New Perspectives on Alcohol Treatment
September 21st, 2008 |
A GoodTherapy.org Featured Column written by Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC
Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile
We recently returned from a conference on alcohol treatment called “New Perspectives.” The conference, hosted by Edgewood treatment center in Nanaimo, Vancouver Island, British Columbia, was, indeed, as advertised. Presenters echoed the same theme: the usual methods of “treating” alcohol abuse and dependence don’t work. While this isn’t news to some of us who’ve looked at the statistics for over twenty years, it is the first time we’ve ever attended a conference that wasn’t hyping the same old failed models. Perhaps being Canadian – a country not quite as enamored with the Minnesota 12-Step Model – helped. Whatever the case, it was a refreshing change.
Happily, the conference’s focus was on differentiating between clients engaging in alcohol abuse and those suffering from true dependency, and differential treatment based on the individual’s condition, not a monolithic “one-size-fits-all” regimen. The presenters’ stats paralleled our own experience – 85% of people with alcohol problems are abusers and only 15% are the dependent ones for whom a “disease” label may be warranted. That estimate correlates with our experience, but we go a step further and suggest that the very few in the “dependent” category ever seek treatment and that the perspective client population is more like 95% alcohol abusers and only 5% dependent.
What difference does that make? For starters, it means that 95% of current treatment practices are only applicable to 5% of the client population, if that. Frankly, current practices serve no one but the industry that employs them – a revolving door business dependent on promoting ineffective methods and relapse in order to keep profitable beds filled.
Since current practices aren’t effective, what is? The research is clear, and has been for a long time: motivated clients with outside support and a belief in their ability to change their alcohol abuse have an excellent prognosis. Clients especially benefit from intense, short-term, outpatient treatment with support from anti-craving medications and the use of Cognitive Behavioral Therapy.
So why are we still stuck with ineffective programs? There really are two major reasons – first, treatment is a multi-billion dollar industry with no financial incentive to change. The marketing of the “powerless, disease, forever-recovering, 12-Step” model has been spectacularly successful and no one has any incentive to prune that money tree simply because it doesn’t help clients.
Secondly, effective treatment is hard work and requires staff with actual skills, knowledge, and expertise – something beyond merely having stopped drinking last month or last year. But residential programs require huge numbers of low level staff and have hundreds of hours to fill. How better to accomplish that than by employing “lifers” who can’t stay dry outside of continuous treatment, and an endless repetition of the “Steps” as “doing something,” and meetings passed off as group therapy?
Are things changing? Not really. Twenty years ago we were told that our research based methods were “twenty years ahead of the times.” Two decades later we’re still eighteen years ahead. The problem is that providers have no incentive to change, the public has been effectively brainwashed, and most programs start off based on false premises which even the best intentioned reinforce.
For now, the real message is clear – if you want help with your alcohol problem, be very, very careful where you get it. Most programs will not only take your money, but will also leave you drinking more within a few months, and frequently within a few hours, of discharge. Sadly, treatment centers have no motivation to do what actually helps – quite the opposite. Remember that when you look for help for yourself or someone else.
In our next installment we’ll take a look at the disease model and why it’s so popular, both with providers and with some clients
For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com
©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.
how do we know the difference between a genuine therapy centre or not. drinking buddies may not give you the best references..
Huh this one really left me with a lot to think about. I have never really given much thought to the differences between being dependent on alcohol and an alcohol abuser. That makes a lot of sense! And of course it is a multi million dollar industry- treatment programs like these take the responsibility for the problem totally away from the abuser. For them it is the “disease” that causes the problems and not the choices that one makes when he or she drinks too much. Great work! I will definitely be looking for the next installment.
Obviously the 12 step model works for some people but not for others. Are there some lesser known treatment models or programs that have higher success rates than this? If so where can I learn more about them?
Thanks for the comments and, first, Slyvain – it’s tough to find a therapist or programs which will work with you. You can narrow thinmgs down a bit by chacking the listings at the Moderations Management Organization or at the Harms Reduction, Abstinence, Moderation Organization whose links are on the Resources page on our website.
Thanks you too Amy – we’re always glad to be of help.
Wow, I agree with Amy, this is a lot to think about!
I am a recovering alcoholic, now for 17 mos 8 days, after drinking socially with family, friends, workmates for 30 yrs. When our Doctor told my late husband & I that we were alcoholics, of course, we were shocked. Regardless, we accepted it, then had to deal with severe health affliction from just that !!!
I’ve been trying to spread the news/warning about this for 6-7 mos now, only to discover there are many others who have been hit, but are too ashamed to relay their knowledge to others.
One thing I can almost guarantee, is that when alcohol hits your health, 99% of the time there’s NO cure, and getting rid of having it in your life, is very easy. In fact I now have a deep bitter hatred of it all !!!
Many of us have been trying to get our Government, to make it mandatory for all manufacturers to have large Health Warning Labels on each container. While I realize that’s not going to solve all the problem, hopefully it will help our youth!
As I’ve said in other columns, our young people eventually, will have to take over running many Company’s, including our Government, and therefore, we’ve got to somehow ensure that they do not allow liquor to destroy their health. Otherwise, what will happen in the future ????????
As always we appreciate the responses (and your tolerance of my occasionally clumsy typing)… To answer you, Eric, 12-Step based recovery has about a 5% success rate over five years. Other things have higher rates but have never had the promotion attached to them. You can read about alternatives in “Changing For Good” by Prochaska, et.al.; in The Three Minute Therapist by Edelstein (most of it’s available at hia Three minute Therapist website) and, an older reference, Peele’s Diseasing of America.
One problem is that nothing works very well for high percentages of people. 5% for AA, another 5% just give it up, possibly 30% figure out what works for them on their own; combinations of CBT and Naltrexone have good success rates but require skilled therapists.
We work with people to figure out what will work with them without a bunch of pre-ordained “musts” and “have tos” and “can’ts” and out clients do a lot better than the industry averages. But we also screen out people who don’t want to change their drinking.
It’s true that for some people – the Nanaimo Conference suggested 15% – alcoholism acts like a real disease and needs to be treated as such but there is still little agreement as to what that treatment should be. There is an ongoing, and severe, conflict between the “industry” and the research that isn’t apt to be resolved anytime soon.
For the foreseeable future, people are well advised to approach “treatment” with skepticism, a firm grip on their wallet, and a lot of research. Unhappily, when people need help, they are rarely in a position to be informed consumers and the results are predictably absymal.
It is a shame that genius marketing has led some programs to be a success when they really do not work that well for everyone at all!
But that is true with so many things in society Charmaine. People allow what they think is the most “current” or interesting thing to catch their eye and they simply have to be a part of that. I think that some of these rehab programs have been like that. People with problems automatically hop on board just because of the name recognition and expect the program to work miracles and quite frankly that is just not always the case. In fact there are more people who slide back into their addiction problems after completing some of these rehab programs than you would have ever thought possible. There is no one size fits all fix to addiction the way that many of these programs claim to be. Recovery is very much and individual journey, one that requires just the right program along with strong dedication, and it is only through all of these things coming together that one will be able to make peace with his or her addiction issues.
Thank you, Nancy – that is so well said. Changing a habit occurs in the context of a person’s life and requires a real change in one’s life, not merely a slight shifting of focus. While we individualize our work with every client that only work when clients want to change and are willing to proactively pursue a more rewarding life. Sadly, many still want the magic wand, or for everyone else to change, or merely to get someone off their back. Happily, we’re able to screen out most of those and to have room for the motivated ones.
AA worked for my brother but he was ready to make a life change and ready to commit to whatever it took to make that happen for him. Therein lies the key to success I think. He knew change was going to be hard and would require a great deal of work- he had no illusions that this would fix him via absolutely no effort on his part. I think that if more abusers realized this from the start and perhaps more programs placed even more emphasis on the culpability and responsibility of the abuser in changing his or her life then more people would find success and happiness on the road to recovery. Thank you.
That is a very valid point that you make about abusers needing to know up front that the responsibility for them to make a change lies only within themselves. It sounds like your brother and probably the entire family has had to do a lot of hard work to get him through this. I am glad that his treatment program went well for him and I wish him continued success with sobriety.
Too many people have made too much money in “treating” alcohol addiction without veer solving the real problems. Those who have profited in this way should be ashamed of themselves. I know we are a free market society but it is not right to profit from others’ suffering.
The frequency, quantity and degree to which an individual consumes alcohol are also very important when it comes to differentiate between an addict and a normal alcohol user. alcohol consumption over a long period of time may result in withdrawal tendencies and dependence Thank you
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A therapeutic effect is a consequence of a particular treatment which is judged to be desirable and beneficial. This is true whether the result was expected, unexpected, or even an unintended consequence of the treatment.
jack
This is a very interesting posting with many ideas to “chew on.” Lest my response become an article in itself, I’ll stick to just a couple of points that intrigue me. The first thing, that Steve and Marjorie both put so succinctly, is that the key to success in addiction recovery is that the person realize their own responsibility for their actions and for making changes in their life. It may not be anyone’s “fault” that they became an addict (genetic predisposition, family patterns, maladaptive relationships, etc., all can play a role), but once they realize that they have the problem, it becomes no one’s responsibility but their own to do something about it.
A second idea is that meeting people where they are (in terms of therapy) has been demonstrated to be the most successful way to engage a client to change. The “pre-ordained musts and have-to’s and can’ts” usually serve to give people the reasons they’re looking for to leave treatment. If you can help someone discover how they can achieve something they want from their treatment, they will have the motivation to at least begin to do what they need to do to get it.
The third point, or question, actually, is who are these people who are making so many bazillions of dollars on treatment? I know that places like Hazelden and Betty Ford Center charge a lot (A LOT!!!), and there may be no end to celebrity “treatment” centers (which sound like ultra-spas for the ultra-spoiled); but I can’t imagine that these are the places that most people would end up for serious substance dependence treatment. I live in the Chicago area, and there are few places for “regular” people to receive treatment. Some (not enough, in my opinion) hospitals have inpatient units (like the one I did my internship at — where people made about $15/hour). Hospitals that accept insurance and Medicare and Medicaid (which a great number do) are only reimbursed for so much, and these are not “for profit” places, anyway. There are some charitable agencies that run “no frills” inpatient treatment centers for people with no money; it doesn’t seem like anyone is getting rich there either. AA is FREE. Now, there may be a lot of people who don’t understand addiction (and I think that’s an understatement) that end up sending inappropriate candidates for treatment. But if you accept that 15% of people with alcohol dependence truly fit the disease model, you can’t really condemn the treatment if people who don’t have the disease are treated with it. (Antibiotics are great on bacteria but are pretty worthless on viruses; you can’t honestly criticize the treatment if it’s used on the wrong problem.)
Thanks for presenting such a “juicy” topic for discussion and thought!
Carol Cann
Well, okay – your first two points are well taken and we don’t disagree. The third point, however, to us means that providers have a responsibility to not mislead clients – which 99% of alcohol treatment providers do (never mind, M.D.’s, judges, Dr. Phil, and Dear Abby). You wouldn’t support M.D.’s who pretended that anti-biotics were appropriate treatment for viruses would you?
If you are also promoting the “disease” model you are doing everyone a disservice, and with a belief in “powerlessness” being the #1 predictor of(and excuse for) relapse… Well many conclusions seem obvious to us.
Granted that there are many underfunded “programs”. But if their approaches have an efficacy rate of <5%, when the spontanious remission rate is well above 5%, why should they be funded at all?
As for the Hazeldens and Betty Fords – there are a ton of them in the U.S. who further victimizine clients already victimized by circumstances. Betty Ford now charges $40,000+ for what amounts to less than 12 hours of actual 1×1 time with a real professional counselor – and you have to clean the toilets as some sort of weird Synanon rite.
Oops, here we are adding an article to your article about an article..
Enough – but thank you for wking up our Monday morning!
Ed & Mary Ellen
I have been involved with AA for over 20 yrs. now. In the beginning, I was forced to attend by the judicial system, so actually got nothing beneficial whatsoever from the program. Steps? What are those?
During the past 5 yrs. I have taken the program seriously and made every effort to swallow it whole; but sooner than later, I would break my sobriety and relapse with a spree-binge…
It has been said that I am too intelligent to ‘get this simple program’. Sort of a back-handed compliment.
As a recovering Catholic, I never did get along with the powerlessness(?) admission, the constant probing for personal defects (sins?) and the necessity of attending meetings, and more for the rest of my life.
These days, I do a positive affirmation almost every day- “Today, I quit drinking so as to improve my life, forever.” And I visit recovery based sites on the web for at least an hour each evening.
So far it’s working, and I get along with my co-workers, boss, and even some AA people.
It does take constant vigilance: of where my mind might be trying to head off to… “Wouldn’t it be nice…” or “one won’t hurt”.
Those are dangerous shoals which I have to fend off immediately, or end up on the rocks! (no pun intended)
Tom
Hi Tommy,
Your post is a good example of why AA isn’t for everyone but isn’t necessarily a negative thing. I love your affirmation — that seems to capture the whole idea. Here’s a link to a blog post that was in the New York Times a few months ago that really addresses those “one won’t hurt” demons. I think you will like it.
http://proof.blogs.nytimes.com/2008/12/08/its-the-holidays-how-about-just-one/
Carol Cann
You can also erase most of the demons with a bit of CBT. A particularly useful book is Three Minute Therapy – a resource we use with clients all of the time. The good part is that the skills are transferable to most of our problem areas.