Why Addiction Treatment is a Disaster--Maia Szalavitz

Persephone In Exile's picture
Submitted by Persephone In Exile on Sun, 07/08/2012 - 21:26

Forums:

Anyone who has been through rehab or any other type of addiction treatment in America knows that it is radically different from any other sort of medical care. Now, a groundbreaking new report from the National Center on Addiction and Substance Abuse at Columbia University confirms the woeful details. Titled “Addiction Medicine: Closing the Gap Between Science and Practice,” the study is scathing in its condemnation: addiction treatment is a “non-system” that the medical profession has almost entirely neglected, leaving it to a patchwork of treatment programs, including many that offer unproven therapies, untrained staff, little medical supervision and less accountability.

“Some [programs] promise ‘one time’ fixes; others offer posh residential treatment at astronomical prices with little evidence justifying the cost,” the report concludes. “Even for those who do have insurance coverage or can pay out of pocket, there are no outcome data reflecting the quality of treatment providers so that patients can make informed decisions.”

Advocates have long argued that addiction is a disease (a brain disease, according to neuroscientists), but we sure don’t treat it like one. Unlike with virtually any other medical condition, there is no accepted national standard of care. Some 90% of programs involve the use of 12-step programs—endorsing meeting, confession, humility and prayer as key parts of recovery—and these types of recommendations are, shall we say, rare in other mainstream medicine.

In fact, the main qualification for providing care is having suffered from addiction oneself. While there are many wonderful people in recovery who do great work helping others, there are also plenty who are complete disasters......

Read the rest at:
http://www.thefix.com/content/CASA-report-addiction-treatment-failure8399

First-Things-First (not verified)

Tue, 07/10/2012 - 22:57

live_free_or_die's picture

live_free_or_die

Mon, 07/09/2012 - 06:26

Would you please provide your research. I would like to read it and this is something we all should be aware of. Thanks so much for sharing.

Alcoholics Anonymous: MyNotGodHasItCovered®
http://www.expaa.org/
http://bereanresearch.com/
http://badrecovery.blogspot.com/
NOT AA:
Rational Recovery, SOS, HAMS
http://alcoholabusesolutions.com/

Clara's picture

Clara

Mon, 07/09/2012 - 09:57

I think the biggest shams in the world are cosmetic sales and weight loss.

Remember Christopher Stevens when you vote.

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Persephone In Exile

Mon, 07/09/2012 - 08:41

Actually, it is different. I'm a pretty anti-medication person myself (just for me, not when it comes to others), but even so, the medications doctors offer are scientifically studied and tested. They are proven to help in at least some capacity. Your doctor didn't offer you all of the options, but he didn't offer you a placebo either. With most treatment centers, you're dealing with employees who very often actively oppose any medical treatments that clash with their preconceived notions of "recovery". Or, at the least, there are (as pointed out in the CASA study) no standards by which these places operate. Some may offer, for example, someone detoxing from opiates a taper of suboxone. Some may instead tell that person that the suffering through of the withdrawals with no medical aid will strengthen their sobriety. Most in the latter category will mislead potential patients by telling them that they will be given medications to help the withdrawals, when those meds end up being things like blood pressure medication instead that doesn't do near what was promised.

Yes, it's a sham. But it is different from offering patients tested options. What doctor would tell a patient (and get away with it) in any other setting that your only help is a bunch of steps that will only work if you believe in them? What other business model? Could a car dealership sell you a car for $30k but tell you it is essentially magic and will only work if you believe in it (and a higher power)? No. They'd all be shut down and investigated for fraud.

http://badrecovery.blogspot.com/

First-Things-First (not verified)

Tue, 07/10/2012 - 22:56

Persephone In Exile's picture

Persephone In Exile

Mon, 07/09/2012 - 09:09

I don't really think that was being knit-picky, but that's fine with me. I've been remarkably NOT helped by most areas of the medical industry myself, and understand what you're saying. This area is just so out of line with the rest of the medical industry.

http://badrecovery.blogspot.com/

live_free_or_die's picture

live_free_or_die

Mon, 07/09/2012 - 06:29

FTF says: “Recommendation, cut red meat, cut dairy, and go on a low hypoglycemic diet (basically avoid sugar and anything your body recognizes or metabolizes like sugar).”

I recommend to the alcohol abuser to quit drinking (vodka, bourbon, beer, wine, etc.). If support is needed, seek a doctor, a psychiatrist, a nutritionist, etc.-somebody trained in the medical field.
Or you can listen to an AA member (sponsor), a person who has no solutions to the substance abuse issue other than having been an abuser themselves and to offer up a religious solution.

FTF says: “They sure as hell don't want you cured if you can be a returning customer. Only problem is that as the years go by the returns get more costly and you get closer and closer to the grave from lack of treatment.”

I say AA/12 steps is no different. AA/12 steps needs the substance abuser to admit they have an “incurable disease” that requires life-long attendance at meetings in “the rooms” to forestall the “disease”. AA does not want people cured-how could AA want you cured? AA does not offer a cure, AA offers lifetime membership in a religious fellowship.

Alcoholics Anonymous: MyNotGodHasItCovered®
http://www.expaa.org/
http://bereanresearch.com/
http://badrecovery.blogspot.com/
NOT AA:
Rational Recovery, SOS, HAMS
http://alcoholabusesolutions.com/

First-Things-First (not verified)

Tue, 07/10/2012 - 22:57

avogadno's picture

avogadno

Mon, 07/09/2012 - 09:57

Thanks lfod, that's a great recommendation!

"I recommend to the alcohol abuser to quit drinking (vodka, bourbon, beer, wine, etc.). If support is needed, seek a doctor, a psychiatrist, a nutritionist, etc.-somebody trained in the medical field.
Or you can listen to an AA member (sponsor), a person who has no solutions to the substance abuse issue other than having been an abuser themselves and to offer up a religious solution."

Pro Empowerment!
Truth about AA: http://orange-papers.org/menu1.html
Expose AA: http://www.expaa.org/

Clara's picture

Clara

Mon, 07/09/2012 - 10:06

But I would like to see success stats of the alternatives. I know that AA works for me. What I find contradictory about some of the posts on OPF is that people will offer alternatives to AA simply because they don't like AA, not that they have any real proof or experience that these alternatives workat all or any better.

Tom freely admits that he has no figures for SMART because he doesn't track. I sent an email to Jim at SOS, and he hasn't responded yet. While I will tell people to do their own research about alternatives to AA, I can't specifically recommend anything I haven't experienced for myself.

it doesn't matter to me if people use phrases like "evidence based" because I heard similar language supporting every product in my bathroom that does nil. There are medications out there that might have years of research to support it, yet it didn't work for me. I also know pharm salespeople that tell me of the efforts to place these meds and for doctors to perscribe them. I could probably bypass the dr visit and buy what I need in Mexico based on enough of my own research. Doctors have litte if any personal experience with what the recommend. How many times a day to you hear some attorney suing pharm companies on behalf of side effects from taking those drugs with years of studies behind them?

Remember Christopher Stevens when you vote.

Persephone In Exile's picture

Persephone In Exile

Mon, 07/09/2012 - 10:59

Why would the solution be to replace the 12 step treatment center model with that of another program in the first place, Clara? There ARE numerous studies on the benefits in addiction treatment of motivational interviewing, CBT, etc., not to mention getting people help for underlying issues dealing with trauma that they might be covering up with substance abuse. I realize you're on some crusade against SMART here, but that doesn't exactly speak to the issue of this thread.

http://badrecovery.blogspot.com/

Clara's picture

Clara

Mon, 07/09/2012 - 11:18

I had motivational interviewing in AA, PIE. I also had CBT, etc. I know people that got help through AA for recognizing underlying issues that they thought they were solving, dealing with or hiding from with drink.

I am not on a crusade about SMART at all. It was just the program that was touted as some sort of savior when no one can really give me any stats that it as a whole works any better than anything else. I have to admit that I laughed when I saw the trick of using some "powerful" statement such as "SCAT" to my addiction or "enemy..." It is rather contradictory to laugh at someone feeling their disease "talks" to them when this other program tells you not only to NAME your addiction, but to talk IT as if it is a person. For some reason, people think this is fine. That is what I don't get.

I am just going with the flow, PIE. When someone posts something that interests me, I post back just as you do.

Remember Christopher Stevens when you vote.

Persephone In Exile's picture

Persephone In Exile

Mon, 07/09/2012 - 11:32

Wow Clara, your AA group had people in it that were licensed and trained to practice these techniques with others in the fellowship?

Regardless, I wasn't talking about AA. This thread is about treatment centers, not meetings (other than the ones that happen in treatment centers that seem to cost several hundreds of dollars apiece.)

http://badrecovery.blogspot.com/

Clara's picture

Clara

Mon, 07/09/2012 - 12:50

I didn't know you had to be licensed to do that since, of course, all one has to do is download the facilitators handbook from SMART and have a desire to help others... But the fact is that fully one third of my womens group were licensed professionals in mental health and/or addiction.

You can imagine how surprised I was to see much less of it when I moved from the beach.

I am of the belief that sometimes the value in a treatment center is to get someone out of a certain environment.

Remember Christopher Stevens when you vote.

Persephone In Exile's picture

Persephone In Exile

Mon, 07/09/2012 - 13:16

Fully 1/3 of your group were licensed professionals in these fields? That's interesting. I always wondered which meetings were composed of the two-hatters.

Just so you know, I'm not a part of SMART and know very, very little about SMART, so I'm not going to get into that argument here, least of all with you. My point was simply that if you were getting any of the above mentioned therapies in your AA group, then it was either by people who weren't licensed to do so, or it was under the table by people who weren't charging (which was apparently the case). I'm sure this was the same group that hated people coming to them for help with problems that went beyond alcohol, correct? Lovely bit of helpful spirit there.

I think the idea of treatment as a place to go for at least 30 days where you cannot use or drink is actually of very good value. However, as for getting out of a "certain environment", in my case (and that of many, many other people) you are going straight from a somewhat controlled environment (unless you attend NA) to one in which everyone is talking about drinking and using, all while patients are encouraged to build bonds with their fellow patients. This can be a VERY negative thing, for reasons I may or may not go into later.

http://badrecovery.blogspot.com/

Clara's picture

Clara

Mon, 07/09/2012 - 13:34

Perhaps you should read up about it, PIE, as those are the therapies talked about often on these boards. It would appear that you don't need to be licensed or I doubt it would be pushed.

Yes, some of these women took on real tough cases in the rooms. A professional of any kind doesn't have to charge for services, and if their sponsees benefited from their additional education and experience, good for them. My sponsor helps people with legal difficulties and doesn't charge them. He's also been known to charge a dollar for 5th steps of guys in prison so he can claim atty/client privilege. Some people have done pretty bad things and need some help getting it worked out.

No one hated anyone coming for problems other than alcohol. The problem is when people want to jump on AA for not working for them when they are there for a problem it was never designed to address. It's an alcoholic helping another alcoholic. No one wants to hear about inveterate gambling, the closet eater or the sex addict except on a private level. It is sort of obvious through the name.

Remember Christopher Stevens when you vote.

Ironic's picture

Ironic

Mon, 07/09/2012 - 14:01

So you admit that your sponsor helps protect criminals?

Now we are getting somewhere. Love that honesty! Is OPF helping you change, Clara?

First-Things-First (not verified)

Tue, 07/10/2012 - 22:58

Clara's picture

Clara

Mon, 07/09/2012 - 14:06

What is to admit to an attorney being a constitutionalist who helps all? That's much better than protecting criminals against AA! Not that I don't appreciate the effort, though. I don't want mandates, either.

Remember Christopher Stevens when you vote.

Clara's picture

Clara

Mon, 07/09/2012 - 13:45

Two hatter must be a rehab phrase. I don't know what you mean, but I do know that these women were in AA because they were alcoholics. They didn't go to other fellowships.

Remember Christopher Stevens when you vote.

Persephone In Exile's picture

Persephone In Exile

Mon, 07/09/2012 - 13:59

Just a term used on these sites:

http://stinkin-thinkin.com/dictionaary/

Two-hatter – An AA who also plays the role of a therapist or social worker, and uses his or her position to manipulate others into AA, and into believing the AA dogma; regardless of the fact this is blatant conflict of interest, and goes against AA’s own traditions. (see Twelve Traditions).

http://badrecovery.blogspot.com/

First-Things-First (not verified)

Tue, 07/10/2012 - 22:58

Clara's picture

Clara

Mon, 07/09/2012 - 14:13

That's pretty funny. I wonder how many people went to school, only to become alcoholics later in life.
No wonder stinkin-thinkin was closed down. Nothing like spreading bad information.

What does it really mean, PIE?

Remember Christopher Stevens when you vote.

Persephone In Exile's picture

Persephone In Exile

Mon, 07/09/2012 - 14:17

Clara, are you implying that ST was "closed down" by people other than those who ran it? That doesn't seem to be the case, and all of that is still available to link to (obviously...).

Two hatter. One who wears two hats, metaphorically. In this case, the one hat of an AA or NA "recovering" member, the 2nd hat of an employee in the addiction/alcoholism field. Considering the "spread the message" theme of the program, that can be a considerable conflict of interest in the eyes of quite a few people.

http://badrecovery.blogspot.com/

Clara's picture

Clara

Mon, 07/09/2012 - 14:27

As you said, just a term used on that site. A site I just left has it as people that go to two fellowships.

I don't see a conflict of interest. Their sponsees where already in the rooms when choosing them to sponsor them.

Remember Christopher Stevens when you vote.

Persephone In Exile's picture

Persephone In Exile

Mon, 07/09/2012 - 16:09

Clara, no, it is not just a term used on that site, it was already in use.

Examples from other sites (written by two hatters who are, oddly enough, discussing the possible conflict of interest and other problems that one can face being a two hatter):

http://www.leademcounseling.com/the-forum/round-table/two-hatter
http://myrecoveryspace.com/groups/view/id_7/title_Two-Hatters/

Referenced in an area not related to recovery:

http://firechief.com/news/nvfc-two-hatter-20100621
(Plenty more in relation to firefighters).

Google. Learn how to use it;) You'll be surprised what's out there.

http://badrecovery.blogspot.com/

Clara's picture

Clara

Mon, 07/09/2012 - 16:17

I did google the term and came up with something different, but I can see where rehab speak bleeds over. A person in both fellowship, AA and NA, were 2 hatters.

It still doesn't matter. These women sponsored women that were already in the fellowship so I cannot see a conflict of interest. I would say these particular gals were very fortunate.

Remember Christopher Stevens when you vote.

Persephone In Exile's picture

Persephone In Exile

Wed, 07/11/2012 - 13:15

I just linked a site with people in the same position as the women you're trying to bring up here discussing being "two hatters" and you're still bringing up some women whose butts you were kissing back in SC? Are you going to discuss the topic, or are you going to just continue to bring up anecdotes about people you've supposedly known?

Oh, and yes, two hatter is partly, at least, a rehab term. This is a thread about treatment centers, after all, not SMART, not your old meeting, not using knives or crab soup. Please make a note of it.

http://badrecovery.blogspot.com/

Clara's picture

Clara

Mon, 07/09/2012 - 19:52

Ahhh, PIE, I'll be deciding what I talk about, thank you. You can always just jump over my posts if you choose. I can talk about anyone I choose, and these wonderfully caring and loving women will be people I talk about for the rest of my life. They were great and are still friends.

As for the crab soup, it might help you to make a note of who brings that up more often. It isn't me, dear.

Remember Christopher Stevens when you vote.

Persephone In Exile's picture

Persephone In Exile

Mon, 07/09/2012 - 19:59

Yay.

http://badrecovery.blogspot.com/

becket's picture

becket

Mon, 07/09/2012 - 16:17

So this is one who just plays the role of therapist or social worker? Or is this a person who is licensed in either profession? Because if it's just someone playing a role, why care what she says?

“The essence of the independent mind lies not in what it thinks, but in how it thinks.”
― Christopher Hitchens, Letters to a Young Contrarian

Free

Mon, 07/09/2012 - 15:48

is commonly used in the Southern Hemisphere as well. Here it's taken to mean a therapist/ counsellor/ psych who is simultaneously treating and sponsoring. People attending BB and 12 by12 meetings used the term pejoratively. After a few months of therapy, my stepper therapist started pressuring me to find a sponsor. I didn't get it, arguing that surely we could cover the steps in therapy, but he said he couldn't ethically be my sponsor AND therapist - that I'd have to choose which role I wanted him to take. To his credit, he guided me into finding a female sponsor - offering suggestions of women he thought suitable.

avogadno's picture

avogadno

Mon, 07/09/2012 - 19:30

PIE, Ya mean like people wanting to sell you drugs? Perhaps people that suggest getting high, either during or after treatment?

Yeah, NA has an abundance of of "members" that go there for this specific reason. Maybe not in treatment, although I've known people to sneak drugs in. In fact, I met a dealer in my after care group. He was sentenced to treatment because he was a seller, not a user. Doh! Bad enough that we are encouraged to bond with the groups that have these active personalities, even if we try to stay away we have to listen to their shares. I met more active dealers and users in the program then I knew before I ever had been to a meetings. Scary, very true though.

Pro Empowerment!
Truth about AA: http://orange-papers.org/menu1.html
Expose AA: http://www.expaa.org/

becket's picture

becket

Mon, 07/09/2012 - 13:51

"(other than the ones that happen in treatment centers that seem to cost several hundreds of dollars apiece.)"

Where's the cost breakdown? Or are you just relying on supposition?

“The essence of the independent mind lies not in what it thinks, but in how it thinks.”
― Christopher Hitchens, Letters to a Young Contrarian

First-Things-First (not verified)

Tue, 07/10/2012 - 22:59

live_free_or_die's picture

live_free_or_die

Mon, 07/09/2012 - 16:05

And are the substance abusers of the world being presented with an UNBIASED picture of the 12 steps FTF?

Alcoholics Anonymous: MyNotGodHasItCovered®
http://www.expaa.org/
http://bereanresearch.com/
http://badrecovery.blogspot.com/
NOT AA:
Rational Recovery, SOS, HAMS
http://alcoholabusesolutions.com/

becket's picture

becket

Mon, 07/09/2012 - 16:20

Is that really a concern of yours lfop? You are one who continually presents a negatively biased viewpoint regarding any 12-step situation. In order to find absolutely no bias, one would have to search in places other than the Orange Papers Forum.

“The essence of the independent mind lies not in what it thinks, but in how it thinks.”
― Christopher Hitchens, Letters to a Young Contrarian

live_free_or_die's picture

live_free_or_die

Mon, 07/09/2012 - 16:49

Take a shot at honesty old man.

I ask you, judge bucket, up to, say five years ago, was the U.S. presented an UNBIASED picture of the effectiveness of AA as a solution to alcohol abuse?

You should ask Dr. Jerry Neil Rand about the effectiveness of "12 step treatment" in this country becker, but hurry as I think he will be in the California Penal System ( as AA predicted).

My concern is not yours.

Alcoholics Anonymous: MyNotGodHasItCovered®
http://www.expaa.org/
http://bereanresearch.com/
http://badrecovery.blogspot.com/
NOT AA:
Rational Recovery, SOS, HAMS
http://alcoholabusesolutions.com/

Persephone In Exile's picture

Persephone In Exile

Mon, 07/09/2012 - 16:15

FTF, I do believe those who have had to deal with 12 step programs and have grievances against them have the right to speak out about it all. Is that biased? Of course it is! Do we have the right to speak about this? Yes, we do.

As everyone is getting a very biased view of the 12 step programs already, and a glowingly positive one at that, I don't think you can see much harm in a very small attempt to level the playing field.

http://badrecovery.blogspot.com/

becket's picture

becket

Mon, 07/09/2012 - 16:22

No need to level the playing field. This isn't a game. You get to choose what's right for you and so does every other person alive. You don't get to unduly influence others, nor does anyone else. Fact is, everyone tries to influence one another. If people could just learn to keep their hands and their minds and their biases to themselves there wouldn't be so much controversy or strife over this issue.

“The essence of the independent mind lies not in what it thinks, but in how it thinks.”
― Christopher Hitchens, Letters to a Young Contrarian

live_free_or_die's picture

live_free_or_die

Mon, 07/09/2012 - 16:48

AA is all about undue influence judge becker. Its a damn culty religious program.

Busy brainwashing millions. And killing some folks in the process.

My concern is not yours judge.

Alcoholics Anonymous: MyNotGodHasItCovered®
http://www.expaa.org/
http://bereanresearch.com/
http://badrecovery.blogspot.com/
NOT AA:
Rational Recovery, SOS, HAMS
http://alcoholabusesolutions.com/

avogadno's picture

avogadno

Mon, 07/09/2012 - 16:22

FTF, If AA didn't tell people it was the only way and those that left would end up in 'jails, institutions, and death', then maybe it wouldn't be opposed so much. Perhaps if it wasn't a religious group fronted as a quit drinking program then some former members wouldn't hate it so. The negative anecdotes including the controlling sponsors and guru 'know it alls' are unappealing. So yeah, those of us that experienced the nasty aspects of faith healing do have a biased opinion against AA. Other than that, you said it right. Advertise the opportunities well, "let the people decide what works for them".

Pro Empowerment!
Truth about AA: http://orange-papers.org/menu1.html
Expose AA: http://www.expaa.org/

First-Things-First (not verified)

Tue, 07/10/2012 - 22:59

live_free_or_die's picture

live_free_or_die

Mon, 07/09/2012 - 17:58

my friend. You know that.

Alcoholics Anonymous: MyNotGodHasItCovered®
http://www.expaa.org/
http://bereanresearch.com/
http://badrecovery.blogspot.com/
NOT AA:
Rational Recovery, SOS, HAMS
http://alcoholabusesolutions.com/

First-Things-First (not verified)

Tue, 07/10/2012 - 22:59

live_free_or_die's picture

live_free_or_die

Tue, 07/10/2012 - 15:29

I know, it's obvious. Doing AA time takes time away from your life, precious time. You know that?

FTF, how many hours would you say you have wasted in the roomz of AA?

Alcoholics Anonymous: MyNotGodHasItCovered®
http://www.expaa.org/
http://bereanresearch.com/
http://badrecovery.blogspot.com/
NOT AA:
Rational Recovery, SOS, HAMS
http://alcoholabusesolutions.com/

avogadno's picture

avogadno

Mon, 07/09/2012 - 19:36

I'm not sure I understood what you meant, FTF. About non AA related news, in my area any mention of other options would have been met with a guru grunt, "Outside Issue", followed by a bunch of bobble-head buddies nodding in agreement. Virtually you had to accumulate a significant amount of clean time before being able to speak without interference. If I had known about other free programs or any option other than the program, I likely would have wanted to leave and/or give it a try. Like you, I didn't know of any. Good luck with your plan!

Pro Empowerment!
Truth about AA: http://orange-papers.org/menu1.html
Expose AA: http://www.expaa.org/

First-Things-First (not verified)

Tue, 07/10/2012 - 23:00

avogadno's picture

avogadno

Mon, 07/09/2012 - 15:05

So what? If a person dislikes AA, finds this or other sites and asks for advice, there is nothing wrong with listing a few other methods and let them read about it. That's what it's about, choice....

Another picture that reminds me of your threatening comments:

Pro Empowerment!
Truth about AA: http://orange-papers.org/menu1.html
Expose AA: http://www.expaa.org/

Clara's picture

Clara

Mon, 07/09/2012 - 15:24

Poor posture. Wouldn't do anything.

And I agree that everyone should be familiar with the options, but it really isn't accurate to offer those options without stats of success. Besides, it wasn't my post.

Remember Christopher Stevens when you vote.

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