When Lindsay Lohan entered the Betty Ford Center, as part of a court ordered rehabilitation programme, it was her second time as a visitor, and her sixth stint in rehab.
Yet, it is still not clear whether her 90-day course of support will go any way to solving her addiction problems.
The revolving door to high-profile rehab clinics would suggest that these residential support systems, which regularly treat celebrities individuals with drug and alcohol addiction problems, appear to fail as often as they succeed.
As Harry Shapiro, director of communications for Drugscope, explains: "In truth, there isn’t much clinical ‘gold standard’ evidence to demonstrate the effectiveness of rehab when contrasted to other interventions."
While the idea of a rehab conveyor belt that can clean up 'dirty' addicts, and return them to the community good as new, is very attractive -- in reality, the effectiveness of residential rehab depends on a wealth of factors.
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"If somebody does better in rehab than on other methods, there may be a host of reasons for this, which have little to do with the intervention itself. It could have more to do with the individual, their history and circumstances, which is impossible to account for in a research study."
A recent report by the National Treatment Agency (now part of Public Health England), completed in July 2012, points out that the popular notion of a spell in rehab, beloved of the tabloids, is not representative of mainstream treatment and recovery services provided in England.
“The best performers see more than 60% of their residents go on to overcome dependence, while the poorest struggle to enable 20% or fewer to overcome addiction," states the report.
"For every 10 people who go to rehab each year, three successfully overcome their dependency, one drops out, and six go on to further structured support in the community. Of those six, two overcome dependency with the help of a community provider, at least two are still in the system, and at least one drops out."
After rehab, Lohan will undergo 18 months of psychological therapy, according to NY Daily News.
Elspeth Henderson, head of communications (drugs and alcohol) for Public Health England, agrees that residential rehabilitation works best when it’s used in conjunction with treatment in the community.
“It needs to be part of package of support available to people everywhere in the county, depending on their individual needs.”
At present, there is a high relapse rate from rehab, but dropping out or returning to treatment should not necesarily be regarded as failure, suggests Shapiro.
"Addicts often have several goes at treatment generally (not just rehab). The evidence is that each time round they are likely to do better than the previous time. And the longer they stay, the better chance they have."
"Many people in this situation are trying not only to shrug off an addiction of many years standing, but also trying to deal with all the reasons why they became addicted in the first place. To imagine this can all be sorted by a few weeks in rehab is by and large unrealistic. "
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Lindsay Lohan
In England, there’s no such thing as a mandatory requirement to undergo rehabilitation, according to Henderson. Yet courts may encourage individuals to voluntary take part in treatment, as part of their sentencing.
However, according to HuffPost UK blogger and founder of Charter Day Care, a residential and counselling treatment facility Mandy Saligari, about a third of those entering state funded treatment services in the UK are motivated by the legal system.
"This could be a drug rehabilitation requirement of their sentence, or similar," explains the addiction therapist.
"As so many people enter rehab involuntarily with their backs up against a wall, it is not unusual for someone not to be there ‘for the right reasons’."
Unless treatment is holistic, lengthy and fully tackles the context that prompts addictive behaviour -- rather than focusing on abstinence -- a relapse mentality can become easier to adopt, suggests Saligari.
"The more you relapse the more you think you can live in relapse; you will seek out a relationship or community to enable you and this is how you will live.
"It is a feature of addiction that the addict doesn’t finish. Provide a standard and the addict will do just enough to get by.
If you set the bar that relapse or ‘controlled using’ is acceptable, then that is what they will do. Sad as most drug addicts seeking help want abstinence."
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Rehab England Facts
- There are around 100 rehabs in England that are regularly commissioned by public authorities, and over 4,000 users who were in treatment during 2010-11 accessed them as part of their treatment pathway. Yet this is only a fraction of the overall picture of drug treatment in England.
- The average time spent in residential rehab is 13 weeks.
- Residential rehab currently accounts for 2% of people in adult drug treatment but 10% of central funding. On average a period in rehab costs £600 a week, making it much more expensive than non-residential treatment services.
- In 2010-11, commissioners planned to spend about £42m on residential rehab.
- Rehabs are more successful at retaining and treating residents with severe alcohol dependency than drug addicts – possibly because dependent drinkers have more personal and social capital to invest in recovery.
For more information about help with drug addiction, please contact the Frank helpline and for advice on alcohol dependence, visit Drink Aware.