Thursday, July 18, 2013

The Problem With Alcohol/Drug Rehab Programs

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The death of Cory Monteith has launched a much needed discussion on the flawed 12 step method that seems to be the basis for most drug and alcohol rehab programs.   These programs - I attended some session some years ago with a family member, so I have seen it first hand - stress abstinence only, ignore modern scientific knowledge, and in many cases have too much of a tie with lunatic conservative Christian mindsets.  It is little wonder that far too many individuals go in and out of these programs like a revolving door.  A piece in The Daily Beast looks at the short comings of these programs.  Here are highlights:

Charlie Sheen has been there. So have Courtney Love and Lindsay Lohan. In fact, Lohan will complete her sixth stint at an addiction treatment center at the end of this month before jumping into the arms of Oprah Winfrey. For every troubled star, it seems, there’s an accompanying stay (or three) in rehab. It only takes a casual tabloid reader to note that the system isn’t working as well it could.

The death of Glee star Cory Monteith,  . . .  has reignited a debate among addiction experts over the efficacy of rehab centers—many of which continue to be built around traditional 12-step, abstinence only-programs despite a growing body of evidence that this approach doesn’t work for everyone. To wit: a 2012 report from the National Center of Addiction and Substance Abuse at Columbia University (CASAColumbia) concluded that many addiction programs don’t employ the kind of progressive, science-based approaches that have been shown to be effective in studies, and that “only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge of what works.”

Part of the problem is that addiction, which wasn’t formally recognized as a chronic brain disorder by the American Society of Addiction Medicine until two years ago, was long considered a behavioral problem rather than a mental-health issue. That stigma is one of the reasons addiction treatment is far from current with the latest scientific literature, says Anne Fletcher, who spent years interviewing rehab patients and researching the facilities taking care of them for her book Inside Rehab.

In fact, the stagnation seen at rehab centers today, both inpatient and outpatient, can be traced back decades, Fletcher says, to when the medical community would actually refuse to treat alcoholics and drug addicts. Addiction programs thus adopted Alcoholics Anonymous’s 12-step approach as a form of treatment, no matter that AA was designed to be a self-help program.
“The treatment model sprung up in a vacuum,” says Fletcher, which is why so many rehabs—including the most expensive ones in the country—remain grounded in the same one-size-fits-all treatment approach. Eight out of 10 programs in the U.S. today still incorporate the 12-step model in some fashion, she says, adding that group therapy is another staple of most programs even though there’s little evidence that this type of counseling helps.

Other systemic failures include inadequate credentialing standards for addiction counselors, with more than half of states in the country not requiring so much as a college degree, according to the 2012 CASAColumbia report.  . . . .

Forty to 60 percent of people treated for alcohol or drug dependence relapse within a year after discharge, according to a study published in 2000 by the Journal of the American Medical Association.

[M]any conventional drug rehabs refuse to educate their patients about medication-assisted treatment—primarily because abstinence-only approach remains so predominant in the U.S. As a result, many patients don’t have access to FDA-approved drugs that could potentially save their lives.

“There’s an attitude in addiction treatment where the facility thinks it knows what’s best for the patient,” says Fletcher, “but there’s strong research that involving the client in the treatment process and giving them a say in what goes on increases their chances for long-term recovery.”

What's most important, critics agree, is flipping the script on a treatment system that hasn't kept up with the times. "Constantly sending me to rehab is pointless," Lohan told CNN in May. "I've been court-ordered to do it six times. I could write the book on rehab."

Failed abstinence only sex education  has shown the illogical nature of abstinence only and the bogus "ex-gay" ministries have proven that "praying away" one's problem doesn't work.   My relative has succeeded in their process, but largely because they (i) rejected abstinence only approach, (ii) rejected the Christian brainwashing that was part of the program, and (iii) got therapy from a licensed psychologist familiar with modern knowledge. 

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