Private Drug Rehab Fort Lauderdale: Can It Cure Addiction?

Can private drug rehab cure addiction?

Anyone who has checked into a drug or alcohol rehab has had the same dream. Something will happen during the month or more inside, and the addiction will be erased from the brain for good.

The honest answer is no. Rehab is one option among several. It is not the default, and a stay in a facility cures nothing by itself.

Dr. Leeds, an osteopathic physician in Fort Lauderdale, has treated medication and drug dependence for over two decades from a small office rather than a treatment center, and this page is his answer to the person shopping for a private rehab. That person deserves to hear what a private doctor can offer instead, and why one of the most common reasons people are sent to rehab, dependence on a prescribed medication, is not addiction at all.

So, what actually happens inside a rehab, which parts of it treat the condition, and what if the condition was never addiction in the first place?

What happens in drug and alcohol rehab?

A residential program begins with an assessment and, for alcohol, opioids, or benzodiazepines, a supervised withdrawal period. Then come the weeks of programming: group counseling, some individual therapy, family sessions, and a curriculum built around the twelve steps.

The rest of the day is filled with what the brochures photograph. There is equine therapy, art therapy, morning yoga, a gym, movie nights, trips to the beach, and, at the luxury end, massage.

There is nothing wrong with a horse. It has simply never prescribed anything.

Patients who have been through more than one program often describe the same discharge: a folder of worksheets, a list of meetings, and not a single prescription for the condition they came in with.

Does luxury rehab work?

We all know the old saying that you get what you pay for. In rehab, what the price buys is mostly the amenities, and the medical care underneath may be no better than a state-funded program, or thinner.

Imagine checking into a beautiful resort with a broken leg. The food is excellent, the massage is relaxing, and the ocean view is lovely. Yet, if no one sets the bone, you check out a month later with a broken leg and a bill. Addiction is not a fracture, and the comparison only goes so far, but it goes far enough. A rehab that does not know how to taper a benzodiazepine slowly, does not use medication for opioid dependence, and does not send its patients home on naltrexone has not set the bone.

So, ask what the medicine is before you ask about the horses.

Private treatment centers could do better.

There is a real opportunity inside a private program, because the patient is safe, sober, and paying attention. Real medical treatment could fill that month.

Family therapy could be delivered by trained psychologists rather than fitted around a group schedule. Buprenorphine and naltrexone, two affordable medications with long track records when they are prescribed properly, could be started before discharge rather than never.

Unfortunately, many programs still measure success by the number of days a person stayed substance free inside the building. That number says almost nothing about the year after.

If a rehab sends a patient home after a long admission without naltrexone or buprenorphine, has it really provided the best care it could? In Dr. Leeds’ opinion, it has not.

Rehab does not have to be a building.

The most dangerous dependencies respond to medical treatment, and medical treatment does not require a campus. It can be delivered quietly, in a small doctor’s office with a staff of two or three, or over a video call from your kitchen table.

Call it a private rehab non-facility. Why do so many people need to know about your medical condition? Does it improve your outcome? Of course, it does not.

There is also the matter of who delivers the treatment. Large group sessions are often run by counselors who are themselves in recovery, and while their experience is real, it is not medical training.

In fact, for many patients the small office is not the fallback at all. It may be the best place to be treated.

Physical dependence is not addiction, and the difference decides the treatment.

Physical dependence is not addiction. Dependence is what the body does when it adapts to a drug taken every day, and addiction is a pattern of behavior, the compulsive use that continues despite harm.

A person can have one without the other. While the person who took Klonopin exactly as prescribed for ten years and now cannot stop is dependent, not addicted, the person who uses opioids compulsively is usually both.

The treatment must match the condition. In medicine, we have an established tapering method for many of the drugs that cause physical dependence: the Ashton Manual and the Maudsley Deprescribing Guidelines for benzodiazepines and psychiatric medications, buprenorphine for opioids, and naltrexone for alcohol.

This is the principle behind everything on this page. If a medical taper exists for a condition, it should be used, gradually, with the patient directing the pace, and not replaced by an addiction program that was built for something else.

Rehab was built for addiction. What happens when its model is applied to a patient whose only problem is dependence on a prescribed pill?

Rehab is the wrong tool for benzodiazepine dependence.

Addiction treatment centers now advertise benzodiazepine “detox” for people who took Xanax, Ativan, or Klonopin (alprazolam, lorazepam, or clonazepam) exactly as their doctors instructed. The patient who walks in is treated as a person with an addiction, because that is the only kind of patient the program was designed for.

Unfortunately, the taper then fits the insurance policy rather than the nervous system: seven days, ten, fourteen, or thirty, whatever the plan will cover. The clinical goal is “substance free by discharge,” and the patient sits through twelve-step meetings and group therapy that have nothing to do with physical dependence on a prescribed medication.

A benzodiazepine taper done properly is measured in months, and a year or longer is often appropriate. Cutting it to two weeks is not a faster version of the same treatment. It is a different, and dangerous, event.

One warning stands above everything else: never stop a benzodiazepine suddenly, and never let a taper turn into an abrupt stop. Sudden discontinuation can trigger seizures and can be life-threatening. However a taper is shaped, it should be gradual and medically supervised.

In September 2020, the United States Food and Drug Administration (FDA) updated the boxed warning on every benzodiazepine to state that stopping suddenly, or reducing the dose too quickly, can cause withdrawal reactions that are life-threatening, including seizures, and that the dose should be reduced gradually. A rehab that discharges a patient benzodiazepine-free in fourteen days is working against the label.

Fortunately, the alternative is simple to describe. A slow, patient-directed taper at home, with a doctor who follows the Ashton Manual and the Maudsley Deprescribing Guidelines and who sets the pace by how you feel rather than by a calendar, is what benzodiazepine tapering by telemedicine looks like. Work with your prescriber on the shape of it, and do not let anyone rush you.

For opioid dependence, a private doctor with buprenorphine usually does as well as rehab, or better.

A rehab that does not use medication treats opioid dependence with a month of abstinence. Then it sends the same brain, with the same receptors, back into the same world.

Buprenorphine, the medication in Suboxone and ZubSolv, is the medical treatment, and medication-assisted treatment, or MAT, is the established medical treatment for opioid dependence, not a second-tier option behind abstinence. A private physician can provide buprenorphine treatment in an office or over a video visit, and the patient keeps their job, their home, and their privacy.

In Dr. Leeds’ experience, a private doctor prescribing buprenorphine usually does as well as or better than a rehab that does not use MAT. Many patients skip the facility altogether and do better than they would have inside one.

While it cannot offer a bed, telemedicine can deliver most of what outpatient rehab delivers: the visit, the prescription, the conversation, and the follow-up. Residential care remains the right choice for the minority who need round-the-clock observation, and a rehab that starts buprenorphine and sends patients home on it is a better rehab than the one described above.

For alcohol, naltrexone and the Sinclair Method are the private-doctor alternative.

Alcohol rehab means a supervised withdrawal, then a month of abstinence built on meetings. While that is the route most people know, for many drinkers there is a quieter one that never requires a bed.

The Sinclair Method, or TSM, uses naltrexone taken about an hour before drinking. Over months, the reward from drinking fades, a process known as pharmacological extinction, and cravings and consumption gradually fall.

TSM does not require abstinence to begin, which makes it a fit for gray area drinkers as well as people with alcohol use disorder. Naltrexone can also be taken daily by a person who has chosen abstinence, and either way a Sinclair Method doctor can provide it without a month away from your life.

Alcohol withdrawal is a medical matter. Nobody who drinks heavily every day should stop suddenly on their own. That conversation belongs with a doctor, or in an emergency department if a person is already sick.

What about the twelve steps and group meetings?

In many meetings you will hear that psychiatry, psychology, and medical treatment did not work, and that the fellowship is the best and last hope. How many of the people who hear that message have seen a psychologist experienced in treating addiction? How many were ever offered medical treatment? Often, no one asked.

Dr. Leeds once wrote meeting attendance into his own progress notes as an order and printed it for the patient. His view changed over the years, and he no longer recommends meetings as part of medical care.

The reasons are plain. Most meetings are not professionally moderated, members are encouraged to share private health information with strangers, and Narcotics Anonymous, in its own literature, puts its faith in prayer and spiritual practice and treats medication for addiction as something other than recovery, so recommending its meetings as part of medical care would be a contradiction.

Still, patients who attend meetings are respected, and the choice is theirs. A sponsor or a family member invited by the patient is welcome at a visit, and no patient of Dr. Leeds is ever required to attend a group.

When does residential rehab make sense?

Sometimes a person benefits from immersion in therapy and from distance from the outside world. A person who needs round-the-clock observation, or whose home is not a safe place to get well, may do best inside a building for a while.

While the best option for many patients is a private doctor, private rehab in a residential setting can work. Yet, in that setting, it must not rely on old, outdated, and unproven methods, because medical science has moved a long way in a few decades.

A good rehab starts buprenorphine and sends patients home on it, offers naltrexone at discharge, and refuses to taper a benzodiazepine patient in two weeks. When rehabs provide better therapy and better medical treatment, they will have better and more consistent outcomes.

And, if you have overdosed or you are in a crisis right now, call 911 or go to the emergency department first, and if the crisis is despair rather than a drug, call or text 988, the Suicide & Crisis Lifeline. That decision comes before any question about rehabs or private offices.

How do you decide between rehab and a private doctor’s office?

This is an excellent question, and the answer depends on where you are right now. If you are at home and still in control of your life, you may have to make the decision on your own, and the best first step is usually a consultation with a doctor who has experience treating dependence.

Ask that doctor the questions on this page. Is there a medication for your condition? Can it be prescribed by video? What would a facility give you that an office cannot?

Nobody has run the study that would settle rehab versus office for every patient, and this page does not claim otherwise. What Dr. Leeds will say is that whether the drug is a benzodiazepine you were prescribed, an opioid, or alcohol, a treatment usually exists that a doctor can provide without a facility, and it deserves to be your first question rather than your last.

Dependence and addiction are hard conditions to face alone. You do not have to check into anything to begin. You only have to ask.

Dr. Leeds’ practice is not a rehab.

Dr. Leeds runs a small concierge telemedicine practice in Fort Lauderdale, not a rehab. Its main work is benzodiazepine and Z-drug tapering and psychiatric medication deprescribing, by video for patients in Florida. For opioid dependence, buprenorphine films and tablets are prescribed by telemedicine for new patients in Florida, with in-office visits available in Fort Lauderdale, home induction with phone support, and a low-dose start when fentanyl is involved. For alcohol, the practice offers naltrexone, including the Sinclair Method. It does not offer counseling as a separate service or long-acting injections, though Dr. Leeds counsels and coaches within medical care, refers out when a patient wants a therapist, and can advise on injectable medications in a consultation. It does not run a facility and does not require meetings. A consultation can be booked on its own. It is not a medical visit and does not create a physician-patient relationship.

If you are weighing a rehab admission against a private doctor, contact Dr. Leeds to arrange a consultation and talk it through.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.