Working In Rehab: a numbers game

Check this out: Do you like numbers? Ok, here’s a few statistics: according to the Treatment Episode Data Set (TEDS) report, as published online by the Substance Abuse and Mental Health Services Administration (SAMHSA), almost 2 million people were admitted for substance abuse treatment in 2010 across the United States, and just over 2 million people were admitted for the same problem in 2009. These are the most recent years for which such statistics exist. The average number treated over the five years prior to this was between 1.8 and 1.9 million people per year, admitted to just over 13,000 facilities licensed or certified to treat individuals for substance abuse. According to the same data tables, between 7 and 8 percent of these admissions—again, on average—are kids. By kids, I mean ages 12-17, and most of these kids are between 15 and 17. That’s about 150,000 teens per year entering programs, in outpatient or inpatient settings—rehab, as the shorthand goes—for the treatment of substance abuse. And by the way, substance abuse is only one of many problems these kids have. This is the kind of information you’ll find in my forthcoming book about drug rehab and teens, due out soon–though, don’t be misled: my book won’t be dominated by numbers. In fact, you’ll see (I hope) that it takes a skeptical view in general of the application of numbers to my profession.

You see, my profession, that of a therapist, is about making a personal connection with people. I know that sounds like sanguine bullshit, but unlike the average entrepreneur, I’m not selling a product alongside a transient interaction that purports to represent commitment. I’m talking about a solid idea that’s quietly being marginalized in the business of mental health services: it’s the relationship(s) that heal. Not so, according to the larger systems in charge: hospitals, insurance companies; managed care. For them, it’s about “quantifiable” aims, that which can be tracked in terms of symptoms, so-called “scales”, tests of one sort or another. Go to a program, especially a hospital based program and you’ll hear the mantra: tests, tests, we must do tests. Later there will be estimates, both of prognosis, and of the money involved. It’s a reductionist process. Why? Because those paying say so, that’s why. They’ve even enlisted scientists to this cause. By scientists I mean researchers of mental health, people scrambling to publish studies whose findings will rubber stamp the proposed treatment approaches. The process here is tautological: find that which confirms efficacy of the pre-ordained standards. Make it understood that the most cost-effective approaches are the best. Proselytize use of those models that are the easiest to train to the growing numbers of fledgling professionals who are eager for jobs and at best secondarily concerned as to what they’re teaching.

How do I know people like me are looking for jobs? If you don’t believe me, believe a ph.d. Hey, that rhymes. In a report for the California department of Mental Health in 2009, John Shea indicated that positions for social workers, marriage and family therapists, and other counselors would grow by 22%, 21%, and 33% respectively (projected until 2016). His report indicated that over 22,000 people held MFT licenses at that time. That number now stands at over 33,000 according to department statistics. Whoa, that’s growth for you. I wonder if the jobs will run out. At what point does the Board of Behavioral Sciences start making its licensing exams harder to pass, thus titrating the numbers coming into the field. There. That’s a token for those who may wonder who I am to say what’s happening in the business of drug treatment. My question back: who do I need to be?

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