Does Drug & Alcohol Rehab Work?

What does it mean to say that drug or alcohol treatment ‘worked’ for an individual? Unfortunately, there’s no simple answer to that question.

Some would argue that abstinence is the only measure of treatment success; others would say that happiness, having a job, having better relationships with one’s family, and housing are all important factors in determining whether treatment has been successful.

This is just one of the many issues that we face when talking about drug and alcohol success rates.

In this article, we discuss other issues with measuring treatment success; whether relapse equates to failure, how we can improve drug and alcohol treatment, treatment outcomes in the UK, and treatment outcomes for different substances.

Issues with measuring success rates for drug or alcohol treatment

The fundamental problem, when it comes to measuring treatment success rates, is that addiction and mental wellbeing are very difficult things to quantify: there is no objective test to determine how addicted someone is to substances, nor is there an objective test for mental illness.

In this sense, addiction and mental health differ from physical health conditions such as hypertension, which can be measured through the objective means of a blood pressure test.

When measuring how someone is coping in the aftermath of addiction treatment, there are some objective things which can be measured, such as employment and housing status.

However, subjective judgements also play a part. A good measure of someone’s mental health is to simply ask them how they feel.

Using a range of questions which invite objective and subjective answers will give you a complex picture of an individual and how their life is going after rehab treatment.

It may be difficult in some cases to determine whether that complex picture amounts to a success.

Take the example of an individual who, having been to drug or alcohol rehab, still uses substances occasionally. However, they have made huge improvements in other areas of their life, such as work and relationships. They also report feeling much happier in themselves.

Does this qualify as a success?

The answer to that question depends on what criteria you use to measure rehab outcomes.

How do we measure success in drug and alcohol treatment?

There are a huge number of variables to take into account when measuring treatment success. Rehab centres need to look at least some of the following:

How often does the individual use substances? And in what quantities?
How many times have they relapsed? And how long were the intervals between relapses?
Have they entered employment? Have they started attending school, college or university?
What is their physical health like? Are they in better physical shape than they were before treatment?
Have they been in trouble with the police since treatment?
What is their mental health like? Do they feel happier in themselves?
Have they been involved in any accidents since treatment? (E.g. car accidents, injuries).
What are their relationships like? Do they have friends, family and loved ones to take care of them?

When should these questions be asked? If you ask someone these questions just after leaving rehab, they will give you one set of answers; ask them again six months later and those answers may be very different.

Ideally, these questions need to be asked at the point when the individual leaves rehab treatment, and again six months after treatment. This should give a more accurate sense of how the individual is getting on, and how they have progressed after leaving rehab.

Relapse and success rates: does relapse constitute failure?

According to Noeline Latt,

70–80% of patients with established alcohol dependence will relapse within the first year. The prognosis with treatment is better overall; approximately 30–40% are abstinent at 10 years and, in some treatment programmes, rates of 70% are achieved. ^[1]

Given the very high rates of relapse that accompany drug and alcohol rehab, it would be perverse and wrong to describe all of these relapses as ‘failures’, not least because doing so is unhelpful for those in recovery.

Nowadays, recovery is often understood as a kind of journey; relapse, by extension, is a bit like a wrong turn. It is unfortunate, and should be avoided at all costs, but it can still be corrected.

When someone relapses, the worst thing they can do is decide that their recovery is a total failure. Instead, they should view relapse as a learning experience. They should ask themselves what caused the relapse, and then try to put systems in place which prevent the relapse from happening again.

A relapse may be a sign that some aspect of treatment is not working as well as it should: therefore, rather than abandoning recovery altogether, someone who has just relapsed should consider trying a different approach. It may be that a new kind of therapy, a change in lifestyle or different medication can help them to get back on the right track.

What makes some drug or alcohol treatment programmes more successful than others?

Generally speaking, programmes that offer a wide range of therapy and highly individualised treatment plans for their patients are the most successful.

But why is it that these factors lead to high success rates? And what other important factors are there in determining treatment success?

A full course of treatment

Research shows that a full course of treatment, beginning with a medical detox, continuing with inpatient or outpatient care, and followed up by aftercare, is the most effective way to treat drug and alcohol addiction. ^[2]

Medical detox. A medical detox is highly desirable, especially for those with long-term substance use problems. Detoxing under medical supervision is the safest way to detox.
Inpatient care. If you are able to get away from work and home commitments for a short while, inpatient care is a very good way to immerse yourself in a sober environment, away from temptation.
Outpatient care. Cheaper than inpatient care, outpatient care offers a good option for those on a tight budget, or those who have too many commitments at home to stay in an inpatient rehab. Read more about the differences between inpatient and outpatient rehab here.
Aftercare. A key part of any good treatment programme, aftercare is the treatment you get after leaving rehab. It can incorporate support groups, counselling and mentorship programmes.

Why is it that programmes which offer a full course of treatment tend to be the most successful? A simple explanation is that treatment which lasts longer tends to have higher success rates. This may be because many patients with SUDs ‘require multiple treatment episodes over several years to reach stable recovery.’ ^[3]

Treatment for those with complex needs

Another factor which leads to higher success rates in rehab treatment is the ability to cater to specific treatment needs.

People with SUDs often have complex needs, which can include:

Physical health problems, sometimes causing chronic pain
Mental health problems
Mental and physical disabilities
Dependence on multiple substances

A good inpatient rehab should be equipped to deal with these needs. Doing so correctly will provide a much better experience for patients.

If you have one of these needs, and are looking at different rehab options, make sure to ask about what the rehab can offer you in terms of your specific needs.

A range of therapies

Another key component of drug and alcohol treatment success is therapy. A good inpatient rehab will offer a range of therapies, so that patients can choose the therapy which best suits their addiction.

Below are some of the main therapies which are on offer in drug and alcohol rehabs in the UK and abroad.

Cognitive Behavioural Therapy. One of the most popular forms of therapy, CBT helps patients to identify and modify negative patterns of thought. It is very helpful for SUD and mental health disorders such as depression.
Contingency Management. CM offers incentives to patients for staying abstinent. For instance, a sample of drug-free urine may entitle a patient on a CM programme to a prize of reward. This can be very useful in tandem with a talking therapy such as CBT.
Dialectical Behavioural Therapy. DBT is similar to CBT, but is aimed at those with more severe mental health problems, who may pose a danger to themselves. It focuses on acceptance and change.
Motivational Interviewing. MI is based around a course of short interviews, which are designed to establish a patient’s motivations and use them to inspire them to abstinence and/or further treatment.

What are the success rates for drug and alcohol rehab in the UK?

Whilst it is not always easy to find statistics on success rates for drug and alcohol rehab, the UK government does publish some annual statistics on this subject, which you can find here.

According to the latest statistics, 47% of people who started addiction treatment in the year 2019/20 completed the course of treatment successfully. Of the other 53%, the majority (36%) dropped out or left before the end of the course. ^[4]

We can also look at how these success rates vary by substance. Those in opiate treatment have the lowest success rates, at 24%. Those in alcohol treatment have the highest success rates, at 59%.

A note on these figures. Although these figures provide an interesting snapshot of the state of drug and alcohol treatment in the UK at the time of writing, they do not tell the whole story. They suffer from a few limitations: firstly, their definition of ‘success’ is relatively narrow; and secondly, we do not know how these individuals fared after leaving treatment.

For a better understanding of treatment outcomes in the months after leaving rehab, let’s take a look at the statistics on ‘self-reported outcomes’, also published by the UK government in the same set of statistics.

The self-reported outcomes show that six months after leaving treatment, the average number of days spent using substance is significantly lower across the board. This suggests that treatment is effective.

For opiate users, the average number of days spent taking opiates is 8.9 days, compared to 22.4 days before starting treatment.

For alcohol users, the average number of days using alcohol is 11.2 days, compared to 21.3 days before treatment.

However, there is not as much change in education and employment as would be hoped. The average number of days spent in education after treatment is 10.5, compared to 9.6 before treatment; the average number of days in employment, meanwhile, is 18 days after treatment, compared to 17.7 before.

These figures show that treatment in the UK does help individuals to cut down considerably on their substance use, but it is less good at helping them to enter gainful employment or education.

Final thoughts: does drug and alcohol rehab work?

Drug and alcohol rehab does work, and it is effective when it comes to reducing substance use. This is shown by the statistics quoted above, in particular the self-reported outcomes after six months.

Where there is still room for improvement, however, is in the areas of employment and education. It would be good to see individuals who have been to rehab finding jobs, since employment security tends to lead to a range of positive outcomes.

That being said, it may be unreasonable to expect rehabs to help individuals get jobs after rehab, and if their substance use has improved, then that represents a major success.

References

[1] Addiction Medicine. By Noeline Latt, Katherine Conigrave, John B. Saunders, E. Jane Marshall and David Nutt, (Oxford University Press, Oxford: 2009).

[2] ‘Continuing Care Research: What We’ve Learned and Where We’re Going’, James R. McKay. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670779/

[3] ‘Managing Addiction as a Chronic Condition,’ Michael Dennis, PhD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797101/

[4] ‘National Statistics: Adult substance misuse treatment statistics 2019 to 2020: report,’ Published 26 November 2020.
https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2019-to-2020/adult-substance-misuse-treatment-statistics-2019-to-2020-report#treatment-outcomes