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Helping Clients See into the Opaque Rehab Industry

Rehab is on the rise for substance misuse. Yet it remains a largely hidden phenomenon, often obfuscated by slick marketing, and both therapists and the families of clients may feel cut off from the treatment. Dr. Joe Nowinski, PhD, clinical psychologist and addiction specialist, explains how we can support our clients to make a truly informed choice if they decide to enter rehab


Many of our clients make the unfortunate mistake of confusing alcohol/drug rehab with a ‘cure’ for addiction, much like a prescription for an antibiotic can cure a case of pneumonia. This often leads to unrealistic and unfortunate expectations on the part of the substance abuser – and, importantly, his or her loved ones – and too often to disappointment. The truth is that rehab – getting sober – marks only the beginning of recovery. Staying sober is an entirely different matter.

Upwards of 2.5 million Americans enter treatment facilities for substance abuse problems every year, and the need for treatment is, if anything, growing in the face of the opioid crisis along with steady increases in alcohol use. Many of these people defy old stereotypes of the addict and are in fact younger and more middle class than those stereotypes suggest. The over 14,000 rehab facilities are currently at capacity and new ones are opening every day.

Despite its ubiquity, rehab remains pretty much a hidden phenomenon, especially to the family members and loved ones of those who enter it. Often desperate for help, addicts (and more likely their loved ones) are apt to choose a rehab facility based on scant information. Often an online referral service (which may receive a fee for each referral) or a brochure that is basically an advertisement form the basis for a decision.

Unlike other medical diagnoses, addiction treatment stands alone in being pretty much opaque to the loved ones of those who enter rehab. In way of comparison, imagine that one of your clients was diagnosed with cancer, but rather than being included as a stakeholder in treating the diagnosis, you were told that you (and their loved ones) should let the doctors take care of that; meanwhile, family members (and possibly you as a therapist for the addict or a loved one) should basically stay out of it. How would that make you feel? How would you react? Yet this is essentially the message that loved ones and most therapists get once the substance abuser enters rehab: “Let us take care of it. You don’t need to know what goes on here.” As therapists and counsellors, we cannot allow this to happen, and so we need to stand ready to assist both those who suffer from substance use disorders and their loved ones to make informed decisions. After all, we may very well be one part of a comprehensive treatment plan.

Throw Back the Curtain!

There are, to be sure, high-quality treatment centres that offer rehab. However, to be sure that our clients are signing up with (and possibly paying a lot of money for) one of these, they need to know what to look for. And that can be like throwing back the curtain in the film The Wizard of Oz. Is there anything of substance behind the curtain? You (and they) have a right to know.

When looking for a rehab (or talking with what may well be nothing more than a salesperson on the phone), I suggest you and your clients be prepared to get answers to questions like these before making a decision:

• Do you incorporate evidence-based interventions into your program? If so, which ones? Can you show proof that your staff have received formal training in these interventions?

• Do you evaluate the outcome of your program after patients return home? If so, how? Do you have outcome data (on sobriety after rehab) that you can share?

• If your centre relies largely on group therapy, what are the topics that are covered in these groups? How large is a typical group and how often do the groups meet?

• What kind of ‘recovery plan’ do you provide for patients after discharge? Will it include psychotherapy? Medication? Group support (such as AA)? Do you help them arrange for this aftercare? Can you get a copy of this aftercare plan?


Joe Nowinski

Joe Nowinski, PhD is a clinical psychologist and author of Almost Alcoholic: Is My (or my Loved One’s) Drinking a Problem? He also teaches an online graduate course for the Hazelden Betty Ford Graduate School of Addiction Studies. For more information visit

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