Inside Rehab

The Surprising Truth about Addiction Treatment - and How to Get Help That Works

By: Anne M. Fletcher

Narrated by: Marguerite Gavin

Anne M. Fletcher is a trusted New York Times best-selling health and medical writer who visited 15 addiction treatment centers - from outpatient programs for the indigent to famous celebrity rehabs; from the sites of renowned 12-step centers to several unconventional programs - to find out what really happens. What she reveals ranges from inspirational to irresponsible and, in some cases, potentially dangerous.

As always with her books, Fletcher gets the inside story by turning to real people who "have been there", interviewing more than 100 individuals whose compelling stories illustrate serious issues facing people in rehab and endemic in the rehab industry today.

Fletcher exposes 12 supposed facts for the falsehoods they are, including "rehab is necessary for most people to recover from addictions"; "highly trained professionals provide most of the treatment in addiction programs"; and "drugs should not be used to treat a drug addict". Fletcher's most important finding is the alarming discrepancy between the treatments being employed at many rehab centers and the treatments recommended by leading experts and supported by scientific research. Inside Rehab also highlights what is working, spotlights state-of-the-art programs and practices, and offers advice and guidance for people seeking quality care and treatment for themselves or those they care about.

Inside Rehab is the first book to give listeners a thoughtful, sensitive, and bracingly honest insider's view of the drug and alcohol rehab industry in America. For people seeking quality care for themselves or a loved one, Inside Rehab is essential listening, offering a wealth of accurate information and wise guidance.

©2013 Anne M. Fletcher (P)2013 Tantor

Critic reviews

"It's startling, difficult, and important information for those traveling toward recovery, and anyone who wants to help." ( Publishers Weekly)

Good !

A lot of repeating same info but overall very informative. It's good to know that people are starting to understand that this is a complicated issue and all people are different. There are abusers and addicts who are bad people but they were that before drugs. Drugs don't make a person bad but have influence over making bad choices. the person has the choice. Stereotypes of all kind are hurtful and are counter productive. It's sad we live in a world with such judgement and not enough understanding on what really lies beneath that most likely caused the addiction in the first place. Rehab is a scam , AA is a religious like cult and if addiction is to stop we need to start pushing harder for different ways to help.

Much Needed Primer on the State of Drug Treatment

If you or someone you know needs drug or alcohol treatment, read this first. Fletcher exposes the sad state of addiction treatment in the US, and why it costs many families 100's of thousands of dollars for very little effect. She interviews therapists, administrators, and patients of rehab centers across the country to bring this issue to light. She is also hopeful, as she discusses additional treatments, often more effective and much less costly. As a Therapist, I recommend this book for any and all patients needing drug and alcohol treatment.

Solid - But Sometimes Reminds of Consumer Reports

I think Fletcher has done a commendable piece of work here. She's researched, she's interviewed, she's thought it out and she writes convincingly. She effortlessly bats down the "AA is the Only Way" crowd with - hang on - scientific evidence. Not only doesn't AA fail a lot of people as "treatment", it probably shouldn't even be the first line. If addiction is a disease, then it deserves to be treated medically, like TB, not spiritually. It's common sense that nobody tells a diabetic to accept powerlessness over their blood sugar because that is not going to help anybody conquer it successfully, and when it fails, tell them it's because they didn't really want to get better. The treatment protocol can't be "the leeches aren't working! Get more leeches!".

However...

What keeps me from giving the book 5 stars is that from time to time Fletcher switches from an objective and insightful discussion of treatment to advice on choosing and paying for rehab that sounds more like a naive and breezy "how-to". Some of it is silly: consult your insurance company about in-network facilities, and keep notes about everyone you speak to, and get them to guarantee in writing what they will pay for your treatment. Has she never been on hold with Blue Cross? "Certification is no guarantee of payment. Payment decisions are made at the time claims are reviewed", or thereabouts. You should also call the rehab and ask what approaches they take, such as whether they will prescribe medications to assist in detox or maintenance; ask about the professional qualifications of their staff including their education, training and experience; whether there is individual therapy in addition to group; whether there will be a refund of advance payment if someone drops out or is kicked out; and on and on and on. Compare to find the best fit for you.

The problem is, addiction treatment is not a consumer good being marketed to and purchased by consumers. These are sick people who need health care. They aren't buying a car. They can't comparison shop. Anyone in need of rehab will not be in any shape to be spending hours on the phone with the insurance company, which is the one that will drive the bus in the end no matter how much work you do since your only choice will likely be what they'll pay for. Likewise hours on the phone with rehabs, which will likely be unwilling to disclose a lot of information on staff and treatment approaches, on the theory that if you still think you have any say in your treatment and can pick and choose based on what you think will work best for you, you aren't really ready for it anyway. Sure, Mom & Dad could make the calls for you, should you still have them, and should you all still be speaking. That's no answer to someone who is on their own.

A very good piece of work, overall, but buying into the myth of the "healthcare consumer", which this book pretty much does whether or not it uses the phrase, mars it.

Voice

It gets annoying when the speaker felt the need to lower her voice to imitate a mans voice when speaking the male parts. This Made listening to the narrative difficult. I’m only half way through the book and had to order the physical book in order to finish. The content is too good not to finish this book. I’m a medical professional and this formation is very important to my research in this field. Please revise this piece. It’s like nails on a chalkboard.

Great book, not great narration

I really feel like this book was valuable and insightful, yet I quit listening to it 3 times. The narrator HAS a way OF emphasizing the wrong words IN A sentence, that sometimes even muddies what the sentence means. But other than that, it was great. Lots of important information and resources, shared by a author that is motivated by science and empathy.

A good idea, but I wish it were better done.

What could have made this a 4 or 5-star listening experience for you?

Aside from the snarling tones of the reader, I felt like this book tended to be repetitive, inconsistent, and sometimes poorly argued. Big swaths of the book felt like listening to summaries of Yelp reviews. The author repeatedly presents complaints of former patients of these programs without ever providing context.

What could Anne M. Fletcher have done to make this a more enjoyable book for you?

I wish the author had spent more time doing research into the current state of research and regulations. For example, at one point she lists a complaint of a patient that a hospital didn't allow the patient to use their own medications that they brought with them. In fact, this is for legal reasons. This could have been a great resource, but she shouldn't have settled on this draft. The book needs more organization and context.

How did the narrator detract from the book?

The narrator sounded angry or outraged the whole time. It was like she was trying to add too much drama to the thing. It's sad because although she struggled with the pronunciations of prescription drugs, her diction and pace were very good.

What reaction did this book spark in you? Anger, sadness, disappointment?

This book mostly sparked tedium and sometimes annoyance.

Scattered

Any additional comments?

I am not sure what the author's intent was in writing this book. She begins to touch on various topics yet does not do any of them justice: what types of rehab, where to find/how to look for rehab, problems in various treatment approaches, good things about various treatment approaches. None of these is covered in enough specificity to be informative or helpful. She references the various programs she visited, but it is not clear why--is she recommending them? Using them as some sort of prototype? Were they just close by? I expected a thorough discussion about rehab history and state of the science and profession now. Instead I came away with lots of bits of disconnected information.

The narrator is an embarrassment. Simple English words are mispronounced so often that I found myself wincing over and over again. Her attempts at differentiating speakers when presenting quotations were terrible.

In sum, I'm not sure who this book is intended for or what one might get out of this book. I am a retired mental health professional. I was hoping for a book that covered where things are in the state of the rehab treatment circles, just for some casual updating, basically out of a professional curiosity. I was disappointed.