How Holistic, Integrative Healthcare Treatment Can Effectively Treat Addiction
“12 Step programs are very popular, but if you’re looking for figures and randomized trials and scientifically rigorous studies of how they work and for how many people they work ‒ you will not find those studies. You will find anecdotal evidence ‒ for people that it did work [for] ‒ but unfortunately we don’t have the scientific basis to say how many of all those people that tried a 12 Step program ‒ how many of those did not succeed.”
—Ruben Baler ‒ Health Scientist, National Institute on Drug Abuse in The Business of Recovery
Despite the fact that rehabs and 12 Step-based programs demonstrate below a 20 percent sober recovery rate at one year, in study after study (based on a 30-60 day rehab term), they are still the two most recommended and court-ordered responses to addiction disorder and substance-related crime by the professional community. According to a government report, the average substance abuser involved in government sponsored rehabs visit six rehabs in their lifetime (all paid for by taxpayers), regardless of the fact that there is no evidence whatsoever that repeat stints lead to sustained sobriety. These findings illustrate an 80 percent failure rate. Of those studied who had completed a rehab program, the vast majority was NOT sober at one year. These dismal facts may best serve to motivate us towards a change in response.
Moreover, addiction treatment providers are typically not held accountable for their patients’ outcomes: the CASA report (The 586-page that CHI Recovery’s treatment is based on), found that nearly half of all patients with illegal drug problems are referred to treatment by the criminal justice system and, of course, it is the patients, not the counselors or program directors, who go to prison if they fail.
“Even the judicial system contributes to the confusion by often mandating AA attendance to offenders who arrive in court as the result of criminal charges associated with substance abuse (most commonly driving under the influence).
It is completely inappropriate and dangerous for courts to be mandating AA treatment. This amounts to malpractice. It’s medical malpractice by the judge. It’s as foolish as if the judge said to you ‘ok ‒ you have an infection ‒ I mandate that you take penicillin because I believe that’s the effective drug.”
—Lance Dodes, MD ‒ Addiction Expert & Author ‒ Harvard Medical School Graduate in The Business of Recovery
Comprehensive, integrative, and sustained holistic healthcare treatment, which has been structured on evidence-based research, is indicating that 70-80 percent of participants are sober at one year. Improved diversion strategies are indicated and are now recommended for all agencies claiming to offer “treatment.”
“AA is not really a treatment ‒ it’s a fellowship. If you go to your doctor to be treated for cancer or heart disease you expect your doctor to be doing what the science says is the best treatment available for what you have. That has not been the standard in addiction treatment.”
—William R. Miller, PhD Emeritus Distinguished Professor University of New Mexico in The Business of Recovery
The answer is not very straightforward. According to TIME magazine, there is no standard definition of “rehab,” so there is no standard metric of success for rehabilitation centers. Some facilities simply measure how many of their patients complete their programs; others consider sobriety in the follow-up months and years after “graduation” as the threshold for success.
TIME writer David Sheff, who almost lost his son to drug addiction, spoke with Joseph A. Califano, Jr., former Secretary of Health, Education, and Welfare and founder of the National Center on Addiction and Substance. Califano told Sheff, “The therapeutic community claims a 30 percent success rate, but they only count people who complete the program.” Califano adds that the other 70-80 percent have dropped out by the 3-6 month marker.
Sheff points to outdated philosophies and one-size-fits-all programs as reasons for the ineffectiveness of so many programs. The successful approaches, in Sheff’s assessment, “don’t rely on best guesses or tradition.” Like Johnson, Sheff sees hope in treatments that are “evidence-based treatments (EBTs)” and facilities that emphasize research-based therapies, such as Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management, in addition to medication.
Let’s take a look at what rehabs offer compared to recommended healthcare treatments:
- Isolates from “triggers” through isolation
- Provides supervised detox
- Educates: “Addiction is a disease”
- Introduces Twelve Steps, a community based support system
- Provides little to no psychotherapy or medical treatment
Recommended Healthcare Treatment
- Assists in integrating client into work, school, job training, volunteering
- Provides comprehensive medical evaluation plus MD supervised detox with pharmaceutical support therapies
- Educates re: Addiction, family systems, Cognitive-Behavioral Therapy, DBT, fiscal management, nutrition, exercise, STDs…
- Provides extensive ongoing group, family, relational and individual therapy with a licensed, addiction and trauma skilled therapist continuously, for a minimum of 4 to 9 months
Since many treatment centers do not follow up with their patients, the “100 percent” success rate some cite only applies to those who complete the length of their stay. Even those who boast a more modest “30 percent success rate” only draw that figure from the immediate sobriety rates after treatment, not from six months or three years down the road. Good outcomes are contingent on adequate treatment length.
Self-help groups can complement and extend the effects of professional treatment. The most prominent self-help groups are those affiliated with Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA), all of which are based on the 12-step model. Most drug addiction treatment programs encourage patients to participate in self-help group therapy during and after formal treatment. These groups can be particularly helpful during recovery, offering an added layer of community-level social support to help people achieve and maintain abstinence and other healthy lifestyle behaviors over the course of a lifetime. (National Institute on Drug Abuse, Dec. 2012)
New drugs will also challenge the conventional wisdom around AA being the primary ‒ often only solution to substance abuse. There is also the very real possibility that AA is not helping people with other mental or behavioral disorders that can be easily masked by substance abuse. The AA mantra of “more meetings” could well be counterproductive to many who arrive at the fellowship with a wide range of psychological, behavioral and other clinical issues. Ultimately, whether AA is scientifically effective ‒ for whom and how many ‒ is a secondary issue. No one argues that it has helped to destigmatize substance abuse and it definitely helps some. Unlike for-profit treatment plans, however, AA has never had fees or dues of any kind since its inception in 1935 ‒ and likely never will. The real issue then is a $35 billion a year industry that’s largely based on funneling substance abusers into the free fellowship of AA ‒ or simply providing large doses of AA meetings themselves.
Long-term recovery and sustained sobriety are achievable for everyone who is struggling with addiction or substance abuse issues. With proper guidance and support, recovery can be reached and sustained.