate for adolescent users, just as criminally offending users may have different requirements than those who are not. Polydrug users are particularly likely to relapse, so any treatment program must be cognizant of client usage patterns. Drug abusers with weak social networks have a greater likelihood of post-treatment relapse than those with strong support systems, thus emphasizing the importance of this issue being addressed in treatment.

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