How Helpful are Addiction Program Ratings for Consumers?

There may be no more confusing path to care than the one that awaits people with addictions. Getting past stigma and shame is step one. Many then struggle to secure financial resources and emotional support. Understanding the right level of care can be as bewildering as finding a good nearby program. Many people regrettably resist available help. It is estimated that fewer than 15% get needed treatment.

How does one find treatment when ready? Lists of programs are everywhere, offered by governmental agencies, accreditation organizations, and several private entities. How should one negotiate the first hurdle of understanding the levels and types of care available? Proprietary websites can unfortunately slant their explanations toward what they offer or sponsor, while public sites are usually unbiased.

SAMHSA is a governmental agency with robust online information for matching problems with program types. Their digital tool for locating facilities, findtreatment.gov, is geared to be comprehensive rather than evaluative. For example, the tool found 305 addiction programs within 25 miles of my ZIP code. You can filter results by treatment type, age, and other features, but this is essentially a well-organized phone book.

Proprietary ratings are generally presented with an aura of credibility, but the critical question is the type of information profiled. The general types commonly used are expert opinions and objective clinical findings. Each can have low or high value. It depends partly on the specific data collected and partly on whether multiple data points are used to present a comprehensive, multifaceted picture.

Unrated programs are the most common limitation with private rating systems. A lack of reliable data leaves far too many unrated. This impacts smaller states and cities, low-volume facilities, and measures lacking adequate data. Consumers sadly discover that many rating systems illuminate only a tiny corner of a field for them. Another surprise is that few ratings in our field use any objective clinical data.

Medical hospitals set the standard here. Consider the ratings done by U.S. News for more than 30 years. Ratings for cancer care and cardiology feature patient outcomes, in addition to important factors like patient experience and staffing levels. Yet the publication’s psychiatry ratings are based only on physician opinion, and an exclusive reliance on expert opinion is the most common standard for our field’s ratings.

Consider a survey by Newsweek of the “Best Addiction Treatment Centers.” A “reputation score” provides 80% of each program’s rating (with 20% on accreditation status), and no real basis for these ratings is available. One cannot know an expert’s depth of knowledge about each program. In addition, such subjective ratings are potentially compromised by unknown motivations or interests.

This subjectivity pales in comparison to Newsweek’s primary deficiency related to unavailable data. Ratings are only provided for the 20 states with the highest number of addiction treatment centers. California has 55 treatment centers rated while Colorado has only 5. Also, the ratings are not highly discriminating when available. The ratings in California range from a high of 92% to a low of 76%.

How will these percentages be understood by most people? A rating above 75% would seem pretty good in most contexts, and so the rating is likely to convey endorsement for any treatment center given a rating. Newsweek introduces its methodology with the empty assurance that “this ranking was created through an elaborate process.” Finally, it lumps together programs with very different services.

Consider a choice in California between Hazelden Betty Ford, Bayside Marin, and Phoenix House California. Since all have ratings above 82%, it might seem that each would be fine for a potential client. Yet these are very different programs and the rating provides little help for an individual seeking a good fit in terms of insurance funding, treatment philosophy, or 12-Step orientation.

Recommendations from experts or peers will never go out of favor. We follow the guidance of those we trust, regardless of why we trust them. Yet ratings in medicine have moved beyond trust. Most have also been collecting data on objective measures for some time. Our field cannot follow their lead until we reach agreement on measures and start reporting data routinely. The key is routine data reporting.

Programs must be expected to report, whether it be subjective or objective data. Consumers know that sample size matters, and yet most would prefer having a majority of programs rated rather than just large providers. Our field looks inferior to medical care providers given the limited state of our ratings. We can do better. Let us not wait for regulators or accrediting bodies to mandate greater transparency.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.