Going Local: The Advantages of Community-Based Treatment

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For decades, the mention of alcohol or drug rehab conjured up two contrasting images in people’s minds.

One image – the idealized version – looked like this: a seaside retreat on a faraway coastline nestled in lush rolling hills leading down to a perfect beach at sunset. The comforting scene evoked an air of peace and contemplation, perfect for escaping the woes of the daily grind, getting clean and sober, and returning to life a new person, free of addiction and the problems that went along with it. Clients imagined themselves in a private bungalow tucked under shade trees, next to a swimming pool, adjacent to a gourmet dining room, across a perfectly landscaped courtyard from a repurposed farmhouse where they’d receive counseling, participate in yoga or meditation classes, and get daily acupuncture, massage, and aromatherapy treatments.

The other image – the gritty reality version – looked like this: an antiseptic hallway in a hundred-year-old mental hospital lit by flickering fluorescent tubes, with white tile floors, walls covered in chipped and peeling drab-green paint, leading to a common room where patients in various states of mental distress played checkers, stared out the windows, or kept to themselves. The scene was anything but inviting, and the opposite of peaceful and comforting. Potential patients knew these as places to endure, survive, and escape as soon as possible. They expected burly orderlies, overworked doctors, forced medication, and bland, cafeteria-style food with overcooked steam-table vegetables, Salisbury steak for dinner, and chunky green Jell-O for desert.

The New Paradigm

If you were thinking about seeking treatment for a substance use disorder, which one would you have chosen? The luxury spa from “Lifestyles of the Rich and Famous” or the hospital that evokes images of the classic film “One Flew Over the Cuckoo’s Nest”?

The good news is that now, you don’t have to. That false dilemma is a thing of the past.

Here’s a secret about treatment that’s been hiding in plain sight for all these years. There is no evidence that traveling for treatment or receiving treatment in a luxury resort-type setting improves treatment outcomes.

Not one shred of evidence.

Search the available data for best practices in substance abuse treatment and you find a list that says effective treatment programs share the following characteristics:

Components of Effective Treatment

  • Patients receive a full biopsychosocial assessment upon admission.
  • Clinicians create an individualized treatment plan based on the initial biopsychosocial assessment. Effective plans address co-occurring disorders as well as alcohol or substance use disorders.
  • Patients receive a mix of evidence-based therapies that meet their needs. Treatment matches  their drug or alcohol use history and their treatment history. It matches their medical needs, their personal preferences, and what resonates with them. Treatments typically include behavioral therapy, group therapy, addiction education, and Medication-Assisted Treatment (MAT) when appropriate.
  • Patients participate in community supports such as AA, NA, Refuge Recovery, or SMART Recovery.
  • Patients have access to a full continuum of care. Patient need access to detox, residential treatment, partial hospitalization treatment, and outpatient treatment. They also need acccess to a robust, preplanned, ongoing aftercare program.

Not a word about silk sheets, swimming pools, and gourmet food. Although if we’re being honest, who wouldn’t want all that?

We all would.

It’s the Treatment

But the point here is that – and let’s be very clear – although these luxury, travel for treatment centers help people address their addiction problems and save lives every single day of the year, it’s the treatment that saves their lives, not the trappings.

And not the travel.

Thankfully, with the recent increase in awareness about addiction triggered by the opioid crisis, coupled with the recognition that alcohol and substance use disorders are chronic, relapsing diseases and should be treated as such, the false dilemma described above – that treatment must either be like a luxury vacation or a sentence in an archaic sanitorium – is slowly fading from our collective consciousness. It’s replacement: the realization that effective treatment for substance use disorders falls somewhere in between.

It doesn’t have to be luxury, and it doesn’t have to be bare bones. All it has to do is work. And whether it works depends on the program, the people, and the follow-up after treatment. There’s one more thing. A growing body of evidence shows that treatment that happens in the community – meaning that for the person receiving treatment, it happens within a reasonable drive from home – is associated with positive outcomes.

Community-Based Care: Treatment Close to Home

Before we discuss the advantages of seeking treatment close to home, we’ll briefly address the disadvantages of seeking treatment far from home. Ironically – leaving cost aside for a moment – the disadvantages we’ll mention are commonly listed as advantages by destination treatment centers. Here they are:

  • Traveling far from home to get away from it all helps you focus on treatment. It’s easy to dispell this misconception with a simple adage: no matter where you go, there you are. Someone who travels for treatment might be disappointed to learn that if they have an alcohol or substance use disorder in Michigan, they’ll also have it in Malibu. Location does not change who they are or what they’re dealing with.
  • When treatment is over, you return to your old life as a new person, and everything will be different. This misconception is also easily dispelled. When you get back home, everything will be right there where you left it, as you left it. All the stressors and all the people didn’t go through treatment, and you’ll have to deal them as they are.

Now we’ll discuss the advantages of getting treatment close to home, which are all supported by research and backed up by common sense.

The Advantages of Community-Based Treatment

It’s more affordable. When you’re seeking treatment, cost matters. Eliminating the cost of travel to/from a destination rehab can reduce the overall cost of treatment by thousands of dollars.

It increases time in treatment. Time in treatment is one of the prime indicators of treatment success. The longer a person stays in treatment, the greater their chances of a positive outcome. This study shows:

  • Patients who travel less than one mile for treatment are 50% more likely to complete treatment.
  • Patients who travel more than four miles for treatment are likely to have a shorter stay than those who travel less than four miles.

It increases participation in community-based aftercare services. This study of over thirty-three thousand veterans shows the further a patient lives from their treatment facility, the less likely they are to utilize aftercare services:

  • Patients who travel ten miles or less for aftercare services were more than twice as likely to utilize those services
  • Less than forty percent of patients who lived more than twenty-five miles from their aftercare services used the available aftercare services.

It facilitates family engagement. Evidence shows that when families participate in the treatment process, it increases the likelihood of positive outcomes. When treatment is close to home, it’s much easier for families to learn, grow, and heal alongside their loved one. Family members can more clearly understand what the person in treatment is going through. They can also learn the language and techniques of therapy. Both put them in a better position to offer more helpful ongoing support to their loved one.

It allows patient to apply their new skills. This is particularly true for participants in outpatient or partial hospitalization programs: since they live at home or in sober living facilities, these patients can apply the new coping skills and relapse prevention tactics in real time and in the real world. They can then share their experience with clinical staff, who can help adjust, change, or work on their sobriety skills as needed.

It makes MAT possible for people with Opioid Use Disorders. MAT – or Medication Assisted Treatment – is the new gold standard for the treatment of opioid use disorders. When access to the physicians who prescribe and dispense medications like Methadone, Buprenorphine, or Naltrexone is easy – meaning close to home, located in the community – it increases the chances that patients will seek and stick with their MAT program.

Out With The Old, In With The New

The era of treatment for substance abuse happening either in exclusive, posh resorts or in underfunded public hospitals is over. False dilemma: exposed. Medical and mental health professionals now treat substance use disorders like chronic, relapsing diseases. We no longer stigmatize our patients. They no longer have to choose between treatment that’s out of reach and treatment that makes them feel like an outcast from society. The general public now understands the truth of substance use disorders, as well: they can happen to anyone at any time, and the best way to treat them is by offering people the latest and best evidence-based therapies where they need them most – in the community, close to home.