Rehab as a Revolving Door

In dealing with the problem of addiction, some state and provincial governments pursue the ideology that focusing on recovery is the best way to approach the problem of addicted constituents. Some governments, for example the current Conservative government (2019-2023) of the Canadian province of Alberta, persists in ignoring the benefits to addicted individuals of a harm-reduction approach which acknowledges an unsafe drug supply and the life-saving value of safe injection sites.

There is strong evidence that a focus on recovery centres, particularly those that are privately run, is problematic if that is the only approach a government will contemplate. Initial results for rehab centres, namely that individuals have made good recoveries, can be quite misleading. 

When examining addiction recovery, it’s crucial to appreciate that addicted individuals are inescapably influenced by the stimuli that routinely surround them when they take their doses. These “drug cues” explain why recovery from addiction is so difficult. Evidence abounds that exposing recovering addicted individuals to these cues produces dramatic changes in their brain activation patterns, which are accompanied by strong cravings that are likely to promote a relapse into taking drugs again.

Recovery centres claim impressive rates of recovery, but the reality is much different. Consider the conditions present in recovery centres: the user is not in the familiar surroundings that activate strong cravings, and, as such, they find it substantially easier to refrain from using drugs, especially after they have gone through withdrawal.

This sounds great until you consider the concept of the rehab centre as a revolving door.  This suggests that the “recovery” produced in these centre may not be as impressive as is often claimed. The reason has to do with why people repeatedly need to enter recovery centres, and it is here where the claims of the province simply are not credible.

Strong cravings are produced by the drug cues in the user’s surroundings and the absence of these cues in rehab centres makes it much easier to stay clean. This is the crux of the problem. For example, the website of the Fresh Start Recovery Centre, established by the current Alberta government, includes this statement: “Our goal is to send parents back to their kids, sons and daughters back to their families, and to restore people back into their community.” Another recovery centre, iRecovery, says essentially the same thing: “Ongoing support from your own community is also key in managing your substance abuse disorder.”

These statements betray two things. First, these private recovery centres don’t appear to be very familiar with what the research makes crystal clear, and second, a focus on recovery only can make it seem that governments appear more concerned about looking like they care about addicts than really helping them. The giveaway is the word “community” and how they want their patients to go back to their communities, friends, families, etc.

The research conclusions could not be clearer: relapse is almost guaranteed when users are exposed to precisely the same cues that strongly induced their cravings in the first place. This is what makes addiction so traumatic and difficult to deal with. To have the best chance of true recovery, users require new surroundings where, as in the rehab center, these drug cues are not present.

Instead of having recovering addicts return to their familiar surroundings, what is needed is a broad range of support to allow them to begin new lives in environments void of drug cues.  In addition to new living arrangements, they would also require psychological and social support as well as meaningful employment opportunities. This is where the government needs to invest if it seriously wants to help individuals who misuse drugs.

Promoting a revolving door strategy that encourage relapses and a return to the rehab centre is excellent for the bottom line of rehab centres but does little for drug addicts. Governments need to take a much broader approach, where harm-reduction strategies play a central role.