How to find good addiction treatment, according to experts

Looking for drug rehab? It can be extremely difficult — and horribly expensive. In some cases, families spend years and thousands of dollars before they find treatment that works.

Michel Cote, whose two daughters are now in recovery from opioid and meth addictions, said it took his family 10 years and $200,000 to find a small clinic that finally helped.

“I got to a point where I didn’t think anything would work,” Cote, who lives in Silicon Valley, said. “I actually thought that this was probably hopeless, and it was just a matter of time until the big disaster hits. But we had to keep trying.”

For Vox’s drug addiction treatment project, The Rehab Racket, I reached out to experts to figure out how to make this process a little better for people seeking treatment.

Above all, experts emphasized that patients should go for the most comprehensive and individualized treatments possible. It’s crucial not to settle for a one-size-fits-all approach, even if those worked for someone you know. Addiction is a complicated illness that varies from individual to individual, so different approaches can work better for different people. Programs should assess patients and adapt based on their needs.

Beyond that, here are 11 questions that are worth asking any treatment facility that you or a loved one is looking into:

1. Do you diagnose and treat physical and mental health conditions, besides addiction? Drug use can cause physical health problems, and addiction can co-occur with different mental health issues. If these aren’t treated as well, recovery can be much more difficult — if, for example, a person is using drugs to self-medicate depression or anxiety.
2. Do you include medications for addiction in your treatment program, and what role do they play? Medications like methadone and buprenorphine are shown to produce better outcomes and better retain people in care for opioid addiction. Some medications also work for alcohol addiction. If a program rejects medications in general or for anything but detox, that’s a red flag. In particular, watch out for stigmatizing rhetoric about medications “replacing one drug with another.” The programs should use medications, when needed, for longer-term maintenance therapy.
3. What do you do to ensure someone remains in recovery in the long term? Recovery can take years or even decades. Relapses are common. There needs to be a plan, from intensive outpatient to psychotherapy, for what comes after an initial bout of treatment. If a program promises a cure after one period of treatment, that’s a big warning sign they’re not serious about long-term recovery.
4. How do you handle relapse or continued drug use? There are legitimate safety and security reasons for preventing and stopping drug use at treatment facilities, but experts say relapse shouldn’t be used as a justification for discharging a patient. Instead, relapse is a sign that someone actually needs more treatment. It’s important to make sure that facilities will work with people who relapse and, if necessary, connect them to higher levels of care.
5. What’s your success rate? Addiction treatment typically succeeds 50 to 60 percent of the time. If a program claims a success rate of 80 percent or more, it’s likely not being honest with you. Find out how treatment centers track outcomes, and beware unrealistic promises. In the end, experts say the best answer to this question may be blunt honesty: an admission that success and what that even means varies from individual to individual.
6. What kind of treatments do you focus on? Look for evidence-based treatments like medications, cognitive behavioral therapy, motivational interviewing, and contingency management. Be wary of approaches with little to no evidence, such as equine therapy, wilderness therapy, and confrontational approaches. Ask what evidence facilities have for what they do, and be cautious of practices that are backed by few or no studies published in scientific journals.
7. Do you screen for what level of treatment is necessary? Not everyone needs inpatient rehab; in fact, experts say more than 80 percent of people struggling with addiction likely don’t. Programs should screen for what level of care is necessary, using formal guidelines like the American Society of Addiction Medicine criteria. Different levels of care, including outpatient, should be treated as legitimate options. If a treatment facility insists on a one-size-fits-all approach, something is very likely wrong.
8. Do you have licensed medical professionals on staff? You can ask for a list of full-time staff. Look for MDs, nurse practitioners, and physician assistants. If no one on staff has the kind of certification you’d expect at a doctor’s office, that’s a big cause for concern.
9. Are you linked to a broader health care system? A connection to a hospital network or other health care system can be a sign of quality, since those facilities are generally held to a higher standard. It can also improve access to other health care needs. If a place isn’t part of a broader health care network, it should at least have relationships with other health care systems for referrals.
10. What insurance do you accept, and how hard do you work to make sure the treatment is covered? Not only can this save you money, but it can be a sign that the treatment facility is more likely to be legitimate. If it has connections with health insurance companies, that can be a good sign.
11. Are you accredited? Accreditation from the Joint Commission and CARF is not a guarantee of success, but it does suggest the facility at least meets some baseline standards and is open to some accountability.

One more tip: If possible, talk to other patients about their experiences, and look online for complaints. Treatment facilities aren’t always honest about what they do. But you can try to verify claims with other patients, who sometimes hang out in social media groups; online reviews on Google, Yelp, and other platforms; and complaints filed through state agencies or problems reported by news outlets.

It’s a big ask of patients and their families to go through this kind of list, especially when they’re desperate and worried about the risks of addiction or overdose. But experts say it’s tragically necessary, given how dysfunctional America’s addiction treatment system can be.

“The fact that we even need to even come up with these homegrown guides, I think, emphasizes how broken the system is. We don’t need to come up with a homespun guide to how to access cancer care or stroke care,” Sarah Wakeman, an addiction medicine doctor and medical director at the Massachusetts General Hospital Substance Use Disorder Initiative, told me. “It’s pretty ridiculous that the responsibility is put on patients and families to try to navigate this really broken system.”

Thanks to Keith Humphreys at Stanford, Sarah Wakeman at Massachusetts General Hospital, John Kelly at Harvard, Tami Mark at RTI International, and Paul Earley at the American Society of Addiction Medicine for their help in putting together this list.