How to Choose a Rehab

💡 Insight

Last issue was about what nobody tells you before you go. This one is about the decision before that: where. Most people choose a rehab the way they would choose a hotel in a hurry — whoever answers the phone, whoever has a bed, whoever the insurance approves first. That's understandable. You're usually choosing in a crisis. But a few questions asked before admission can separate a program that helps from one that just holds you for twenty-eight days.

Here is what to look for, roughly in order of importance.

1. Accreditation and licensing.

Ask whether the facility is licensed by the state and accredited by the Joint Commission or CARF. It isn't a guarantee of quality, but it's a floor. A place that can't clear that floor has told you what you need to know.

2. Real medical detox — or a real referral.

Withdrawal from alcohol and benzodiazepines can be medically dangerous. Ask who manages detox, whether there is a physician or nurse on site around the clock, and what happens if something goes wrong at 2 a.m. "We'll call 911" is not a detox protocol.

3. Their position on medication.

For opioid use disorder, medications like buprenorphine and methadone are the best-evidenced treatments there are. For alcohol, naltrexone and acamprosate help many people. Ask directly: Do you start or continue these medications? Do you require people to taper off them? A program that treats medication as failure is working from ideology, not evidence.

4. Who actually does the therapy.

Ask how many licensed clinicians — LPCs, LCSWs, psychologists, psychiatrists — are on staff, and how often you'll see one individually. Lots of groups led by techs is cheaper to run than one-on-one work with a licensed therapist. Also ask whether they can treat co-occurring depression, anxiety, or trauma, because for most people the substance was never the only thing going on.

5. What happens on day 29.

The highest-risk window is the weeks right after discharge. Ask what discharge planning looks like, whether they set up outpatient care, and whether anyone follows up. A good program starts planning your exit the week you arrive.

6. Red flags.

Be wary of anyone who offers to pay for your travel, promises a cure or a specific success rate, pressures you to commit on the first call, or won't tell you plainly what insurance will and won't cover. And be careful with "helpline" numbers that route you to whoever bought the ad. You can search SAMHSA's locator at FindTreatment.gov directly, for free.

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✦ Quote

"When a man does not know what harbour he is making for, no wind is the right wind."

— Seneca, Letters to Lucilius, Letter 71 (trans. Richard M. Gummere)

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◎ Prompt

If you or someone you love is choosing a program right now, write these six headings on a sheet of paper and make the calls with it in front of you. Write down the answers — and note which questions got a straight answer and which got a sales pitch.