Not all of California’s drug and alcohol rehabilitation facilities are required to follow evidence-based treatment standards — that could all change in 2023, however, thanks to the passage of a California bill in fall 2018.
The bill, SB 823, targets alcohol and drug abuse recovery and treatment facilities and sets these rehabilitation centers on a path toward mandatory evidence-based treatment.
Approved by former California governor Jerry Brown in September 2018, the bill requires the state Department of Health Care Services to adopt evidence-based treatment criteria from the American Society of Addiction Medicine, or ASAM, as the minimum standard of care for all California rehabilitation centers — both publicly and privately funded — to be eligible for a license or to renew their license.
The bill, authored by state Sen. Jerry Hill, D-San Mateo, aims to increase oversight of California’s growing addiction recovery industry to ensure that patients, families and insurers who utilize and pay for rehabilitation are provided with fact-based treatment.
“By requiring nationally recognized evidence-based treatment criteria, like that of the American Society of Addiction Medicine, for licensure of these facilities, we will ensure that their clients receive the best care available and not be subject to expensive anecdotal treatment options with no proven efficacy,” Hill said in a press release.
Evidence-based treatment criteria are supported by research demonstrating that certain practices or aspects of the treatment work, according to Amy Mericle, a research scientist at both the Alcohol Research Group and the Public Health Institute.
More than 30 states currently require some form of ASAM criteria, and scientists such as Mericle say California being added to that list is a good thing.
“As a researcher, part of what I do is to develop evidence-based practices and to develop the evidence behind certain practices,” Mericle said. “You would want programs … to be able to point to things that are evidence-based rather than doing things that they may have an instinctive or intuitive sense might work but haven’t been studied.”
Mericle also explained that parts of California are recovery destinations for people seeking help with addiction. Part of Southern California is even referred to as the “Rehab Riviera,” with about 1,100 rehabilitation and treatment facilities in only four counties.
“Rehab Riviera” has a dark side, according to an investigative series conducted by the Orange County Register in 2017. The newspaper found that, among other issues such as systemic fraud and addiction exploitation, many California rehabilitation facilities were not following evidence-based standards.
Dave Sheridan, president of the National Alliance for Recovery Residences, said that although many rehabilitation centers do great work, some — including those exposed by the Orange County Register — use “flaky practices” that can do more harm than good.
“Flaky practices are mainly things that lack rigor, like getting people to sit around in a group and talk about their lives,” Sheridan said. “There’s a way to do it that’s evidence-based, and then there are ways to do it that get people to talk about their trauma but don’t do anything about it.”
Sheridan added that Drug Medi-Cal providers have been required to adopt ASAM standards for several years. Publicly funded programs have been moving in the direction of evidence-based standards for some time, so SB 823 is simply moving the rest of the treatment industry there, he said.
According to Mericle, there was not much opposition to the bill overall, but funding was a concern for some treatment programs when it came to actually implementing the ASAM standards.
“Treatment programs will need to have the staffing and resources to ensure that these standards are being implemented to make the transition,” Mericle said. “So if they haven’t been implementing evidence-based practices in the past, they are able to make that shift to start implementing them from this point forward.”