Does size matter? This question gets batted around on all kinds of topics. Some may wonder if a bigger university is better than a smaller one. Others have firm opinions regarding the size of the city or town they live in. But what about addiction treatment? Can small treatment facilities offer the same benefits as larger ones? In our opinion, they absolutely can. Furthermore, we believe that small treatment facilities can offer a few benefits that larger treatment facilities cannot provide.
We will discuss the advantages of small treatment facilities in due time. First, we would like to discuss why larger treatment facilities may not be all they’re cracked up to be in some cases. We would also like to make some notes regarding state-funded treatment facilities, which are often small but cannot provide adequate care in many instances due to the unfortunate circumstances of their funding. But before we discuss any of that, we’d like to discuss education. Believe it or not, some of the benefits of small treatment facilities are very similar to the benefits of private schools.
Similarities Between Treatment and Education
So that we do not offend the many public school graduates who may be reading this, we should note that there are several aspects of public school that many consider to be advantageous. Students are exposed to a wider social setting, with a curriculum that fits what most of their generational peers are learning. In a Huffington Post article by Robert Niles, founder and editor of Theme Park Insider, it is suggested that the appeal of private schools is largely illusory due to their ability to admit only the students that will reflect best upon the school.
But while private schools may have the ability to enhance their reputation by cherry-picking their students, there are still many benefits to a private education. While it has been discovered private school students do not necessarily perform better on tests than public school students, they still have a tendency to be relatively satisfied with their education. This has been attributed to many things, but class sizes are among the most commonly cited. Smaller class sizes allow for more one-on-one interactions between teachers and students, enabling students to ask more questions and seek help in the specific areas that are troubling them.
Education journalist Janet Murray writes in an article for The Guardian that some people think private schools to be unfair. After all, those with limited financial means cannot simply up and send their children to private school just because they want their child to receive a quality education. Kids who are forced to go to public school due to their parents’ lack of funding are therefore receiving the short end of the stick, while those who attend private schools are being rewarded for their family’s wealth. This opinion does not take all sides into account. Still, it is not an uncommon view among those who wish to attend private school and are unable to do so.
While some small treatment facilities may have this particular drawback, not all of them do. Many small treatment facilities such as Amethyst Recovery offer free verification and placement programs in order to help as many patients as they can, even if they cannot help them in a more direct fashion. Many patients are also able to afford treatment by making use of their health care and insurance options. In terms of education, think of these like scholarship programs.
Furthermore, it should be noted that addiction treatment is very often education-based. Patients must learn about themselves and how their addiction has affected them. Those who suffer from co-occurring disorders will have to learn twice as much, because they will have a built-in trigger that they must learn to manage. In addition to psychoeducation and substance abuse education, family education is also a primary part of the standard treatment model. In short, education plays a big role in addiction treatment. Small treatment facilities are therefore similar to private schools with smaller class sizes. Since the patients do not outnumber the staff at alarming rates, the counselors are not too overwhelmed to provide patients with the one-on-one interaction they sometimes need. Group therapy is wonderful, but the ability to speak with a therapist in a more intimate setting is sometimes necessary.
Issues with Larger Treatment Facilities
We’d like to say before going into the following details that we have a lot of respect for the treatment centers we are about to mention. Without Hazelden and the Betty Ford Center (which merged last year to become the Hazelden Betty Ford Foundation), the current standard model of addiction treatment may not exist in its current form. The benefits of treatment might not be as widely known, and many people who are sober today would not have been helped.
That said, larger treatment facilities are far from perfect. Their name recognition increases the likelihood that prospective patients will have heard anecdotal evidence of their successful treatment, and the fact that many larger facilities have as many as 100 beds or more is helpful in ensuring that they will have open space. But they can also cost anywhere from $30,000 to $50,000 or even in the six-figure range, even when they are classified as a non-profit. Then there are the treatment centers that seem more like swanky hotels than anything else.
These large facilities have helped turn addiction treatment into a $35 billion industry. And while that sounds like a good thing, you’re likely to hear that number quoted by opponents of the recovery community when they are attempting to argue that treatment centers are motivated by profit rather than the drive to help people. These opponents will often publish research that conflicts with most commonly accepted addiction statistics and demographics, defining relapse as total failure and arguing with many of the basic fundamentals of addiction treatment that have helped thousands recovery today. Don’t get us wrong, the recovery community as a whole is not perfect. There are many ways in which it could improve, but bashing it as a whole will often be enough to convince some people that they are better off without treatment at all. While some of them may recover, many of them will surely die.
Of course, these large facilities did not intentionally fuel opponents of addiction recovery simply by making a profit. But if their executives were to discover that giving up their six-figure salaries could put an end to all opposition against addiction treatment, would they do it? Probably not. And to be clear, we aren’t suggesting that they’re greedy. The real issue is that treatment centers actually use quite a bit of that money for marketing. If you’re familiar with paid product listings on Google, then you know a bit about how this works. Companies pay Google to show up at the top of search results. When that company is a treatment facility with at least an extra $1 million per month lying around, these listings are easy to acquire. But that doesn’t always mean they’re going to offer the best treatment.
So remember that just because a treatment facility is large and shows up at the top of Google search results does not mean that it’s worth your money. Real marketing shows the heart behind the treatment center, without all of the flash of search engine optimization and pay-per-click advertising. Any treatment center has the potential to help a patient. But if you feel like a facility is all flash and no substance, it isn’t the worst idea to trust your gut.
Issues with State-Funded Treatment Facilities
Small treatment facilities may be able to offer a fair amount of one-on-one interaction between patients and counselors, and they may not suffer from a surplus of flash and a dearth of substance. But that does not mean that they are all beneficial. This is because, as noted by the National Institute on Drug Abuse, many of these small treatment facilities rely on government funding.
There is nothing wrong with state-funded facilities, but not every state is able to offer the same level of funding. The result is that many small treatment centers suffer from an extreme lack of financial assistance. Hilary Clinton has proposed a $10 billion plan to help rectify this issue, but there is no telling how her proposal will pan out in the end. Maine is just one example of a state that is currently seeking additional funding for a new addiction treatment program. Some states are doing significantly better than others, but many are struggling to keep their treatment centers above water.
Lack of funding is not the only problem facing many state-funded treatment centers. Another problem, which especially relates to small treatment facilities, is the use of waiting lists. These lists can be months long, which is problematic since close to 40% of addicts will not enter treatment if wait-listed for two weeks or more. In fact, between 25% and 50% of addicts who are put on waiting lists will never enter treatment at all.
With the limited capacity of state-funded facilities, the waiting list is not the only issue that tends to arise. The other issue is the commonly cited “revolving door” issue in which patients seem to enter a state of chronic relapse after every attempt at seeking treatment. This is something that many patients experience outside of state-funded facilities (often when their insurance runs out), but it is much more common when the limited space and even more limited funding of a government-run treatment center may sometimes require patients to leave before they are ready.
Finally, a major problem with state-run facilities is that lack of funding may often prevent them from seeking out the best possible addiction counselors. While a well-funded treatment facility will have licensed or certified addiction counselors (LACs/CACs), a poorly funded facility may only have registered addiction counselors (RACs). These are counselors who have worked with addicts, but have not actually studied counseling and therapy at the collegiate level. Of course, this depends upon the state. But in many states, RACs need little more than a GED. There are also many state-funded facilities that use outdated methods or methods that are simply ineffective. Again, this is often through no fault of their own. They are doing what they can on a shoestring budget. But in many cases, that just isn’t enough.
Why Size Doesn’t Matter Here at Amethyst
We are fortunate at Amethyst Recovery in that many of the issues discussed above do not apply to our programs. Since we are not state-funded, we are able to seek the help of quality staff members. Since we do not spend $1 million per month on marketing, we are forced to be honest with our prospective patients. And since we are a relatively small treatment center with only about 30 clients and 27 staff members, we are able to offer intimate care with a quality dose of one-on-one interaction between counselors and patients.
It may seem as if a small treatment facility would be unable to offer a wide array of services, but we pride ourselves on services such as our court liaison program for those with legal troubles. This is just one example of how our small treatment facility acts as an additional benefit to those in need. Since we have relatively few clients to handle at a time, we are able to provide them with individualized care that accounts for the specific circumstances of their addiction and recovery.
Since we are a relatively small treatment center, patients also stand a much better chance at acquiring a spot in one of our sober living facilities. This is important, as addiction often requires ongoing treatment if the patient is to truly recover. Many patients are not ready to leave treatment and immediately leap headfirst into the “real” world. By providing them with a form of transitional housing, we enable them to ease their way into sober living.
One of the final benefits that we should mention of recovering in a small treatment facility is the ability to form a strong and sober support network. While larger facilities may have more patients, an intimate facility such as Amethyst allows for a much more tight-knit patient community. Since there are fewer patients, they will be able to get to know each other on a deeply personal level. In doing so, it is not uncommon for patients to develop a vested interest in each other’s recovery. Patients can later contact the friends they made in treatment, as a means of support in addition to their sponsors.
Amethyst Recovery may be a small treatment facility, but this is a case in which quality is surely more important than quantity. If adding seventy more beds to our facility meant that our patients would not receive the same individualized treatment regimen, the same opportunities for one-on-one interactions with the staff, or the same intimate fellowship with other patients, then we would have a moral obligation not to add those beds. Because it might be a way of increasing profit margins and adding to marketing, but that is not our main goal here at Amethyst. We are here for the patients’ welfare, not their wallets. We won’t do anything to jeopardize the level of care that we are able to provide.