Why are many treatment centers operated like a car wash?

We have a broken system of care. Let's start over!

When people think about substance use and mental health treatment, many picture a kind of 'car wash' for recovery: someone enters the program, something magical happens, and they emerge clean, sober, and ready to take on the world—healthy, happy, and productive. It’s a comforting idea but far from reality. The truth is that treatment is complex, deeply personal, and rarely follows such a neat, linear path.

The car wash model assumes that treatment within a 30-day program will prepare individuals to return to life without relapse. However, the data tells a different story: 80% of people relapse after completing a 30-day program, according to ChatGPT.

At our treatment center, we work with clients who have been through more than 25 rehabs before coming to us—programs including McLean Hospital’s Fernside Program (an affiliate of Harvard Medical School), the Betty Ford Center, Clinic Les Alpes, Hazelden, Passages Malibu, Cirque Lodge in Utah, Crossroads in Antigua, the Caron Foundation, and many other well-respected facilities. Some of these clients paid upwards of $165,000 a month for care, only to relapse upon discharge.

It’s easy to point fingers and blame the program for these outcomes. But here’s the hard truth: no treatment program, no matter how prestigious or expensive, can guarantee relapse prevention. Relapse is not a failure—it’s a reality.

So, rather than clinging to the illusion that we can eliminate relapse, we must reimagine how we approach treatment.

What are the origins of the "Car Wash" approach to treatment?

In the 1940s and 1950s, the Minnesota Model introduced a 30-day treatment program that became the blueprint for substance use treatment. Health insurance companies quickly adopted this model, authorizing 30-day stays—not because it was backed by strong clinical evidence, but because it fit their payment structures. Fast forward 80 years, and this 'one-size-fits-all' approach to care—often called the 'car wash' model—continues to dominate despite its consistently poor outcomes. Isn’t it time we challenge this outdated framework and prioritize treatment models rooted in evidence and individualized care?

This may sound funny, but I do not believe in treatment, and I co-founded a treatment center.

The idea of 'treatment' often feels like a car wash—check-in, go through the therapy spin cycle, and come out 'healed.' And the 30-day magic number? There’s no evidence that it leads to better outcomes, but it has been ingrained in the DNA of our industry. Recovery isn’t neat, tidy, or bound by a calendar, yet we keep clinging to this outdated one-size-fits-all approach.

We Can Do Better: Reimagining Addiction Treatment

The time has come for treatment providers to rethink the services we offer. Here’s how we can make meaningful change:

1. Personalized Lengths of Stay: Let’s move beyond rigid minimum lengths of stay and focus on individualized care. Each person’s recovery journey is unique, and their treatment duration should reflect their specific needs—not a predetermined timeline.
2. Acknowledging Reality in Treatment Settings: Pretending that people don’t use drugs in treatment or sober living homes does more harm than good. Consider this: 15% of deaths in U.S. jails and prisons are due to drug overdoses. If drugs can make their way into high-security environments like jails, they can—and do—enter residential treatment centers. Overdoses happen in these settings, but we don’t have to accept them as inevitable. By leveraging wearable technology, we can detect potential overdoses early and intervene to prevent unnecessary deaths.
3. Harm Reduction Works:?Studies show that harm reduction reduces deaths, infectious diseases, and hospital visits, increases treatment admissions, and improves outcomes. Harm reduction programs reduce healthcare and criminal justice costs.
4. Your chosen lifestyle in a community setting:?Let's build programs that provide compassionate, nonjudgmental care tailored to the individual’s unique needs and circumstances. Where we prioritize harm reduction and understanding, creating a safe space for people to engage in care without feeling pressured to conform to rigid expectations or societal norms. By respecting lifestyle choices and emphasizing personal agency, we will foster trust and collaboration, empowering individuals to take meaningful steps toward wellness on their terms. This approach reduces barriers to care and enhances outcomes by addressing the person as a whole rather than a problem to be fixed.
5. Calling on Health Insurance Leaders To the executives of health insurance companies: Whether knowingly or unknowingly, your policies have created a system that often incentivizes relapse and contributes to treatment resistance. It’s time to break this cycle. Hire skilled actuaries to analyze the actual costs of emergency room visits, chronic illnesses like liver, kidney, heart, and lung diseases, and injuries from car accidents. You’ll find that comprehensive, community-based wraparound services are far more cost-effective and humane than perpetuating the revolving door of inadequate treatment.

It’s time to abandon the "car wash" model of addiction care, where people cycle through treatment again and again and invest in systems that foster long-term recovery and well-being. Together, we can create a future where treatment isn’t just about survival but about thriving.