Viewpoint: We Need to Rethink Rehab

Our current treatment system for addiction is unnavigable, unregulated and unsuccessful. It needs an overhaul

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When my son Nic became addicted to methamphetamine and other drugs, I was panicked, overwhelmed and desperate to save his life but had no idea what to do. I’d heard about rehab, where you send people with drug problems, but I soon learned that there’s no standard definition of it; instead it’s a generic word for a wide variety of treatments, including some that are outrageous. Past-life therapy? Exorcism? Tough-love programs in which patients are made to scrub bathroom tiles with a toothbrush or cut grass with scissors? Even in more-typical rehabilitation programs, patients are not seen by licensed practitioners — no doctors or psychologists — only self-anointed “experts” with no training or credentials, unless you count their own recoveries from addiction to heroin, alcohol or other drugs.

(MORE: Q&A with Anne Fletcher: What Really Goes On in Drug Rehab)

I chose a rehab center for Nic that was recommended by a friend who had sent her son there. The program lasted 28 days, after which he relapsed. Over the next six years, he was admitted to six residential treatment programs and four outpatient programs. He would do better for a while, but then relapse. Each relapse was crushing. I thought he might die.

Every year in the U.S., 120,000 people die of addiction. That’s 350 a day.

I’ve already written about my experience with Nic, but for my new book, Clean, I wanted to understand why so many suffer and die. So I undertook an investigation of the treatment system that so often fails. I learned that no one actually knows how often treatment works, but an oft-quoted number of those who abstain from using for a year after rehab is 30%. Even that figure is probably high. “The therapeutic community claims a 30% success rate, but they only count people who complete the program,” according to Joseph A. Califano Jr., founder of the National Center on Addiction and Substance Abuse and a former U.S. Secretary of Health, Education and Welfare. “Seventy to eighty percent drop out in three to six months.” Over the course of my research, I did hear one statistic that I trusted. Father John Hardin, chair of the board of trustees at St. Anthony’s, a social-services foundation with an addiction-recovery program in San Francisco, told me, “Success for us is that a person hasn’t died.”

(MORE: Being Ashamed of Drinking Prompts Relapse, Not Recovery)

The treatment system fails because it’s rooted in an entrenched, inaccurate view that addicts are morally bereft and weak. If they weren’t, the belief goes, they’d stop using when drugs began to negatively impact their lives. Most treatment centers in the U.S. are based on an archaic philosophy that’s rooted in the 12-step model of recovery. These programs have saved countless lives, but they don’t work for a majority of people who try them. It’s not a fault in the program itself. Its founder, Bill Wilson, wrote, “These are but suggestions.” But many rehabs require them. This is particularly problematic for teenagers and young adults, the very people most susceptible to addiction. Twelve-step programs require people to accept their powerlessness and turn their lives over to God or another higher power. Many adolescents question religion, and in general teenagers aren’t going to turn their lives over to anyone.

In many 12-step-based programs, patients are berated and yelled at if they don’t “surrender” and practice the steps. They’re warned — in some cases, threatened — that if they don’t, they’ll relapse and die. It can become a self-fulfilling prophecy. Addicts don’t think they can be treated if they don’t embrace the program, and so they give up on the idea that they can be helped. They do relapse. Some die. When they do, they’re blamed. Blaming the victims is convenient for those who treated them, because it absolves them of accountability. They can take credit when their patients get well, but they take no responsibility when they don’t. But the bigger problem with 12 steps is that a growing body of evidence has proved that addiction isn’t a choice subject to willpower but a brain disease that’s chronic, progressive and often fatal.

(MORE: The Myth of the Ritalin-Popping American Teen)

Though they aren’t available to many people who need them, there are alternatives to 12-step-based treatments that can improve an addict’s prognosis. These treatments don’t rely on best guesses or tradition. Rather than require contrition and prayer, they use therapies that have proved effective in clinical trials, including cognitive-behavioral therapy designed to train addicts to recognize and interrupt the cues that trigger the relapse mechanism; motivational interviewing, a therapy approach widely used to treat many psychological disorders that helps addicts engage in treatment; contingency management, which essentially rewards addicts for clean time; and psychopharmacology.

Absurdly, the latter remains controversial in the addiction-treatment community, with some factions claiming that you don’t treat drug problems with drugs. But you do, at least in many cases. One of the most effective interventions for opiate addictions is medication, including the opiate agonists and partial agonists methadone and Suboxone. These drugs have proved so effective that Steve Shoptaw, an addiction specialist and psychologist in the department of family medicine at UCLA, says, “I won’t treat opiate addicts unless they take Suboxone.” Most researchers agree that no single therapy is appropriate for every addict. Often they’re used in concert. An effective treatment regimen may include AA, but only for those patients who are open to it.

(MORE: The Addiction Files: How Do We Define Recovery?)

Currently there’s a chasm between these and other evidence-based treatments (EBTs) and rehab programs. Every day addicts fall into it, and many never make it out. Most people in need find themselves in the same frustrating position I was in when I was desperate and overwhelmed, shopping for programs and doing the best I could to navigate an unnavigable system that’s also largely unregulated. In many states, anyone can open a rehab program — no licenses or accreditation are required.

This is slowly changing. More people are being educated about the fact that addiction is a disease and therefore requires treatments based on the medical model. The more consumers are educated and demand EBT, the more the billion-dollar rehab industry will adapt and offer it. That is, the industry will adapt or it will die and be replaced. In the meantime, those who need treatment must do the best they can to find programs that offer EBT. The place to start is by receiving an assessment from a psychologist or psychiatrist who is trained in addiction medicine. Even finding these professionals can be a challenge, but the American Society of Addiction Medicine maintains a directory that is available online. A competent doctor can determine the severity of addiction and the presence or lack of co-occurring psychological disorders and prescribe the next step. It may include a brief intervention, therapy, psychopharmacology, an inpatient or outpatient program that offers quality care or a combination of these things.

(MORE: Addiction Treatment in America: Not Based in Science, Not Truly ‘Medical’)

Meanwhile, the National Institute on Drug Abuse is funding the Treatment Research Institute in Philadelphia, directed by Tom McLellen, the former deputy director of the Office of National Drug Control Policy, to create and test a science-based method of rating treatment quality and determining the likelihood of favorable outcomes of treatment programs. Working with consultants from Consumer Reports, the Treatment Research Institute hopes to create a guide that will help those who need treatment and raise standards in the industry. Another hopeful development is the founding of an organization that could be for addiction what the American Cancer Society is for cancer, called Brian’s Wish to End Addiction. In addition to supporting treatment research, the organization will also launch education and other prevention campaigns and lobby for policy so that, for example, insurance will adequately cover addiction treatment.

After a hellish decade, my son got and stayed sober. His current treatment regimen includes regular sessions with a psychiatrist who sees him for his addiction and co-occurring bipolar disorder and depression. He’s been in recovery now for five years. But of the nation’s 20 million addicts, only 10% will ever receive treatment. And the majority of those who do will be failed by the existing system. Nic is one of the lucky ones. I’m one of the lucky ones. But this should not be about luck.

MORE: Viewpoint: Are Doctors to Blame for Prescription-Drug Abuse?

40 comments
Elizablackwel15
Elizablackwel15

"I wish, I wish, with all my heart, to fly with dragons, in a land apart."


-Max and Emmy

Science may have found a cure for most evils; but it has found no remedy for the worst of them all - the apathy of human beings.

-Helen Keller

I can think of no other field of medicine (or field of anything for that matter) where expertise can be claimed unmolested when there is none. If I claimed to be an expert neurosurgeon or an ace otolaryngologist and I wasn't then people would call me on it (including the neurosurgeons and the ENTs) and I would be deemed a fraud or delusional. If I went out on my porch and started proclaiming I was an expert in anything I am not I would be run out on a rail. Law enforcement and medical help would be called in short order.

Yet doctors with no training in psychiatry or addiction euphoric in their new found sobriety and like-minded camaraderie claim to be experts in addiction and everybody just lets them. Oh they mean well. It's like Max and Emmy wishing to go off in to Dragon Land just by wishing. These guys wished to be addiction experts and we handed it to them. Gave false expertise to the unqualified and granted them power over others. Real bright. 

And the mess we are in his not just because these unqualified and untrained experts banded together and declared themselves so but is also because no one did anything about it as they changed definitions, statutes, regulations, rules, and laws. Everyone complacent that these harmless experts are doing there best or that it will never have anything to do with them. Blinkered apathy. Indifference.

They are now lobbying to get gild the fake ABAM diploma mill self-certification into valid ABMS recognized "board certification" even though they don't deserve it. An interest in something does not an expert make. If we allow this then the ASAM 12-step chronic brain disease model not only swallows addiction medicine but tarnishes all of medicine. We need to point out that ASAM is not a true medical specialty. ABAM is not recognized by ABMS. It is a puppet show of unqualified and irrational authority and we need to call them on it.  It is all a racket.  Profiteers and prohibitionists. And you can't argue with the 12-step zealots. Just look at the comments below.  they think they have some secret knowledge others don't.

guysmiths21rules
guysmiths21rules

I am in Poughkeepsie NY, have been here for 2 1'2 years  came up here from NY City after having a heart attack and then diagnosed with Leukemia in 2010..My last drink in 2011 brought me to Bellevue Hospital detox, who then sent me up here in Poughkeepsie..I did a 28 day rehab, went to what we will call a Halfway House, and then a Sober House . I met another recovering addict there and we now share a nice apartment .BTW I am 59 years old, and know any more drinking could make my heart even worse..(Forgot to mention I have a difibrulator and pacemaker monitoring my heart and oxygen levels.. 

Snce being up here, I have lost TWO friends recently to heroine overdoses., the heroin problem up here is terrible.. Although alcohol and heavy drugs are very different to me, as they say, "A drug is a drug is a drug".. What nobody seems to mention is that Many Programs and Rehabs are manditory for alot of addicts, and also serve as shelters during the winters, especially here in the Northeast..I only mention this because rehabs are often divided between those that really Want to recover, and those just passing the time.. I have heard there are people that have gone in and out of rehabs Countless times, only to return..

 I sometimes wonder what if there were no rehabs, and if you used and became homeless you were on your own??  I know how hard it must be for a parent to give up on their child, but sometimes  "Tough love" may be the only way of saving both your remaining family and letting the addict fend for themselves.. I was homeless myself once, and just toughed it out..What that situation taught me is "Appreciation", it is a very important word in recovery..I wake up without alot, but what I do have I cherish, food on my table, a roof over my head, the bills get paid.. I wish All recovering addicts could see through My eyes, dont take for granted the little things, thank the Good Lord for what you have..Appreciate life, it is a gift..                              Guy Smith

sunflowerhappyphone
sunflowerhappyphone

12-step programs do not promote "moralistic views".  As a matter-of-fact they say - you have a disease (this is called the medical model!!!!).  The Big Book of AA identified alcoholism as a disease BEFORE the scientific community did!!!!!

- the pathologizing of addiction is "the easier, softer way" of trying to treat addiction....giving a meth addict prescription meth in order to "control" their addiction is TOTALLY CRAZY (straterra, vivance, adderol, concerta are all D-methamphetamine) - this "idea" of "self-medicating" has relieved addicts of all personal responsibility for their behavior.....the problem with attempting to treat addiction with "replacement therapy" does not account for the mechanism of "MORE".....and BTW, methadone/suboxone is a failed experiment.  I have seen people on 300mg+ of methadone a day (NIDA guidelines call anything over 100mg "high level dosing") that still present at the methadone clinic complaining of cravings!  BTW - methadone treatment is now actually called "Opiate Replacement Therapy"! .....and it is a publically funded service!!! (that means the taxpayers pay for it!!!)  I read a study a few years ago where they actually asked physicians if they would refer an addicted colleague (another Dr)  to methadone therapy and 100% said NO).

This author needs to research more, his conclusions and statements are erroneous.

I wonder what relationship pharmaceutical manufacturers have to this writer - this sounds like pharmaceutical company propaganda to me.....they are heavily vested in convincing all of us that the only way to change behavior is to medicate it.

TammieSmith
TammieSmith

You know the only people that understand dealing with addcts are the people that are in it at the time. I have felt so alone in dealing with my sons addiction. I have consistently said that our society does not deal with addicts correctly. To me addicts no matter whether it is drugs, food, exercise (of course some are better than others) all are used to fill a void in that persons life. They don't know how to deal with something and instead cover it up or fill it with their particular addiction. Unfortunately my sons was meth. He has never been offered a program, I have asked for help for him since he was 12. I knew that our families divorce,and my sons diagnosis of diabetes that he needed to talk to someone. But all i got from pshychologist and psychiatrists was, "does he want treatment" I was like he is 12 years old, he is 13 years old etc etc., what do you mean does HE want treatment. Now that he has become what society deems a menace to society because we all know that drug addicts steal to get the money they need for the drugs. So off he goes to prison at 22 years old, his second stint. No rehab the last time either. We are throwing away a whole generation of kids becasue all society wants to do is throw them into prisons and forget about them. Kind of reminds be of a leper back in the days. Should we put them all on a island. What is the answer? I would love to get involved. To tell our story. To help someone else, either addict or family member. I would like to create change in our country on how we deal with our kids.

BurnieRubble
BurnieRubble

My biggest trigger is waking up in the morning,,,,,,,,,,,,,,,what can u do about that??

loladrum
loladrum

Treatment does not work, whether it is 12 steps or some other method.  The addict will doubtlessly relapse. Get as far away from the addicts in your life and never look back. They will break your heart, no matter what kind of rehab they have attended.  After many chances and much heartache, lies and theft,  I have no contact with all the addicts in my family who are supposedly "sober." It is just a matter of time. I am so sorry that this writer has lost his son, but addiction has no happy ending.

Edudlufetips1
Edudlufetips1

12 step does not work for a LOT of people. I respect that it has helped countless stay sober, but I think it's rooted in something wrong. the whole idea of powerlessness necessarily takes the blame away from the addict and attributes it to a 'disease' or 'condition' or w/e you want to call it that will ail you forever. It therefore also means you are not credited for overcoming it, 'overpowering' 'it.' As an agnostic, I also felt alienated by the references to religion; as much as they say 'choose whatever higher power you want,' the overtones of God in the Biblical sense cannot be avoided. Ultimately, I would always leave AA meetings wanting to forget the experience with a few drinks right then and there. The fact that a vast majority of rehabs require them is such an injustice to recovery.


I spent many years hopelessly addicted to drugs and alcohol. I never really denied that I was an addict- I knew I was in deep from near the beginning of it all. As an aspiring doctor, I somehow managed to get through graduate school all while addicted-- at that point I could only function normally when I 'leveled out' with a certain level of intoxication. I had to take a few shots before my MCAT just to avoid hallucinations, shakes, confusion, etc. It was chaos.. I would have bombed if I was going through withdrawal, but did just fine while drunk. How pathetic. The addiction obviously gets worse and worse, and eventually I found myself in the hospital with no recollection of the past day and my BAC was at a level that would have most people dead. I was also on other junk and sent to the loony farm for some time. 


Thank goodness I got over that hellish nightmare.What did it for me? The detox is the easy part. Takes a couple of weeks at the most. Staying clean required me to REMOVE all power from addiction. Simply making the understanding that I wasn't sacrificing some long-time friend, that I'm merely getting rid of an enemy was key. It's very hard in the beginning, and can take plenty of time to reach a point of freedom, but not forever. It took me about a year of medium-level resolve and introspection and I do not miss it at all. I would not suggest people place put addiction on this pedestal that it is something greater than you that has ultimate control over you for the rest of your life. That idea is scary enough for some to relapse. It's just a roadblock, something getting in the way of the life you deserve, and for that reason you must find your own, inner way to remove it. 


I don't mean to blab on about my experience as to say it is the right way. I'm merely using it as an example to suggest that the 'ONE' way that all these rehabs suggest- 12 steps- is not the only way, and is more often than not unsuccessful. Good luck to anyone struggling in finding your own, unique way.



Read more: Rethinking Rehab Programs: We Need Evidence-Based Treatments | TIME.com http://ideas.time.com/2013/04/03/we-need-to-rethink-rehab/#ixzz2lj9X4DwG

tselene
tselene

What I saw in real life is counseling centers out to make a dollar (thousands) leaving the patient without real care - sending them to Narcotics Anonymous meetings at their facility where they are berated, and told that their "disease" began as a child, and they will always have this disease - without knowing why they took the drug(s) - possible drugs were a weapon or control, or if they ever took drugs as a child; NA tells them they did (implanting memories).  The counselors are often supposed ex-addicts without any real training, or monitoring, giving out horrid advice, and demeaning patients.  The psychiatrist pops through on occasion to increase prescriptions (most contra-indicated).  Then when the patient really needs help - their finances are low or time is up; out they go, and back they come, a revolving door.  Once out there is more NA meetings telling them how low they are, and how they cannot make it without the group that does nothing more than listen, and move on to the next story teller.  If people were to sit in and listen, really listen you would find these people need medical care, social services, and less prescription drugs - they need help.  But, all they get is an ear, cup off coffee, demeaning remarks, and demands to buy books; then back on the streets they go.  Evidence based medicine is out there; but for some reason it is not sufficient, possibly because insurance companies do not endorse them so therefore it is not popular.  Counseling is really become a bogus setup, and people suffer - at the hands of those supposedly helping.  I recently heard horrid tales of women in Los Angeles dying at the hands of one of these groups; but no one cares enough to investigate.  Why?  It is a money making scheme without proper medical directors and no options aside from telling people they are bad; oddly enough it is alot about peer pressure, and residence so take them out of the fire - does not help as the system throws them back in (courts, counseling centers and NA).

TimTom
TimTom

Columbia University offers free and confidential substance abuse treatment within the context of a research setting ( contributing to ongoing evidence-based treatment), for heroin, prescription pain-killers, benzodiazepines, and marijuana abuse. 

212-923-3031

WWW.STARS.COLUMBIA.EDU 

soiveallproblems
soiveallproblems


Treatment for Drug Addiction and rehabilitation


You are not a hopeless case. Recovery is possible. If you’re ready to begin a drug-free life, call us now at (+1) 8056-034-323. or email us through hiltonrehabitationalcenter@live.com We are available 24/7
Help is a phone call away.


•    Individual counseling
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•    12 step programs
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we restore hope, then we restore life!!

orangeandferal
orangeandferal

Hi David,
I read your first book, Beautiful Boy, as well as both of Nic's books, and I'm waiting for Clean to arrive in the mail as I write these words. I have such respect for your entire family - for standing by Nic as you did (when many loving parents would have given up), for your honesty about the struggles you've endured, and for the way you've worked to turn a personal nightmare into systemic change, as well as hope and inspiration for others. In addition to being in recovery, I am a licensed psychotherapist who lives and works in the San Francisco Bay Area, as the Associate Clinical Director of a drug & alcohol treatment center. I've been working hard to ensure that evidence based treatments are utilized by our clinicians, and that our non-clinical staff are trained to use effective, non-shaming methods to support our clients in their recovery. I'm also widening the array of options for social support in our clinic, to include LifeRing and Women For Sobriety, two secular alternatives to 12 Steps based groups, so that the individuals who come through our center are not forced to engage in a recovery program that feels alienating, forced or against their belief system.The 12 Steps are a useful tool for many - I've utilized them myself for years; they just can't be the only choice for the great diversity of men, women and teenagers fighting to overcome addiction.
Thank you for this article, and for all that you continue to do every day. I'm proud to be part of this fight alongside people like you and Nic.

LG, San Francisco, CA

loriann.witte
loriann.witte

Ever since I was I child I have had a calling toward being the most natural, "do no harm" person I could be.  I call that that feeling the need to live organic and green.   I got caught up in the problems of the world as acted out in my family and our community.  The cherry on top all of that was watching the news.  This experience curved me into the world and out of my heart felt values. Then I started to create these tragedies in my own life in the form of depression, divorce, discontentment. http://get.wirecovery.com/2013/03/living-sober-organic-book-by-wits-end.html

violaball0
violaball0

There are a lot of drug rehab facilities but, as Lora said, people should choose rehabilitation centers that would surely help people achieve their goal such as recovering form drug addiction. It is very difficult to be under the yoke of drugs but there are rehabilitation centers that will help those people. http://www.drug-alcohol-rehabs.org/drug-rehab-cost.html

czydiamond
czydiamond

When the medical profession gets involved, results may be good or bad, but the one sure thing is that rehab becomes prohibitively expensive. Addicts helping addicts, alcoholics helping alcoholics is the most effective, cost effective method. One of the best places I ever saw was just a sober house where residents paid shared rent and food and just supported each other. The latest trend of court ordering drug offenders into rehab is just robbing people blind, doing very little good except keeping people out of prison, when there is no rational reason for the imprisonment in the first place.


pbonjovi
pbonjovi

i have to agree with some of this article as i am in recovery myself and also work for a drug & alcohol rehab.  it's frustrating to see the clients not get all the help they need as most of them also suffer from some type of mental/emotional problems.  but, i got sober through AA and the 12 steps.  i was in detox 3 times and a psych unit once and did not get sober through those institutions.  i had to hit an emotional bottom to surrender to the fact that i had a problem and went to my first AA meeting.  it's true, i had to admit i was powerless over my alcoholism, i had to look at how it made my life unmanageable, and had to turn my will over to a Higher Power.  i was ready to do that...i was DONE with drinking but did not know how to live sober.  i have 6 1/2 years sobriety and i not only learned how to live without drinking and be happy, i learned how to become a responsible adult.  i've learned that the problems and traumas i went through as a child has a lot to do with why i drank and i've dealt with those issues through ALL of the 12 steps.  it saved me a lot of money as i didn't need professional therapy to do that.  this is just my opinion and experience and i share this with the clients where i work.  no one can understand addiction unless they've gone through it themselves.

raymond
raymond

Any quality rehab will be accredited and licensed and will offer CBT, Motivational Interviewing, Contingency Managemenet, Mindfuless Based Relapse Prevention, nutritional consults, Family programs, Medication Assisted Treatment, as well as. Twelve Step Facilitation.  Staff will include MDs, psychiatrists, psychologists, addiction therapists and mental health specialists.  There is no necessity to disparage twelve step programs as you have done in this piece.  Twelve step is just one component of a quality program but it has and will continue to be of major benefit to patients.  The elements embodied in the catch phrases of AA and NA, while deemed archaic in this piece, contain many of the basic therapeutic elements common in all therapies.  Don't be thrown off by the trite slogans. While i would agree that many programs have been slow to adopt newer technologies in treatment, twelve step continues to be an important piece of any quality rehab.  Why deny patients access to one of the more successful long term management tools?  Addiction is chronic and whatever we can do to help patients manage their remissions should be encouraged and supported.

Raymond V. Tamasi, Gosnold on Cape Cod

BorisIII
BorisIII

Most people that go into the therapy field don't have the needed personality type to be any good at it.  Usually people go into the field because they just like the idea of helping people.  Its unusual for people to have respect for every client they meet.  Or care about every client.  Also the pay isn't very good for lots of years spent in college and also they get burned out and lazy really quick.  So the turnover in the counseling field is very high and usually the wrong career for most  of the people in the field.

LisaFrederiksen
LisaFrederiksen

Thank you, David Sheff! I absolutely agree and have seen, time and again, in the work that I do with addicts, alcoholics and their families that understanding addiction as a chronic, often relapsing brain disease and thus following the disease model of treatment (detox, rehab AND long-term continuing care) makes a world of difference. With this understanding, all concerned better appreciate healing a brain is complicated, it takes time and treatments must be specific to the individual's needs, thus treatment options must include all of those you list in your opinion piece - there is no one, nor right, way to heal a brain. 

Unfortunately, much of the supporting research about the brain disease of addiction, dual diagnosis, variety of effective treatment protocols, importance of early intervention and the like, are not widely known. For those doubting or wondering about the validity of the fact that addiction is now scientifically understood to be a chronic, often relapsing brain disease requiring the "disease model" of treatment, as well as some of the other related issues, here are some excellent resources: 1) The Addiction Project (collaboration of NIAAA, NIDA, Robert Wood Johnson Foundation and HBO); 2) Drugs, Brains and Behavior: The Science of Addiction (NIDA); 3) Substance Abuse and Addiction (The Dana Guide - Dana Foundation); 4) If Addictions Can Be Treated, Why Aren't They? (Dana Foundation); 5) Alcohol Screening and Brief Intervention for Youth, a Practitioner's Guide (NIAAA); and 6) the Alcohol Use Disorders Identification Test [AUDIT] (World Health Organization). 

Thanks, again, for all of your work to raise awareness - we need to rethink rehab, we need evidence-based treatments. 

Scout92163
Scout92163

Interesting article promoting his newest book "Clean." 

Long overdue. The "Recovery" industry is mired in myth and magic. The 12 step programs are valuable tools, but their success has been greatly overstated. I'm happy that this book will get the attention needed to bring light to the current systems of treatment.


Thank you, David Sheff, for writing"Beautiful Boy."  

I can't wait to read "Clean."

Stutteringhand
Stutteringhand

I'm not saying that 12 Step programs are for everybody. And I am only speaking from my own experience. But NA has saved my life. It was the only thing that worked for me after suffering 40 yrs of addiction. I believe your article contains some inaccuracies about 12 Step programs, at least as I understand them. I have learned through NA that addiction is not a choice it is a disease. A person choosing to be an addict makes about as much sense as choosing to have a heart attack. In NA groups you commonly hear, "You are not responsible for the disease of addiction, but you are responsible for your recovery." My understanding is that addiction is chronic, progressive, and fatal without treatment, just as many other diseases are. My recovery has not been based on willpower, in fact, it's based on surrender to the reality of suffering from addiction and recognizing my need for life-long program of recovery. Also, NA is a program of attraction, there are no NA members that I know of that would advocate forcing it on anyone. Any rehab that does this, does not understand 12 Step recovery, in my opinion. As an active addict, I had a lot of misconceptions about NA, but was grateful to find out I was very wrong. However, it is not magic and although based on simple principles, they are not easy to live by. But for me, the alternative is suffering and death. I have now learned to love life.

xxxdtox
xxxdtox

There is no outcome based, or evidence based research that matters in the treatment of addictions yet. I have worked in treatment for 15 years. At this point in time this is marketing jargon meant to deliver more and more centralized control and sales to the medical establishment and pharmaceutical companies. What is passing for evidence based is actually a changing of the so called goals of treatment. I am sad to hear Mr Sheff parroting this language as part of his promotional material for his book. Polite of him to acknowledge, and dismiss in the same sentence, (often called patronizing) the one thing in history that has saved millions of lives. I defy him to offer a single "evidence based", "credentialed" program that has saved even 1000 lives.

I cant say if the 12 steps and AA is the only way or not, but we do know that any real alcoholic or drug addict can only said to have been truly treated if they are abstinent from the substance or process in question. Otherwise we may say that they have made some progress, possibly for better but also possibly for the worse, as in "the good is the enemy of the great". Most evidence based research is not measuring abstinence over a significant period of time for an addict. More likely they are measuring other life issues like, employment, family involvement, claims of spiritual well being, any other number of aspects, which, without abstinence will very likely disappear as soon as the addict relapses. The metrics are not established and the methods for reporting are notoriously unreliable. Addicts have huge incentives for dishonesty whether they are sober or not and research does account for this.

Improvements in an addicts life are of great value to researchers and family members who are not suffering the addiction the way the addict is, and have their own needs. The addict knows these gains are fleeting and meaningless for combating their problem. The addict knows that simply having a "better life" is not a solution in itself to their problem.

....
....

Kudos on a well written article and my heart aches for what you went through with your son.

But addiction always starts out as a willing choice, and often addicts are coddled in rehab so they don't deal with the physical, or mental consequences of their actions. They are cushioned in rehab and when put back into the real world they repeat the same mistakes. If they can't do any sort of basic research on the nature of their own addiction, the history of 12 steps, or deal with the long term consequences of illegal drugs they chose to take, then they deserve to be brainwashed into 12 steps, develop bi-polar from abusing meth, or become a byproduct of our poorly designed rehabilitation system.

We have public libraries that have computers with free access to the internet. If you are literate in America, then there's no excuse for being ignorant towards the effects of commonly abused drugs, 12 steps, or what rehab really entails. 'A Million Little Pieces' was a bestseller and around in like 2003....it raises like every question being asked in the article.

commentonitall
commentonitall

David, I commend you for having the courage to take a personal situation such as drug addiction and write about it.  It's important that people become educated on the subject and understand the challenges.  You wrote in this article that, "The treatment system fails because it’s rooted in an entrenched but inaccurate view that addicts are morally bereft and weak."  I agree with you, but you completely missed what is actually the true cause of program failure and that is  an individuals income.  You and your son were lucky to have so many options are your disposal, even though a lot were unregulated like you stated, but what if you didn't even have the option to explore those programs?  I am not judging you or trying to insult you, but this piece is geared towards the middle to upper class drug addict, not the lower class poor addict which constitutes the majority of addicts.

More and more states are taking funding away from drug treatment programs because they are deemed too expensive, yet incarceration is actually much more costly and many states are going towards a privatized jail model simply because it can save and potentially make money.  The idea that a state would take away rehab programs and embrace privatization of our jails as a means to save and actually make money is disgusting and should be banned.  I would like to see you write an article about what is available to lower income and the poor drug addict, many jails don't even offer programs within their facility let alone anything on the outside. In that article you should look at how much money is made off of drugs in the medical community that become addictions and how little is done to counter any abuse.  Open people's eyes and show that there is drug treatment available out there, but only if you have the means to pay for it, which most addicts do not.  Money is considered more important than providing life saving programs to people, that is the true injustice and cause of so many needles deaths from addiction.


willtaylor
willtaylor

I'm not so sure that cognitive-based treatments, such as teaching addicts what their 'triggers' are, or what 'high-risk situations' they should avoid, and various motivational techniques are viable strategies for long-term sobriety.  After learning about those types of things, are addicts supposed to live the rest of their life without experiencing situations that supposedly lead to relaps?  I don't think that's realistic!  I agree that there is a need for more EBT, but the current cognitive-based approach seems like a daydream to me.

LauraBarrera
LauraBarrera

@Edudlufetips1  I am not an addict but my 21 year old son is.  I appreciate your view as a person who has gone through it an I'm sure struggles every day.  It helps me to see the light from the other side.  The person working through the addiction.  Thank you.

thearmbarkid
thearmbarkid

@pbonjovi That's like saying an oncologist can't understand cancer unless he has a small cell carcinoma.

orangeandferal
orangeandferal

@raymond I don't think Mr. Scheff was disparaging the 12 Steps in any way. Reread the article. He was saying something entirely different. (And before you get defensive, please know that I am in recovery, and have used the 12 Steps for years.)
The problem isn't the 12 steps. It's that too many facilities have relied only or primarily on a 12 Step model, without all the other modalities you mentioned. Additionally, for the social support component - which is HUGE - there are secular alternatives - LifeRing and Women for Sobriety, for starters - that should be offered. Especially if a facility receives public funding, as we still have separation of church and state in this country, in spite of many people's attempts to dismantle it.


sooz62350
sooz62350

@raymond Agreed!  Just because one person was not able to find sobriety in AA does not mean anything for the thousands of people who have.  To an outsider, AA may seem trite and religious and unsophisticated, but I believe it is profound and brilliant and far more sophisticated than the therapy many people pay hundreds of dollars for.

sooz62350
sooz62350

@xxxdtox Thank you for your excellent response.  I do not believe my son would be a successful attorney today had he not spent the past several years regularly attending AA meetings.  I often wonder if psychiatry's condescension toward AA, comes from the fact that they'd like to co-opt treatment of addiction for their own financial gain.

Peace_2_All
Peace_2_All

@xxxdtox 

I have know several people that have remained clean and sober and have never set foot into a 12 step meeting.

If I know of people, then most likely i'm not the only one.

Point being is that while I'm sure that AA/NA-12 steppin' has helped many, many people, it is definitely 'not' the 'only' way to achieving and maintaining sobriety.

Peace...

thearmbarkid
thearmbarkid

@.... "A MIllion Little Pieces" is just like stock swindler Bill Wilson's "Big Book:"  full of lies and misrepresentations.

tselene
tselene

@.... This is another one of those, "always".  Why is everyone always addicted to something in these stories, and pieces?  Is it truly a delusion to make people feel they have a problem by saying, "you were always like this?"

I do not see coddling or kindness.

sooz62350
sooz62350

@Lego.my.eggo "Coddled" and "cushioned?"  I don't know what rehabs you are familiar with, but that certainly doesn't happen in all of them.

TammieSmith
TammieSmith

@commentonitall I totally agree with you in regards to income. If you have enough money then you can explore the various programs. As I said in my post my son is on his way back to prison, and i can guarantee you he will not get any help in prison for his addiction. If they would make the punishment fit the crime and find a way to rehabilitate instead of incarcerate our society would be better off. Use the money for drug addicts that normally would be sent to prison and make places designed and geared towards addicts....Hmm novel concept. Also no disrespect Mr. Sheff, I applaud  you and your son for putting yourselves out there.

sooz62350
sooz62350

@commentonitall Agreed!  I feel for parents in Texas who try to get treatment for their teenage addicted children.  Forget it.  In Minneapolis, kids have the option of 28 days of inpatient addiction treatment whether they have insurance or not.  Texas would rather spend its money on prisons.

thearmbarkid
thearmbarkid

@willtaylor I don't think resorting to faith healing is realistic either, but it's SOP in rehabs.

sooz62350
sooz62350

@willtaylor Yeah, I don't know how cognitive based treatment is adequate for an addict whose brain has been permanently changed and whose thinking, rational brain has been overtaken and overpowered by the need for that dopamine rush.