The Importance of Drug Rehabilitation

One of the controversaries in the field of drug treatment is the role that a formal drug rehabilitation program should play in the overall treatment strategy. Some methadone maintenance programs have been able to help patients stabilize their lives in dramatic ways by providing methadone medication without participation in an intensive drug rehabilitation program. Similarly, many prescribers of buprenorphine require minimal or no other treatment as a condition for receiving the medication. Why then, does Kolmac restrict its use of buprenorphine to patients willing to participate in its intensive outpatient drug rehabilitation program?

The answer is that at Kolmac we think that by adding drug rehabilitation our patients have a better chance of achieving a more ambitious goal than stabilization -- a full recovery from addiction to drugs and alcohol. The Kolmac approach represents a return to the strategy used by the originators of methadone treatment -- Drs. Vincent Dole and Marie Nyswander. As described in William L. White’s excellent book, Slaying the Dragon: The History of Addiction Treatment and Recovery in America, their pioneering program in the 1960’s and 1970’s included substantial psychosocial interventions in addition to the administration of methadone. Only when methadone treatment was established in other facilities were the psychosocial interventions eliminated because of limited resources.

Given the variety of patient preferences and the reality of limited resources, however, a health care system characterized by a spectrum of addiction treatment intensities is a necessity. The most widely accepted formulation of this spectrum is the Patient Placement Criteria promulgated by the American Society of Addiction Medicine. In addition to non-intensive outpatient levels of care, these criteria include detailed descriptions of drug rehabilitation programs at a variety of levels ranging from Intensive Outpatient to Medically Intensive Inpatient. The Kolmac philosophy is to concentrate on the high quality delivery of the least expensive of these levels, rather than trying to deliver the full range of levels. More specifically, the Kolmac goal is to deliver drug rehabilitation at an Intensive Outpatient level, which is the most accessible and least expensive level of drug rehabilitation.

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