| "Keep coming back, it works if you work it!" This is | | | | principles of effective treatment. |
| what is chanted at the end of every meeting, but what | | | | Reliance on outdated and ineffective treatment |
| if you have "worked it" and you still keep going back | | | | methods has created an environment that fully |
| and getting drunk or loaded? Now, most people in the | | | | expects individuals to fail, and fail again until such time |
| program will say things like, "Well, you must not have | | | | that rock bottom has been reached. It is often said that |
| really done the steps right," or "You didn't go to enough | | | | once an individual has reached rock bottom that there |
| meetings," or "You didn't pray to your Higher Power," | | | | is only one way to go, UP. The problem with that |
| or "You know you did something wrong or else you | | | | philosophy is that for many people, the ultimate rock |
| would still be sober!" | | | | bottom is death. (Vacovsky, Executive Director, |
| Since what you are told from your very first 12-step | | | | American Council on Alcoholism, May 12, 2005). |
| meeting is, "Your only options are to get sober using | | | | Vacovsky goes on to write: |
| our Program, or it's jails, institutions or death," you tend | | | | "Many, (if not indeed most) alcohol dependent |
| to stop thinking for yourself, (since it was your "best | | | | individuals have lost faith in themselves, and more |
| thinking that got you here"), stop questioning, and just | | | | importantly hope for the future. It is common for such |
| follow what other's tell you to do. This would be fine if | | | | individuals to have numerous attempts at sobriety, |
| this is what worked... but unfortunately, evidence is | | | | most often using 12-step methods. They have been |
| proving otherwise. | | | | programmed to accept themselves as hopeless and |
| The 12-step success rate is showing to be | | | | powerless, with their chance for recovery being slim to |
| approximately 3 percent. Yes, that's right... only 3 | | | | none... It is up to the individual to determine what the |
| percent! (Brown,Treatment Doesn't Work, 1991). Here | | | | most appropriate treatment is. It is up to the treatment |
| are some more startling statistics (Based on Alcoholics | | | | community to provide options that set up individuals to |
| Anonymous World Services' own statistics).: | | | | succeed, rather than be expected to fail." |
| *45% of the people who attend Alcoholics | | | | Sadly, Americans are largely unaware that such |
| Anonymous meetings never return after their first | | | | options even exist. At least, the general public is. While |
| meeting. | | | | the public is being told that "turning your will and life |
| *81% of AA attendees are gone after one month | | | | over to the care of God as you understand Him," as |
| *90% are gone after three months | | | | AA suggests, is the only treatment for their illness, |
| *93% are gone (7% remain) after 6 months | | | | scientifically based research has been going on for |
| *95% never return after the first year. | | | | decades. Results of this research are threefold: |
| So there is a 5% retention rate for the first year. Note | | | | 1. We now have options for treatment that are based |
| that the claimed five percent of A.A. newcomers who | | | | on science rather than fundamentalist religion; |
| are still coming back after one year (and sober, we | | | | 2. Gives back choice and a sense of control to the |
| hope) is exactly the same number as the normal rate | | | | individual, which is proving to be extremely important |
| of spontaneous remission among alcoholics. A number | | | | and |
| of studies have found that a small percentage of | | | | 3. We now have evidence that is in direct contradiction |
| alcoholics improve to the point of remission of | | | | to the traditional view of problem drinking. |
| problems associated with alcohol consumption, and we | | | | What, exactly, is the research finding? Here is what |
| call this spontaneous remission. The preponderance of | | | | some of the experts in the addiction field have found:o |
| studies suggests that a spontaneous remission rate | | | | Well-designed research conducted over more than |
| for alcoholism of at least one-year duration is about | | | | three decades has conclusively demonstrated that |
| 4-18 percent. Successful treatment would, therefore, | | | | problem drinking will not inevitably get progressively |
| have to produce rates of improvement significantly | | | | worse, and that this is one attribute of being a |
| above this probable range of spontaneous remission. | | | | "disease" of alcoholism is simply wrong. Some problem |
| Alcoholics Anonymous comes nowhere near | | | | drinkers "progress," but the vast majority don't.o What |
| exceeding a 4 to 18 percent per year recovery rate. | | | | most Americans believe about drinking problems and |
| If we subtract the usual spontaneous remission rate | | | | their treatment is substantially inaccurate.o Drinking |
| from A.A.'s claimed success rate, we get zero | | | | problems do not occur as a result of a disease. It is a |
| percent for A.A.'s actual effective cure rate. A.A. didn't | | | | learned behavior, and additional learning can therefore |
| make anybody quit drinking - those who quit were the | | | | modify behavior.o For no other "disease" do so many |
| ones who were going to quit anyway. They would | | | | physicians, psychologists and counselors themselves |
| have quit anyway, no matter what treatment they | | | | believe in the non-research-based myths of problem |
| were receiving, or even no treatment at all! | | | | drinking, ignoring the research of their own peers in |
| 93-97% of conventional drug rehabs and alcohol | | | | developing their treatment plans.o "Problem drinkers in |
| treatment centers are 12-step or AA based, so those | | | | the United States are faced with a daunting dilemma |
| who leave AA to look elsewhere, such as | | | | when they seek help. They can either accept the |
| conventional alcohol and drug treatment for solutions, | | | | prevailing myth that abstinence is the only effective |
| are essentially rejoining AA! | | | | means to resolve a drinking problem, or they can be |
| AA hardly sounds like a "proven method," let alone one | | | | accused of being "in denial..."o Insistence by treatment |
| that works for most people. So, if only about 5% of | | | | programs to only offer abstinence has been shown to |
| the people are getting the help that they need, what | | | | deter many problem drinkers from seeking treatment.o |
| about the 95% of the people who are not being | | | | Individualizing treatment is crucial.o Chronic "relapsers" |
| helped? That is the purpose of this article... to provide | | | | can actually be harmed by the 12-step model view |
| much needed awareness to individuals, rehabilitation | | | | that once a slip has started, you are powerless to |
| centers, hospitals, sober livings, and even 12-step | | | | stop; the stronger one's belief in this is the longer and |
| programs themselves so that people with substance | | | | more damaging the relapses are.o The confrontation |
| abuse problems can be helped. The bottom line is this... | | | | and treating alcoholics and addicts like children |
| is the goal to get alcoholics and addicts into AA or NA | | | | commonly thought necessary to help them actually |
| or CA, or is it to actually get them help? | | | | often hinders any change.o Many providers deliberately |
| Professor (and Doctor) George E. Vaillant of Harvard | | | | resist change because they have too much of an |
| University is an enthusiastic advocate of twelve-step | | | | attachment to their own ideas of what should work, |
| treatment, and is currently a non-alcoholic member of | | | | claiming, "I know what worked for me, and I'm sure |
| the Alcoholics Anonymous World Services, Inc. | | | | that it can work for everyone else as long as they just |
| (AAWS) Board of Trustees. So he really wanted to | | | | do what I say."o The only way to resolve a problem |
| prove the effectiveness of AA. To study the | | | | with alcohol is to abstain for life is wrong for the |
| effectiveness of various methods of treating | | | | majority of people. A substantial proportion becomes |
| alcoholism, Vaillant compiled forty years of clinical | | | | moderate drinkers even when achieving abstinence is |
| studies. Vaillant and the director William Clark also | | | | the primary focus of treatment.o Dr. Patricia Owen, |
| conducted an eight-year longitudinal study of their own | | | | Director of Research of the Hazelden Foundation, who |
| where Vaillant reported having followed 100 patients | | | | was a long-time supporter of abstinence-only |
| who had undergone twelve-step treatment. Vaillant | | | | treatment, referred to these individuals as "in recovery |
| compared those people to a group of several hundred | | | | without abstinence" and acknowledged their presence |
| other untreated alcohol abusers. The treated patients | | | | in large numbers among a sample of Hazelden |
| did no better than the untreated alcoholics. Fully 95% | | | | graduates. |
| of the treated patients relapsed sometime during the | | | | Of course, not even all scientists agree on the nature |
| eight-year period that Vaillant followed them. | | | | of and best treatments for alcohol abuse. But this is |
| After initial discharge, only five patients in the Clinic | | | | the twenty-first century, and no one would disagree |
| sample never relapsed to alcoholic drinking, and there | | | | that all patients suffering with an alcohol or drug |
| is compelling evidence that the results of their | | | | problem have a right, just like any other patient |
| treatment were no better than the natural history of | | | | suffering with any other problem, to be fully informed |
| the disease (spontaneous remission). What Professor | | | | of the available options, the risks or areas of |
| Vaillant, a Trustee of Alcoholics Anonymous World | | | | uncertainty, and, after reviewing the relevant |
| Services, Inc. is candidly, clearly describing is a | | | | information, in consultation with one or more providers, |
| zero-percent success rate for his A.A.-based | | | | choose a course of action. This is simply good, ethical |
| treatment program. And it was even worse than no | | | | medicine. Should people struggling with substance |
| help: The A.A.-treated group had a death rate of 29%, | | | | abuse issues accept anything less? |
| which was the highest death rate of any kind of | | | | It is also important to acknowledge that recovery |
| program, significantly higher than all of the other | | | | programs are not necessary to discover how to quit |
| programs. And those five people out of the hundred in | | | | and stay quit. The following is from the Harvard |
| the A.A.-treated "Clinic sample" who successfully | | | | Medical School's Mental Health Letter, the August |
| stayed sober for 8 years are just the result of that | | | | September 1996 issue: |
| same old five percent spontaneous remission rate at | | | | Most recovery from alcoholism is not the result of |
| work, again. | | | | treatment. Only 20% of alcohol abusers are ever |
| Remember that these horrible numbers were reported | | | | treated... Alcohol addicts, like heroin addicts, have a |
| by a Trustee of Alcoholics Anonymous World | | | | tendency to mature out of their addiction... |
| Services, Inc., by a real true believer in A.A., by | | | | In a group of self-treated alcoholics, more than half |
| someone who loves A.A. and was trying hard to | | | | said that they had simply thought it over and decided |
| make it look good, not by some harsh critic of A.A. | | | | that alcohol was bad for them. Another group said |
| who might be suspected of bias, or of fudging the | | | | health problems and frightening experiences such as |
| numbers to make A.A. look bad. | | | | accidents and blackouts persuaded them to quit... |
| Let me mention that I think 12-step programs are great | | | | Others have recovered by changing their |
| for those individuals who it does work for. I have seen | | | | circumstances with the help of a new job or a new |
| it change lives for the better, including my dad, who | | | | love or under the threat of a legal crisis or the breakup |
| has now had 15 years of continuous sobriety, | | | | of a family. Support from a husband or wife was |
| maintaining his sobriety from his very first meeting. It is | | | | important in sustaining the resolution. |
| also a great fellowship to share experiences, strength | | | | Study results from addiction researchers, Doctors |
| and hope. So, in no way am I anti-AA. If it works for | | | | Linda and Mark Sobell, confirm Harvard's 20% |
| you...fantastic. However, it has become clear to me | | | | treatment statistic: |
| that substance abuse is not a "one size fits all" | | | | Surveys found that over 77 percent of those who had |
| problem, and therefore, there can not be a | | | | overcome an alcohol problem had done so without |
| "one-size-fits-all" solution. | | | | treatment. In an earlier study... a sizable majority of |
| The National Institute of Drug Abuse, NIDA, has even | | | | alcohol abusers, 82 percent, recovered on their own. |
| gone on record to emphasize that no single addiction | | | | However, even though it is possible to recover on your |
| treatment method is right for everyone. They claim | | | | own, you may want a recovery program, or at least a |
| that matching treatment services to each individual's | | | | licensed professional for support. The good news is |
| specific needs is critical to success. In addition, | | | | that many more treatment programs are starting to |
| research studies indicate that even the most severely | | | | provide more evidence-based options beyond just the |
| addicted individuals can participate actively in their own | | | | traditional 12-step approach, and this list is growing |
| treatment, and that active participation is essential for | | | | everyday. You can find a complete, comprehensive |
| good outcomes. According to the NIDA, counseling, | | | | directory of over 100 professionals and drug and |
| either individual or group, and other behavioral therapies | | | | alcohol programs all over the U.S. and abroad that will |
| are critical components of effective treatment for | | | | provide you with many options in Melanie Solomon's |
| addiction. It's interesting to note that participation in a | | | | newly released 2nd Edition of "AA Not the Only Way; |
| 12-step program was never mentioned anywhere in | | | | Your One Stop Resource Guide to 12-Step |
| this research based guide which discussed the | | | | Alternatives. |