Rethinking Rehab

Unfortunately the last few years have seen a number of deaths of celebrities who were known to have suffered from alcohol and/or drug problems.  Equally unfortunate is that it is often pointed out that these individuals had entered “rehab,” sometimes more than once. Critics have been quick to jump on this, asserting that rehab itself is ineffectual.  Taking a step further, since it’s assumed that most rehabs advocate for the Alcoholics Anonymous 12 step model of recovery, claims have been made that this model is also ineffectual. Books and blogs abound today, all arguing that AA is either “unproven,” “ineffective,” or downright harmful to those who give it a try. For its part, AA offers no rejoinder, for it is a fellowship which by tradition chooses to eschew publicity or public exposure. AA prefers to simply exist as a fellowship that is open to those men and women who have a desire to stop drinking or using drugs. The inevitable result is that the withering criticisms remain unchallenged, which very well may discourage many people who suffer the consequences of an alcohol or dug problem from ever going to an AA or NA meeting.

It’s time to confront these stereotypes of rehab and AA, beginning with rehab.

Not all rehabs are created equal.

Rehabs vary a great deal. They include rehabs which emphasize amenities such as Malibu Hot tubs or Arizona trail rides—implying in a sense that what recovery from addiction requires a really good vacation. Then there are those, like the Betty Ford Center, which face the reality of addiction and emphasize the perseverance and hard work that long-term recovery requires. Anyone considering rehab would therefore be wise to face this reality and make a choice: a 28-day vacation, or the beginning of a different kind of life?

In recovery, you get what you put into it

On a second front, it is not at all true that the AA 12 step model of recovery is “unproven.” An Institute of Medicine white paper published in 1989 concluded that while AA was ubiquitous as a solution to addiction it was until then largely untested through rigorous scientific research. That paper in turn led to a plethora of such research, most of it funded by federal agencies such as the National Institute on Alcohol Abuse and Alcoholism and conducted at major research universities. However, to this day that information remains largely opaque to the general population because it is buried in academic journals. And since AA elects not to respond to its critics, the critics are free to continue poisoning the well.

To look at just one such study, consider an exceptional longitudinal study conducted by Rudolf and Bernice Moos of Stanford University and published in the journal Alcoholism: Clinical and Experimental Research (2005, 29 (1), pp 1858-1868). They identified and followed a cohort of volunteers who had alcohol problems and divided them into three categories: those who opted at the outset to seek treatment but not to attend AA meetings; those who opted for AA but not treatment; and those who opted from the start to simultaneously seek treatment and go to AA. They then assessed these individuals 1, 3, 8, and again 16 years later. Here is what they found:

  • Group 3 (treatment plus AA from the outset) were the most likely to remain sober at all follow-up points.
  • All those who stopped going to AA at any point were more likely to start drinking again.
  • The longer a person remained n AA the more likely he or she was to remain sober.

This study is important not only because it attests to the efficacy of AA, but also because of what it says about those who chose to avoid AA altogether, those who decided to drop out after a while, and those who remained active. It goes without saying that not every man or woman with a fairly severe alcohol or drug problem is equally motivated to actually do something about it and stick with that decision. Addiction is not like an infection that can effectively be “cured” by a round of antibiotics. Addiction is like any chronic illness, whose “management” requires ongoing care, including life style changes and a degree of vigilance. Yet research has shown that 40 to 50 percent of individuals with chronic illnesses such as diabetes and heart disease do not adhere to their doctors’ recommendations for managing their illness. So it is for addiction.

A tragic (but common) example of what can happen when an individual simply lacks the motivation to do something about their addiction was the late (and great) singer Amy Winehouse. Well known for her severe alcohol abuse, Amy wrote in her signature song, Rehab:

They tried to make me go to rehab but I said, “no, no, no.” Yes, I’ve been black but when I come back you’ll know, know, know.

Like many others Amy apparently believed she could overcome her addiction on her own—without reaching out to others who had walked the same path.

Critics of AA and its 12 step model of recovery will no doubt not let facts like those found by Moos and Moos stand in the way of their continued assault—on rehab and/or AA. Many of these critics, of course, are promoting their own alternatives. But hopefully such findings will at least encourage those who have come to believe that they do have an alcohol or drug problem to try AA or NA as a solution. One such person—also a celebrity—appears to be the actor Alec Baldwin. In writing about his own alcoholism and his eventual decision to seek recovery through a fellowship, Baldwin wrote: “God got me sober that day. God was a black, 65-year-old retired postal worker named Lenny.” Indeed, these words reflect the spirituality of humility that is central to 12 step recovery.

2 Responses to Rethinking Rehab

  1. It has just been proven that addiction is a brain disease not a behavioural issue. Rehab needs to concentrate its focus on psychiatry available to all after detox and continue to include both AA and NA 12 step programs as there is no cure.

  2. Im grateful for the article post.Much thanks again.