Thank you for exposing the problems related to the highly unregulated residential addiction treatment industry (“The brokers and the damage done”). As an addiction psychiatrist with more than 30 years’ experience in the public sector, I’d like to note that there are safer, more effective options.

Addiction is a chronic, relapsing medical disorder; effective treatment is a long-term process best delivered in the local community. Most stable recovery is associated with long-term participation in outpatient treatment, not residential or inpatient care. Relapse rates for individuals with an opioid use disorder range between 85 and 95 percent, and many are at risk for suicide and self-harm.

Because 50 to 70 percent of these individuals also have co-occurring psychiatric disorders, it’s important that mental health services be integrated into their treatment program. What works for opioid addiction is long-term medication treatment (methadone, buprenorphine, or extended-release naltrexone) coupled with counseling and participation in support groups, such as 12-step programs.


This approach would significantly increase adherence to treatment, reduce illicit opioid use, and most important, decrease the risk of relapse and fatal overdose. We are fortunate that this type of excellent private and public sector treatment is available in Massachusetts.

Dr. John Renner, Boston

The writer is president of the American Academy of Addiction Psychiatry and a professor of psychiatry at Boston University School of Medicine.