Expert addiction specialist talks reality of rehab, and why it is not a perfect science

There is no 100% cure for drug and alcohol dependency, but some treatment centers excel at effectively following up with those who are newly sober and most vulnerable.

Studies prove that long term follow-up programs can dramatically increase recovery rates. Smart addiction therapy centers know this, and follow up with services long after initial treatment has been conducted.

The amount of counseling, psychoanalysis and medical care each person needs is as individualistic as we all are, and the success rate for clients varies depending on how much the patient is willing to submit to treatment and attempt to better themselves on a daily basis. The adage “one day at a time” never rings truer than for recovering addicts and alcoholics.

Dr. David Sack

Dr. David Sack


No one knows this more than David Sack, MD, CEO of Promises Treatment Centers, a a board-certified psychiatrist with 30 years experience in addiction therapy and a frequent expert contributor to Monsters and Critics.

Promises Treatment Centers are widely regarded for handling high-profile clients with substance abuse problems. Promises recently was named by BBC as “the world’s most famous addiction center,” and it was rated at the top of list of the “best” treatment centers for addiction in the U.S. in a report earlier this month by ABC and Yahoo! Promises’ facility in Malibu is the one that gets the most interest, mainly for its celebrity clientele, who feel protected and comfortable while addressing their broken personal lives.

Giving each individual their best fighting chance for success is the focus at Promises. “Not every client will bridge from active addiction in sustained sobriety in one treatment episode,” says Dr. Sack. “At Promises we strive to maximize their success by increasing our clients’ resilience to stress, treatment for the family and commitment to sustained spiritual change through 12 step recovery.”

Dr. Sack took over management of Promises in 2008, and during the last three years he has completely revamped the center’s treatment programs – transforming it into the internationally-acclaimed addiction treatment center that it is today. Dr. Sack himself also has been in the news lately for his expert opinion on the unfolding story of Whitney Houston’s untimely death, which has been widely reported in the media to be the result, indirectly or directly, of a long history of chronicled alcohol and drug abuse by the superstar singer.

We asked Dr. Sack what people can reasonably expect when they enter treatment at Promises.

Can you briefly describe Promises’ philosophy to treatment of alcohol and drug dependency?

“While both treatment programs and clients have as their goal complete sustained abstinence from psychoactive drugs, there are a range of positive outcomes that occur when people receive treatment.”

What if someone continues to use alcohol after rehab?

“Among those who have been through treatment but continue to drink alcohol, their behaviors often moderate with evidence that it has positive effects on their lives. These individual report 50% fewer heavy drinking days and a similar reduction in the days missed from work. Health problems which tend to be magnified by drug and or alcohol abuse, improve over the two years following treatment to that of the general population.  Naltrexone, the most commonly prescribed treatment for alcohol dependency, has it greatest effect in decreasing the number of heavy drinking days, not in extending abstinence.”

If there’s no 100% cure, why bother?

 “This raises the question: What should be the goal of treatment?  At Promises we want every client to work toward living a full and rich life that is free of drugs and alcohol.  Our treatments are designed to improve continued abstinence by addressing factors that undermine recovery: other psychiatric problems, family conflict, impulsivity and poor choices, and cravings.”

Aren’t the underlying issues the real reason people “medicate” themselves, trying to right something either chemically imbalanced or a deep psychological trauma that has never been addressed?

“At least one out of three clients in treatment also suffers with another psychiatric problem: major depression, anxiety disorders, post-traumatic stress disorder, insomnia, and attention deficit hyperactivity disorder. In each of these cases, relapse rates are four to 10 times higher if the underlying psychiatric problems go untreated. There is considerable evidence that substance dependent individuals have an exaggerated stress response, and when stressed psychologically, their cravings for drugs increase.”

What is the response to unlocking someone from these behaviors?

“In addition to giving clients the psychological tools to manage stress more effectively, we train our clients to manage down their stress reactions using a range of self-regulation techniques such as neuro-biofeedback, yoga and meditation. Physical stressors, such as sleep deprivation also contribute to cravings and relapse. Teaching clients to manage their sleep-waking schedules and treating insomnia when it does not resolve with behavioral treatment is critical.”

If someone has been damaged by those closest, their family members for example, how do you deal with that? How can you manage the externals of a client’s life?

“Nothing can undermine recovery faster than returning to a family that is in crisis. At Promises, we provide education, therapy and support to the spouses, parents and children of our clients to counteract the difficulties that can occur when a newly abstinent client returns home. Psycho-educational classes provide critical information on the nature of addiction, and family therapy sessions are provided to address the unique needs of each client’s family. An ongoing family support group helps our alumni families build on the changes they’ve begun during residential treatment.”

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