51: Anne Fletcher Shares About Her Book, “Inside Rehab: The Surprising Truth about Addiction Treatment-and How to Get Help That Works”
“Well, one of the things is recognizing that rehab isn’t for everybody… Not everybody with an addiction belongs in rehab.” –Anne Fletcher
On what basis is there for such a claim? Anne Fletcher, an award-winning health and medical writer and author of best-selling books on weight loss and sobriety, spends years of research, visiting programs, interviewing professionals and hundreds of people and families for an incredible, detailed exposé of what’s really in rehab. Her book has received starred reviews and she is ready to share the secrets lurking behind Rehabs. As you contemplate and decide which treatment center to go to, listen in as Anne opens the chapters of what you need to know.
There are hundreds, probably thousands of treatment centers around you. Have you ever wondered what’s in there? Here are some of the unspoken truths about Rehabs and primary care counsellors that you should get acquainted with. Get to know who to trust and who offers the care that will be effective for you and your family. This is not just about change, but how to maintain that change.
Highlights:
04:03 50 Years with Substance Abusers
13:29 The Crisis and the Outliers
21:06 Handling the Hard Choices
26:14 Be Aware of Your Gut Feelings
29:55 Helicopter Parents
31:29 Enabling vs Your Gut Feel
40:04 Teach Me!
45:51 Be Transparent
51:10 Call This Mom
Resources:
Books by Anne
Inside Rehab: The Surprising Truth About Addiction Treatment-and How to Get Help That Works
Thin for Life (Book Series)
Sober for Good: New Solutions for Drinking Problems- Advice From Those Who Have Succeeded
What’s really in a Rehab? Join @TFRSolution as he sits down with @annemfletcher about her book: Inside Rehab: The Surprising Truth About Addiction Treatment-and How to Get Help That Works #insiderehab #credentials #familyinvolvedment… Share on X
Connect With Anne
Website: http://annemfletcher.com/
Email: anne@annemfletcher.com/
RSS: http://annemfletcher.com/feed/
Twitter: http://www.twitter.com/annemfletcher
Facebook: https://www.facebook.com/AnneMFletcherMSRD
Quotes:
13:16 “Well, one of the things is recognizing that rehab isn’t for everybody… Not everybody with an addiction belongs in rehab.”–Anne Fletcher
25:32 “If we introduce people to the alternatives, it’s believed that more people will find a way out of their addiction.”–Anne Fletcher
42:41 “The family really, really needs to be involved.”–Anne Fletcher
44:58 “There isn’t one program that’s going to address everyone’s situation.” –Jeff Jones
49:31 “There really is a big, big gap between science, what science shows to be effective, and practice what actually goes on in the field.”–Anne Fletcher
54:20 “We give people choices. The more choices people are given, the more likely they are to change.”–Anne Fletcher
Got ideas? Perhaps a future podcast? Schedule time with Jeff here: https://meetme.so/jeffjones
Transcriptions
JEFF: So welcome everyone to the podcast Families Navigating Addiction and Recovery. Today, my guest is Anne Fletcher and I am just meeting and, and so I am anticipating a pretty unique and um, lively conversation here and comes with quite a bit of background here, very different than a lot of people that I interview on this podcast. So, and is a book author, but more than that, she’s nationally known as an award winning health and medical writer. So she has written a book inside Rehab, the surprising truth about addiction treatment and how to get help that works. So that’s what we’ll be focusing on here and I really am excited to learn more about this. So Anne, welcome.
ANNE: Good to be with you.
JEFF: Yeah, thank you. So how about if we start out, if you could just introduce yourself and to where people listening can get an idea, a better idea of who you are then my little intro.
ANNE: Well, I’ve been writing books for most of my, my career I say my entire career, but most of my career I did work clinically for a while. I actually have a master’s degree in nutrition science –
JEFF: –Mm.
ANNE: -and it connects to this, believe it or not because –
JEFF: –Yeah, I believe it.
ANNE: I’ve been interested throughout my career in how people change and it’s not just how they change in the first place, but how they stay changed.
JEFF: –Hmm.
ANNE: I’m interested in maintenance of behavior change and uh my first set of books that I wrote are called the thin for life books and they’re about people who lost weight and kept it off. And so it’s a series of books and I wrote about weight loss and weight maintenance people who lost weight and kept it off and how they were able to change their entire lifestyle and their very psychological books, –
JEFF: –Hmm.
ANNE: -and I did that for years. I wrote this series of books and there’s one in there for parents with overweight teenagers as well and –
JEFF: –Hmm.
ANNE: I kind of got tired of writing about weight loss. I did work clinically for a while in in the field because I am a registered dietician by training and I went from there. I realized that there were similarities between people with serious weight problems and people with serious alcohol problems and wrote a book called sober for good, which is –
JEFF: –Hmm.
ANNE: -about people with long term sobriety. I was really fascinated in writing about people who had, again, not just with drinking, um, and many of these people had other addictions as well, but people who had been sober for at least five years. And so I interviewed and surveyed more than 200 people who had recovered in many different ways, not just with the traditional 12 step method.
JEFF: –Right.
ANNE: I looked at what they had in common.
JEFF: Yeah. Oh my gosh. And I’m just like, I am so excited with what you’re saying and I really appreciate your focus of what sounds like curiosity and drive that you have to understand more and more about how people change and how they integrate that change and keep that change and like, you know, perhaps create a whole new life kind of thing so.
ANNE: I’m glad that that comes across because I really have had a passion for that. And what I do is I studied them by surveying them and sending them questionnaires and interviewing them. And then I look at the scientific literature –
JEFF: –Uh Huh.
ANNE: -that is, you know, like what does the research say about people who have been able to maintain behavior change, whether it’s weight loss or sobriety. And then I interview leading experts in the field and then I weave it all together like a giant patchwork quilt. And so that’s how I come up with kind of the 10 keys to success or,
JEFF: –Yeah.
ANNE: And so my latest book, the one that you were talking about inside Rehab was one in which I kind of digressed in that it’s not about keys to success because it’s really, it’s really an inside story of looking at the addiction treatment industry.
JEFF: –Right. Yeah
ANNE: Writing the silver for good I got to know experts, one in particular, Dr. Thomas McClellan.
JEFF: Oh yeah, yeah, yeah. I know that name.
ANNE: He’s very famous in the field,
JEFF: –Right.
ANNE: -he’s a psychologist who was a cofounder of a big institute that’s affiliated with the University of Pennsylvania that studies addiction treatment.
JEFF: –Right.
ANNE: What are the makings of really good addiction treatment?
JEFF: –Yeah.
ANNE: I got to know him quite well and he kept telling me basically how inadequate addiction treatment –
JEFF: –Yeah.
ANNE: -is it states, and he really caught my interest and I really became interested in writing a book that became more or less an exposay of addiction treatment in the United States and that became inside Rehab.
JEFF: Yeah. Beautiful. And so you mentioned Thomas McClellan and I’m just gonna take digress just a little bit, but I know that name Thomas McClellan from things I’ve, I mean I’ve done a fair amount of research myself, but I think he was, uh, drugs are for this country some time ago. And the other thing I learned about him is he had a son that overdosed and you know, one of the comments that I heard him say in a video was, oh my God, you know, I am a person in this country where I should know more about drugs and alcohol than anybody. This happens in my own family and in that moment I didn’t know what to do.
ANNE: You’re exactly right. You’re exactly right.
JEFF: –Oh my gosh.
ANNE: And he was helping me with inside Rehab. He was an unpaid consultant for the book. He was very helpful to me and he was with me, he was helping me when his son died.
JEFF: –Yeah.
ANNE: -and he was definitely –
JEFF: –Oh my God.
ANNE: -drug smart. Just, just to set the record straight, he was deputy, the drugs are during the Oh, first Obama administration.
JEFF: –Okay.
ANNE: And he had two sons and one of them is alive and doing well, but two son’s who struggled with substance use disorders are what we commonly call addiction.
JEFF: –Right.
ANNE: Did die when he had, because of his problems.
JEFF: –Right.
ANNE: Very sad, but yes he’s even leading experts in the field really don’t know what to do, especially when it comes to treatment.
JEFF: –Yeah.
ANNE: And one of the experts I interviewed when I was just starting to scratch the surface with this book was talk to Dr. Alan Marlette, who is one of the leading experts with the relapse model that is used across the country.
JEFF: –Mm.
ANNE: And he said to me, well, I remember very early on when all there was all the talk about Britney Spears and Lindsay Lohan going in and out of Rehab, and I got a call from people magazine and the writer from people magazine said to Dr Marlette: “Can you tell us Dr. Marlette what goes on in Rehab”? And he, he said: “I had to say to myself, I thought to myself, I have no clue”.
JEFF: –Yeah.
ANNE: And that anecdote –
JEFF: –Yeah.
ANNE: -is shared in my book because he really didn’t know what went on in Rehab.
JEFF: –Yeah.
ANNE: All of these things just became, they kind of titillated me and I thought, you know when even the experts don’t know what goes on, I’m going to go inside and find out. So I got my publisher Viking penguin interested in all of this and wrote a book proposal. And one of the big pieces of research that I did was I traveled around the country and I went coast to coast and visited 15 different kinds, when I say Rehab, most people think of the overnight rehab. You go away for 30 days or four weeks or whatever it is. That was the traditional model. We’re now recognizing that people need way more than that. Those who belong in inpatient treatment, but we think of the overnight stay, but I called Rehab in the book outpatient and treatment as well, which is really most treatment in the United States, and we can come back to that. But I called it, call it any kind of addiction treatment because we’re rehabilitating people from addiction. So I went from everything from residential treatment where you go overnight. I visited celebrity rehabs, I visited outpatient treatments where you go to treatment during the day, go home at night. I visited programs that treat indigent people and I went to programs on the east coast, the west coast, and in uh middle America.
JEFF: –Yeah.
ANNE: And looked at what they do in treatment. I was not visiting model addiction programs, although I did visit some that really I wouldn’t hesitate to refer people to, but I was visiting typical addiction treatment programs in the United States that –
JEFF: –Right.
ANNE: -represent what most people get when they go to addiction treatment.
JEFF: Yeah. Oh my gosh Anne i’m just really blown away with your persistence and tenacity because this is no small topic and there are so many different perspectives on what addiction is and where it came from and like is it cause and effect or are there various factors that contribute to it and you know, what can the country do about it and what can a city or community do about it? And then what can a family do about it? And it’s like this is such a huge topic. And you know, for people who have not gotten addiction in their life, they really don’t know at all. But then there’s people like Thomas McClellan who know quite a lot, but then when it happens to them, it’s, you know, like the nervous system gets activated and there it’s like, oh my God, what do I do here?
ANNE: That’s right. And you know, most people you know I, I have a chapter wealthy i’ll quickly review the you know, when I tried to do is look at the obstacles or the challenges. This is looking at the chapters that the obstacles or challenges that people face. So I look at the cost of Rehab and that includes both the emotional cost and the financial cost. I look at the approaches of treatment so that’s kind of getting the best for your buck. You want to make sure you’re getting sound treatment. The most scientifically based treatment you can get, you’re looking at, well one of the things is recognizing that rehab isn’t for everybody rehab doesn’t belong not everybody within addiction belongs in Rehab.
“Well, one of the things is recognizing that rehab isn't for everybody... Not everybody with an addiction belongs in rehab.”–Anne Fletcher #FamiliesNavigatingAddiction&RecoveryPodcast #JeffJones Share on XJEFF: –Right.
ANNE: So how do you tease that out? I look at adolescent treatment and you know, what do you do with, you have a teenager or young adult who needs treatment –
JEFF: –Right.
ANNE: -and what if somebody has a co-occurring mental health problem? So I, these are just some of the things that I try to touch on, some of the big issues people face in addiction treatment. But when you’re talking about where do you start, so you have a loved one or you recognize that you have a problem and the knee jerk reaction is typically well, and and you see this on TV shows all the time. Well they’ve got to go away to rehab and as I said earlier, most addiction treatment and usually what insurance will pay for first is for you to go to an outpatient program. You’ve got to fail their first –
JEFF: –Right.
ANNE: -before you’re going to residential treatment.
JEFF: –You got to fail, fail, yeah.
ANNE: Yeah that’s right. That’s right.
JEFF: –Yeah. I know.
ANNE: How do you choose? Well, some people will go to a pro, they’ll call their neighbor the call the, you know, what’s it Suzy, my best friend, you know, do with her kid or they’ll go to their doctor. Most doctors don’t know much of anything they have very little training and they’re the same thing with nutrition. When you’re trying to find, get help for obesity, but they don’t know anything because they haven’t had training in these areas –
JEFF: –Right.
ANNE: -and in their education. Some people told me, and I did ask this question, how did you find your treatment? They will g this famous actress or sports hero went to this rehab. This is not, you know, a very sophisticated way of choosing treatment. Dr McClellan often says things like, most people spend more time researching a vacuum –
JEFF: –Yeah.
ANNE: -or washing machine than they do looking for addiction treatment.
JEFF: That is such a great comment, it really is. And I really like, you know in your book you have this chapter one size doesn’t fit all. So I am wondering like do you have any tips specifically with that on like from your research, from what you’ve learned, how families can best, like what criteria they can use to figure out like what is going to be a fit for them or like how to start taking steps towards like what type of treatment?
ANNE: Well, I’ll back up for a second. You know I have this whole chapter on what do we know is effective for people who have struggled with substance use disorders, which is really the scientific name for addiction. And one of the things that’s really important for people to understand is that this is important to understand when you’re looking at why we can’t have one size fits all substance use disorders fall on a spectrum and we have everything from mild to moderate to severe. Let’s think about another medical problem. High blood pressure or diabetes it’s not the same disorder for all people. It can be a mild problem, it can be moderate, it can be severe –
JEFF: –Yeah.
ANNE: -and –
JEFF: –Right.
ANNE: I’ll use myself as an example, I have high blood pressure. I started out on one medication but my weight was already down. Usually you, you start out with trying to lose a little weight, getting people to be active yet getting them to use less salt. Then you go to one medication, then you go to two medications. Now I, because I have genetic high blood pressure in my family and it’s pretty bad. I started out with one that I went to two and then I went to three now I’m on four medications, –
JEFF: –Mm.
ANNE: -but you don’t start out there.
JEFF: –Right.
ANNE: So, –
JEFF: –Yeah, yeah.
ANNE: If we look at, if you have a mild substance use disorder and there are criteria, there’s like a checklist that we use. I won’t go through all of them –
JEFF: –Sure.
ANNE: -but there. there’s something called the DSM, the diagnose, I always forget what it stands for. Do you remember what DSM stands for?
JEFF: Diagnostic and statistical manual and now it’s number five.
ANNE: Okay, so we use this manual and we use the checklist that’s there. And you know, if you have a few of the things on the checklist, you have a mild disorder. If you have a more than a few, how many is it? Do you remember?
JEFF: Oh, it can be five to eight.
ANNE: Okay. Then you have a moderate and then then the more you have, you’ve got –
JEFF: –Right.
ANNE: -your disorder and that’s really –
JEFF: –Right.
ANNE: -what puts you in the addiction category. But we don’t use the same approach for the person who has a mild or moderate disorder as a person who has severe. But often people will get thrown in to the wrong category. They end up in a rehab and they don’t belong there. So anyway, it’s really important. And the other thing that happens often is people will go to a treatment program and the same approach and they don’t do well or they come home and they have a recurrence. I prefer that to relapse. They have a recurrence of their problem and the same approach as use over and over again. Well, if I don’t do well on one blood pressure medication, my doctor will change me to something else.
JEFF: –Yeah, yeah.
ANNE: It doesn’t keep using the same thing over and over again. And it doesn’t blame me if it fails. But what happens often with addiction is the patient gets blamed for the failure and we’ll, you didn’t follow the steps. You didn’t do the right thing –
JEFF: –Right, right, right.
ANNE: -saying, well maybe we failed with the approach. Maybe the patient, you know, is not connecting with the approach. Maybe we should try something different.
JEFF: Sure, yeah I so get this and, and one thing that I think of, and one of the things that I know about addiction is there’s a lot of black and white thinking –
ANNE: –Yes.
JEFF: addiction and from my experience, the black and white thinking isn’t just with the individual at the epicenter of the addiction. The black and white thinking kind of transfers out to everybody around them.
ANNE: –That’s right. That’s right.
JEFF: And so it comes as no surprise for me to hear what you’re saying because I’ve worked in some treatment centers and I, I mean I’ve seen addiction professional, a lot of the addiction professionals or people in their own recovery and what they’re doing is really helpful for their own recovery and process and all that. So often times like the substance can stop and they can go into recovery, but the black and white thinking like being able to go from black and white thinking to really looking at, you know, everything that’s going on the context and you know, bringing in pieces of information and like weaving them together. Like what you were saying before, that isn’t always that easy –
ANNE: –Right.
JEFF: -specifically with addiction. So you know, and that’s one of the things that I read about you on your website is that’s one of your skills or guests to able to get information from a lot of different places and then weave it together.
ANNE: Well I certainly try to do that and a couple of examples of one size fits all thinking or approaches and I can’t believe I’m blanking on his name. Who’s the doctor who became so famous, he had the TV show and one time he said, and he was on CNN all the time and he said, um well, maybe it’s better not to mention his name but anyway, because I’m going to criticize a lot of what he did. But he said, you have to have the group without the group, you know, there’s no such thing as addiction treatment, effective addiction treatment without a group. Well, one of the problems is that group treatment for everybody is that’s a misconception that everybody needs group treatment.
JEFF: Well that’s black and white thinking too.
ANNE: Exactly. And in fact there’s very little individual counseling and not everybody does well in groups. I remember one woman, she had a lot of shame, um, in part because of sexual behavior she had engaged in while she was severely addicted to a number of different drugs. And she was shy and she said, um, I was forced to share my secrets and group and I really didn’t want to do that, I’ve never done well in groups. And when she finally got to a nontraditional rehab that did not force her to engage in groups and share her deepest, darkest secrets, –
JEFF: –Right.
ANNE: -she did much better. But one of the things that I’ve found is that, well, here’s an example at high-end rehabs. Now these would be overnight rehabs. I found there’s some type of group counseling, education lecture or other group activity about eight hours a day –
JEFF: –Hmm.
ANNE: including meals and individual counseling at such rehabs can work out to just five hours a week or even less.
JEFF: –Right.
ANNE: So that’s typically eight hours a day in groups. And I thought to myself, well, if I’m spending a minimum of $30,000 a month, and often it’s way, way more than that, I was sending a loved one and paying that, or my insurance company was paying that for treatment and they were getting that little individual treatment. I would not be happy if there was that much group treatment at some outpatient programs. There was no individual treatment or very, very little individual treatment. So again,
JEFF: –Yeah.
ANNE: -this motion that group treatment is for everybody is, you know, again, it’s the, the one size fits all kind of thinking.
JEFF: –Right, yeah, yeah.
ANNE: Another example is that AA is for everybody. The 12 step approach is for everybody and there’s a whole long history behind this.
JEFF: –Oh my gosh, yeah, yeah.
ANNE: We’re not getting into, but now this has changed since I wrote sober for good. When I wrote sober for good about nine out of 10 programs were basing their treatment on the 12 steps. Now it hasn’t, it has changed somewhat. Now it’s about 75% of programs are based on or involve AA in some fashion, about 75% but most people drop out. They don’t stay with AA, so these are people in treatment.
JEFF: –Yeah.
ANNE: And about six to 8% of people with severe problems who are encouraged to attend AA while on treatment. We’ll stop at attending AA in less than a year. So you know, the, the whole idea here is that AA is quite ubiquitous in treatment programs and the idea is that if they were offered more options, then more people would likely be helped.
JEFF: –Right.
ANNE: And there are many options today. You say what are the options? What are the alternatives? We have smart recovery, which has been around for more than 10 years now. That is a non 12 step recovery group that is free to people just as AA is, AA is not treatment. It’s a –
JEFF: –Right.
ANNE: -more like a self-help group. People call the mutual experts called the mutual help groups, so we have smart recovery. There’s another non 12 step group called women for sobriety. There’s another one called secular organizations for sobriety, life ring recovery. There’s many alternatives to AA and many people recovery without going to any of these recovery groups at all. So you know, again, if we introduce people to the alternatives, it’s believed that more people will, will find a way out of their addiction.
“If we introduce people to the alternatives, it's believed that more people will find a way out of their addiction.”–Anne Fletcher #FamiliesNavigatingAddiction&RecoveryPodcast #JeffJones Share on XJEFF: Sure. Yeah. I am aware of a lot of different support groups. The ones that you mentioned, the other one that I am aware of is there’s a Buddhist support group called refuge recovery.
ANNE: Right. And that recently came to my attention and I didn’t know about it when I wrote the book.
JEFF: –Yeah, and there’s one called White Bison for –
ANNE: –Yes.
JEFF: -native Americans. I mean there’s a lot out there.
ANNE: –Yes.
JEFF: And primarily everyone thinks of AA because and you know I, I am not in my own recovery. I’m not an AA person. I have been around AA a fair amount and there’s some things that I think are very beautiful about it in that it’s all over the world and the county that I live in, there’s like 186 a, a meetings every week.
ANNE: –Yeah. It’s great cause it’s a, there’s one on every corner and it’s great when it works, but again, it doesn’t work.
JEFF: Yeah, and there’s some things about AA that are very problematic and AA was started in what, 1935 or something.
ANNE: –I think so yeah.
JEFF: And it’s old thinking and you know, the beauty of it is there, there’s a lot of people, there’s community and I’ve talked to people whose been in 12 steps for 30 plus years and they go back, like they have a sponsor and their sponsor asked them to go back and you know, do the steps all over again. And I was interviewing this one guy on this podcast and he was making the comment when I did that, I realized that I didn’t use the steps –
ANNE: –Mm.
JEFF: -for myself for recovery. But what was the most helpful was when I was at an AA, there were people who were telling the truth and truth was excepted. And so it was community it was likeminded people, it was –
ANNE: –Right.
JEFF: -human contact, and it was trust and honesty. So there’s a lot of wonderful things. And then there’s some things that are problematic in a pretty high bar and etc., etc., so.
ANNE: Many don’t know that sponsors are not professional people, they’re just other people in AA. It’s recommended that it’d be a person with one year of sobriety, but a good sponsor can be wonderful, but a not so good sponsor can be damaging. I remember –
JEFF: –Yeah.
ANNE: -saying at one treatment program, and the treatment program was heavily based on the 12 steps of AA and they were very much encouraging these teenagers to go to, to the meeting that night. And the counselor was going around the room, are you going? Are you, if very confrontational. And one of the things that we know is computational approaches are among the least effective –
JEFF: –Yeah.
ANNE: -of all the approaches that we could use and work for working with somebody where people are put on the carpet and oh there, we used to be terrible confrontational.
JEFF: Oh it’s like the idea of, you know, the first thing that needs to happen is break a person down –
ANNE: –Yes, yes.
JEFF: -and then slowly build them up. And I have friends who went through programs like that and you know, and there are solid with it myself with what I know. I see the potential to re-traumatize someone.
ANNE: Yes, yes and many people who have struggled with addiction women in particular has suffered pretty severe trauma, so that certainly is not helpful. But think about adolescents, you know, many of whom are oppositional. It’s part of the nature of adolescence, –
JEFF: –Right.
ANNE: -confrontational approaches certainly isn’t helpful. But in this one particular group that I observed, the one teenager said, you know, I really don’t like my sponsor and he creeps me out and the counselor didn’t say or do anything about it. And I thought, we do not let adults work with adolescents in any other setting without screening them first. And it really concerned me that you could actually be putting an adolescent in a dangerous situation.
JEFF: Well that has happened more than once i’m sure from your research, you know, that, –
ANNE: –Hmm Mm.
JEFF: -that, I mean, people can go to AA meetings, specifically women, women go to an AA meeting that’s, you know, mainly men and they’re there, you know, to get help and support and they end up getting hit on and you know, etc., etc. And so, yeah, there’s all kinds of challenges and you know, like I’m not here to bash any of them because one of the things that I try to do is, you know, really shed light on what are the different things that are out there and what are the different contributing factors that can increase the potential for someone’s solutions. You know? And, –
ANNE: –Yes, yes.
JEFF: -and that is really, really hard because a lot of those aren’t like, people really have to do a lot of research. They need to dig and I, I come back to your comment about people spend more time, you know, trying to figure out what’s the right vacuum to buy then what treatment center to send their loved one to or something. So, –
ANNE: –Yes.
JEFF: -that’s a huge, huge thing. And I mean the other thing about treatments that I mean, I’m an interventionist, I’m a member of the network of independent interventionists and like we, you know, I communicate with other interventionists to find out like what treatment centers are doing well with a particular situation at any given time. Because when the staff changes, the quality of service changes, I’m –
ANNE: –Yeah.
JEFF: I mean they’re human.
ANNE: Right, and there is a huge turnover at many addiction.
JEFF: –Oh my gosh. It’s like it’s stressful work. And for treatment centers that don’t really incorporate a self-care piece for their team, –
ANNE: –Yes.
JEFF: -it is exactly what you said. The turnover rate is high and higher because people get burned out and they, –
ANNE: I interviewed said it’s as high as a fast food restaurants and these people are often grossly underpaid. I mean they’re –
JEFF: –Yeah.
ANNE: -people that are, are very dedicated. But one of the things I have to say is that one of the big findings, and this wasn’t just my finding, but one of the things that concerned me the most is that many of the state requirements for being an addiction counselor are very low. The main accrediting bodies for, for rehabs don’t ashore. Number one that’s science based care is offered and there’s very inadequate training of people who work in the field –
JEFF: –Right, yeah.
ANNE: -and most people don’t realize that, that the person who is primary, and this is one of the questions that I would ask if I were looking for care and I, after I wrote the book, I had a loved one who was very close to me, needed had a very, very life threatening addiction and needed care and we were restricted because of insurance restrictions to be in the state of Minnesota. We couldn’t go out of state and you think Minnesota, this is the world
JEFF: –Yeah, yeah.
ANNE: we joke that, we say it’s the land of 10,000 lakes, 10,000 treatment centers people said,
JEFF: –Right.
ANNE: -No, –
JEFF: –I know that one.
ANNE: -they’re not all good ones and –
JEFF: –Right.
ANNE: -many, most of them are not good. And I can remember calling, here’s the key one of the key questions is what are the credentials of the primary care counselors? Now that means what are the credentials? Because when I called a treatment center that was recommended to me by a leading expert. The person who answered the phone didn’t even know what I was asking.
JEFF: –Oh my gosh.
ANNE: That question means what are the credentials of the person who will be spending the most time with my loved one while –
JEFF: –Right.
ANNE: -they’re in treatment.
JEFF: –Right.
ANNE: And, so the answer that question was will they’ll probably have a bachelor’s degree.
JEFF: –Yeah.
ANNE: They don’t have a master’s degree, and if you think –
JEFF: –Right.
ANNE: -addiction is one of the most complicated disorders that there is, because if somebody has a really severe problem, they’re probably going to have a mental health disorder to go along with it. We would never, when you think about the complex, the very sophisticated level that a person really needs to have to treat both in addiction and mental health disorders such as bipolar disorder, severe depression, anxiety, all of these –
JEFF: –Right.
ANNE: -things were very common. You need at least a master’s degree and to tell me this person probably has a bachelor’s degree and in some states to be a licensed addiction counselor, you don’t even have to have a bachelor’s degree.
JEFF: –Yeah, yeah.
ANNE: This is very, very concerning.
JEFF: Well, so I want to say a little bit about that –
ANNE: –Of course, go ahead.
JEFF: Just from my own experience, and that is, you know, I mean, I know treatment centers all around the country and there are some of them that it’s like your point is an important criteria for families to be aware of when they check different treatment centers, the counselors that are spending the time with their loved one, what are their credentials, what’s their background? And so I have seen treatment centers that like I am in an area where there is a lot of universities and schools that produce counselors and counselors need to get their hours when they get out of school. And a lot of times they will try to get their hours wherever they can get their hours. And so there’s treatment centers that will pay people that just have a master’s degree. They’re not licensed yet, but they have a master’s degree and they need to get however many thousand hours and they pay them like 20 bucks an hour or something like that. So they have some academic understanding, but they’re like thrown into some really difficult situations. That said, the other thing that, that I’ve seen is I’ve seen treatment centers that have the vast majority of counselors and therapists on their staff, you know, have many years experience and you know, oftentimes more than just a therapist license. And as you said, and I’ve seen this before too, you know, looking at a website and then seeing that really no one has a master’s degree there. They don’t even have a master’s degree at all.
ANNE: –That’s right.
JEFF: And so there’s quite a huge spread there. And I mean the other thing that I’m aware of it, because you know, I’ve worked in some treatment centers is you know, the climate for treatment centers, you know, that changes and that becomes more stringent. And you know, I’ve seen very good treatment centers who were private pay, and then then they got in a situation where they needed to start taking insurance, which was on one level that’s a good thing. And on another level then they were put into a whole different situation. And so it’s like treatment centers are constantly in a different state of flux, you know, things, –
ANNE: –Yes.
JEFF: -things change and, and they’re responding to it the best they can. So the leadership there I know is really, really important so. –
ANNE: –Yep, yeah.
JEFF: There’s no black and white way that I know of to, you know, talk about this other than like what you’re doing and, and that is suggesting some criteria. And look this, look for this. And before we turned on the recording, you said at the end of your book there was like all these questions that someone could look at to help them figure out what questions to ask the treatment center and, and like, that’s golden. That is really, really important. And hopefully, you know, the comment of people spend more time researching a vacuum cleaner than a treatment center.
ANNE: –Right.
JEFF: Hopefully that will change.
ANNE: Right, well I do offer an extensive consumer checklist and you know, you, you might not be able to ask all of these questions, but you could look at the list and decide what’s most important to you and they’re questions like one thing we haven’t talked about is how long is your program.
JEFF: –Right.
ANNE: Is there a finite length? And this would be an example of one size fits all is everybody there for 30 days and sometimes you’re limited by your insurance company, which is absurd –
JEFF: –Yeah, often.
ANNE: -two weeks. But the national institute on Drug Abuse recommends that people be there for, somebody with in the severe category, somebody with addiction be there at least three months.
JEFF: –Yeah.
ANNE: Think about that, it’s really it should be individualized for each person. That really would be the ideal. Now, I worked at a program for, as an educator, I’m not licensed in addiction treatment, but I worked as an educator for three years after I finished the book and it was a unique, that’s called Minnesota alternatives and it was a unique outpatient program treating called dual, dual diagnosis. We treated people with both addiction and mental health problems. And somebody said, how long has the program, there was no answer to that. It was –
JEFF: –Yeah.
ANNE: -individualized for each person. So it’s ideal if they’re, there is no, no ending for the program you, you come and the ideal program would be one that you would come back to.
JEFF: Right.
ANNE: We talk about quote unquote aftercare. Aftercare is often non-existent or go to AA meetings or which, as I already said, is not treatment.
JEFF: –Right.
ANNE: It would ideal if it would be some kind of professionally run program or some kind of treatment. One of the problems is though that extended care or what you would go to after the formal program ends. Um unfortunately it’s often not paid for by insurance, but it would be ideal if it would be something that you would maybe see it an individual counselor. But anyway, that would be another –
JEFF: –Right.
ANNE: -ask would be what happens after the formal program ends?
JEFF: –Sure.
ANNE: What the staff to client ratio is, how much time is spent in group counseling versus individual counseling.
JEFF: Yeah, so the other thing, and, and I’m kind of like throwing my own plug in here right now and, and my own,
ANNE: I know what you’re gonna say and I’m going to agree with it completely go it.
JEFF: And so I mean the other thing that I think is important for you know, when families look at treatment centers is to look at what is the family piece like.
ANNE: Absolutely, and I’ve been wanting to get to that I’m so glad you got to it.
JEFF: Yeah, so it’s like how can the family engage in their loved one’s treatment and there’s like, –
ANNE: –Yes.
JEFF: -there’s not a lot of specific criteria that every treatment center is going to handle that the same way. I know that you know that and just from what I have seen, it’s like I know treatment centers that have a week long program for families,
ANNE: Which usually means four and a half days of psycho-educational.
JEFF: A lot of it, but not all of it. You know, there’s some good programs out there and that’s like one of the best ones that I know. And that’s like aside from, you know, where the family is skyped in or something to, –
ANNE: –But there’s no evidence really that they’re very effective. You know the family really, really needs to be involved and, and usually it’s suggested that they go to Al Anon and there’s evidence that it helps the family but it doesn’t really help them with helping their loved one. You know, it’s an approach where it teaches people that you really can’t change your loved one and we know that you can help your loved one because it’s been shown over and over again in a number of studies, quite a few studies using the craft model, community reinforcement –
“The family really, really needs to be involved.”–Anne Fletcher #FamiliesNavigatingAddiction&RecoveryPodcast #JeffJones Share on XJEFF: –Right.
ANNE: -and family training that you can motivate your loved one.
JEFF: –Right.
ANNE: And –
JEFF: –Right.
ANNE: one of the things that was sad to me was to, to hear that you, you can’t motivate your loved one to change and you go to Al Anon and you hear that you can only help yourself and then you hear that your patient’s probably gonna relapse. Well what are you supposed to do with that?
JEFF: –Yeah.
ANNE: I heard that over and over for adolescents, but you can help a patient who is likely to relapse.
JEFF: –Right, right.
ANNE: Very specific strategies to use.
JEFF: And I mean we’ve been talking about all the complications with the individual with the addiction or substance use disorder or whatever you want to call it.
ANNE: –Yes.
JEFF: You know, and then like what a wide span that is and how difficult that is to understand. And then this family piece on top of it, it’s like, it’s even more complicated and it’s like when we look at the economic situation, you know, the environment around addiction, treatment and recovery, there’s not a lot of understanding about families and like, yeah, there’s the Al Anon thing just back off and take care of yourself largely. There’s the craft model, which there’s a lot of things in the craft model that I have incorporated into what I’m doing.
ANNE: –That’s great.
JEFF: You know, there’s different roles in the family. There’s different strategies to try to help or deal with the stress or deal with the chaos of addiction. So there isn’t one program that’s gonna address every one situation. And you know, what I’ve done is to have a whole family healing program that happens over time to engage families. And it’s online so people can, you know, be a part of the same information, the same conversations regardless of where they live. And it isn’t about like, you know, I know exactly where everybody’s going to get to, but it’s an opportunity for people to be engaged and the same process here one another express themselves, what’s going on.
“There isn't one program that's going to address everyone's situation.” –Jeff Jones #FamiliesNavigatingAddiction&RecoveryPodcast #JeffJones Share on XANNE: Which is what, what Jeff has and what’s Jeff has developed and it’s all in one place, which is wonderful.
JEFF: Yeah, so when I go back and think about, you know, the challenge that you took on when you started researching and learning about addiction and addiction treatment and it’s like an, I’m really struck with like, I’m just getting to know you, but I’m really struck with wow, you’re a curious person who is like a dog with a bone, I’m guessing and just follow the thread and keep asking questions and learning more.
ANNE: Well, thanks for recognizing that it did take about four years to write the book. So, um, and one thing I didn’t mention is that not only did I visit the 15 programs of all different shapes and sizes, but I interviewed more than a hundred people and families who had been involved with addiction treatment programs and then on top of it, close to a hundred experts in the field.
JEFF: Yeah.
ANNE: Staff that included both staffers and academics.
JEFF: –Yeah.
ANNE: And willing to give me lots of input so yeah, there there’s that patchwork quilt again where I weave it all together.
JEFF: Well, I’m gonna you know, I’m gonna have to get the book myself because one of the things that I’m aware of is so much of the information out there about addiction and the people in treatment centers are in their own recovery. And so in some ways that’s wonderful because they know bullshit, excuse my language.
ANNE: Why don’t you be direct? Yeah.
JEFF: Where you know, I may, well I get lied to probably all the time, but the other side of it is it’s easy for people who are in their own recovery to not really be so open to, hey, there’s different pathways out there, you know, and I can help share with you what some of those are. Once I have an understanding of, you know, what your beliefs are, what your needs are, what your past is, what your situation I’m in, etc, etc. And like, so what I hear you’ve done is you’ve come at this, you know, as a curious researcher, not, you know, being surrounded by the black and white thinking of addiction. And boy, when I listen to what you’ve done, you have really, you know, surrounded yourself with a lot of experts and a lot of science and then face to face experiences in treatment centers and talking to people so.
ANNE: Well that is what I tried to do and the book is largely written for lay people, you know, who are faced with the problem. But I also help hoped that I would capture the interest of people who work in the field. And I was very pleased. Um, if I may say that the reviews on major websites like Amazon suggest that people in the who work in the field have, it has captured their interest and people have made comments like I hope everybody who works in the field will read this book and hopefully it will influence some of the thinking in the field.
JEFF: Right. Yeah. Yeah. Well thank you very much for what you have done, I appreciate it. And so with where we’re at right now, is there anything that you wanted to share that I haven’t asked about or you haven’t mentioned?
ANNE: Well, I guess the one area that we haven’t tapped, and I, we don’t have a lot of time to get into a lot of details, but there really is a big, big gap between science, what science shows to be effective and practice what actually goes on the field. And most addiction treatment programs say they’re using scientifically backed approaches and they are to a certain extent, but most are used minimally and or they’re not used as they were meant to be used according to protocols and research studies.
“There really is a big, big gap between science, what science shows to be effective, and practice what actually goes on in the field.”–Anne Fletcher #FamiliesNavigatingAddiction&RecoveryPodcast #JeffJones Share on XJEFF: –Right.
ANNE: And you know, we, this is actually been studied, you know, where they were experts, academics go into treatment programs and they can measure the extent to which the scientifically backed approaches are being used and the names –
JEFF: –Uh uh.
ANNE: -of these approaches, and we won’t go into them now, but cognitive behavioral approaches, motivational interviewing, motivational enhancement, couples, –
JEFF: –Right.
ANNE: -family therapy, something called contingent management and –
JEFF: –Yeah.
ANNE: -experts go in and see if they’re being used and they’re not being used or they’re not being used appropriately.
JEFF: Yeah, yeah, yeah. So one of the things that I want to say Anne is, I know the science is important and the treatment center using that science, the other thing that I’m aware of that is not so easy is just some practical understanding of what’s going to fit in a certain context. And when I look at the statistics of addiction, it’s horrible. It’s, it’s like you know, 150 people or something are dying every day and I am thinking to myself what we are doing. There’s plenty of room for modification and change and you know how like one way that I hear you talking about is to increase the kind of the quality of what treatment centers are doing. The other thing that I think about is is their openness to include complements to what we have right now. Because I really see families early on being, you know, having an environment to engage with education and material and talk with one another anonymously and build trust as they’re ready. Like all this kind of stuff is possible but this whole family piece gets ignored and there’s not a lot of science that I am aware of with that family piece.
ANNE: Yeah, I agree. We need a lot more.
JEFF: –That’s a gap that I see.
ANNE: One area, one area where there is the science and it’s working with adolescents. There’s not science supporting 12 step approaches for adolescents, but they are used all the time that lessons. But there is a lot of, and I give the specific names of the there, I don’t want to say they’re packaged programs with, there are specific approaches used for adolescents and they involve the family and they have been shown to be highly effective for adolescents and –
JEFF: –Right..
ANNE: -they do not involve the 12 steps. They involve parents or significant others –
JEFF: –Yeah.
ANNE: -and they all have been tested and they need to be used much more than they are. A few things that I want to mention specifically when we talk about science and practice, we do know that some really significant things that are, they’re not as hardcore scientific approaches, but things that are highly significant. Um, in terms of helping people get well, one is the relationship between the client and the therapist or the counselor. –
JEFF: –Right.
ANNE: -probably more significant than those names that I mentioned earlier. It’s so important that the client had, it’s called therapeutic alliance.
JEFF: –Right.
ANNE: They like and get along with your counselor. If you’re ever told, if the clients ever told, well, tough luck, you can’t change counselors. Um, and my loved one who went to treatment did not do well and it was a young adult. And so, you know, just barely out of adolescence. If you have a confrontational counselor and you don’t like the counselor, you better believe you have a right to change. You know you’re paying for it or your insurance is paying for it. You need to get along with your counselor. Another thing that we know is, and I have a list of these things, I’m just going to mention two of them right now, the things that we know help people change. Another one is giving them choices. If you’re told this is the only way, and if you don’t do this, you’re not going to get well, –
JEFF: –Right.
ANNE: -no he give people choices the more choices people are given, the more likely they are to change. So, you know, again, we get can go back to 12 step or trying something else, but also choices within. What do you know has worked for you in the past? Many times people know what will work for them, –
“We give people choices. The more choices people are given, the more likely they are to change.”–Anne Fletcher #FamiliesNavigatingAddiction&RecoveryPodcast #JeffJones Share on XJEFF: –Right.
ANNE: -so giving people choices is very important. And the last thing I want to mention too is that it’s not directly connected to, to those last two things that I mentioned, but we know that there’s great failure to use medications that we know can be effective and are effective for treatment of addiction.
JEFF: –Right.
ANNE: They’re not used to the extent that they should and could be used. We have a medications that are effective for alcohol problems, but the one that we have really good data on them being affected for opioid problems.
JEFF: –Sure.
ANNE: They’re not used to the extent that they should be used in addiction treatment programs and it’s very important to ask about them. And I have sections on them in the book and there’s a lot of stuff out there on that’s effective. And if you go to a treatment program and they say, we don’t believe in them, we don’t use them, then I would not recommend going to that program.
JEFF: Sure. Yeah. Yeah. Well, Anne thank you so much. This has been a very light –
ANNE: –Well, thank you.
JEFF: -conversation and I’m aware that I’m like ha having to kind of like stop myself from responding, but thank you very much. I appreciate it.