Does It "Work"?

Factual Questions
1

Not sure (as usual) if this should be in General Questions or Great Debates, but let’s start here and see where we end up.

As New Year’s Eve approaches and California attempts to de-emphasize prison and use treatment in the war on drugs, I had a quick look around the Internet to find success rates for alcoholics and drug abusers undergoing different kinds of treatment.

I am having an extremely difficult time answering what seemed a simple question. What percentage of those who go thru treatment for chemical dependency succeed in quitting? And which treatment is most likely to be successful?

Consumer Report (in 1970) said that 97% of heroin addicts not on methadone relapse. I read another citation that said only about one in two hundred alcoholics are able to stop drinking. All my alcoholic friends who say they are now sober had to go thru treatment at least twice.

So does it work? Is there a treatment plan that has a reasonable chance of causing an alcoholic to stop drinking, or a drug addict to stop using?

2

Interesting question and one I’ve wondered about myself a few times, so I did some digging. Seems from a quick net search that no-one is willing to actually give away figures for the success rates for those who enter rehabilitation programs because they are court ordered or because it might help them gain parole. Most of the sites are private concerns selling their treatment as the best.
The best success rates for these is reportedly 75% for Narconon, (http://www.addiction2.com/narconon_research_overview.html ) which is run by the Church of Scientology. Every other reference seems sceptical about these claims though. Since the same site says, “Whereas almost 90% had been actively involved with crime before Narconon, none were involved with crime afterwards” I’d have to question there definition of crime as well as there definition of success. Even if they are reliable, a 75% maximum success rate for a voluntary program still doesn’t seem real encouraging for the potential of involuntary treatments.
One other site (http://www.karlloren.com/Diabetes/p81.htm) states that “A review of the literature regarding existing drug rehabilitation techniques reveals many uncertainties. In fact, none of the prevalent approaches to treatment has been conclusively established to be reliable. Success rates as low as 33%, not substantially higher than those anticipated from no treatment at all or treatment with placebos are generally considered to be very good.” They then go on to follow the standard procedure of not clearly stating what their success rates are.
This same pattern of suggesting lower success rates in other treatments and then failing to clearly state success rates in their own seems to apply equally to government reports and medical reviews. (http://www.druglibrary.org/schaffer/library/studies/dwda/staff3.htm) states “The New York Narcotic Addiction Control Commission has estimated that only 24 per cent of those who receive detoxification without other services "remain drug-free for any length of time”. The same report then goes to give all sorts of figures about methadone treatment and the number of dropouts, measures of success etc. without ever clearly giving a success rate for those who receive detoxification with methadone.
There are Senate/House/Government/Royal Commision reports available from numerous authorities around the world at least touching on the problem, and all have essentially the same thing to say: “We are spending large amounts of money on these programs, we have unclear/little/no evidence it works, we’ll keep spending the money but we’ll have to do some research to get these answers.
I have found no evidence that there has ever at any stage been a controlled study of people who have gone through involuntary (or at least coerced) drug rehabilitation. I’ve seen a lot of studies of groups that have been treated, but no comparison with another group with the same demographics that haven’t been treated. I could only find very vague references to recidivism rates in untreated individuals such as those given above. Of the numerous reports on treated groups most ended with a conclusion along the lines of ‘the effectiveness/results are inconclusive/unclear, and dependant on a lot of variables that will undoubtedly change over time”. Most give any number of qualifiers for success. I failed to find even one that unambiguously stated “we followed the group for X years, and of the Y subjects Z% were arrested for drug-related crimes during that period and W could not be traced.” This would appear to be a relatively simple statistic to collect and failure to publish seems to reflect a bias on the part of the writer rather than unavailablity of data.
I’d be very interested as well if someone knows of any data at all on the relative effectiveness of involuntary drug rehabilitation programs. At this stage it seems that if there is any evidence at all that they work in the medium to long-term then those that hold this information are very reticent to share it. This seems very odd to me, since if any treatment works the proponents usually trumpet it from the rooftops to try to garner funding.

3

Shodan, could you please define your terms, i.e., “success” means what? Abstinence for life? Five years? Five months? TIA.

Peace

4

Define it how you like Peace! Do you actually have any information relating to the OP based on any definition? If so can you please share it?

5

I have read that it takes an average of seven times for one to finally kick the nicotine habit - one of the most addictive substances out there, and I can attest to that!

And I do know that the success rate (however defined) of people regularly attending AA meetings for at least a year is somewhere around 80%. I would assume that anyone who attends alot of meetings for that long is highly motivated & determined to get sober.

I know three ex-heroin addicts. One was in an in-patient treatment twice (now clean), one guy once (now clean), and one guy has been on methadone for…I think about 6 years. He doesn’t consider himself free of addiction, because he cannot quit methadone, and has relapsed several times. There’s a saying about leaving treatment programs for smack. “Out of the gate by eight, in the spoon by noon, on the run by one.”

6

No, Gaspode, I do not have any hard data, just hearsay. What I meant, was along the lines of Carina’s post: before we argue, what “the success rate” is, we should define it. 80% for one year sounds reasonable for me (for AA). But I am afraid that the relapse rate is about that high in 5 years.

Peace

7

Thanks to all who have responded so far.

Peace - my definition of success in treatment is permanent abstinence from the subject’s drug of choice. I chose this partly because it seems close to the stated goal of AA and other treatment regimens, and partly because it would seem common sense than people enter (or are compelled to enter) treatment so that they can quit using or drinking.

Gaspode - your research came up with the same results as mine, which was mostly why I asked. It is extremely difficult to get a straight answer to this question. I can think of several reasons why this should be so.

Maybe the question can be asked if treatment helps more than simply quitting on their own.

My only experience in this area is quitting smoking. I smoked for several years, quit (on my own), relapsed after a period of eleven months, smoked again for several more years, and then quit (again on my own) and have remained abstinent for the last fourteen years. I have no idea if this is typical, although the experience of several members of my family and friends suggests that it is not rare.

Nicotine is supposed to be among the most addictive of substances, but the number of smokers is decreasing in the US. I wonder how much this is due to people successfully quitting smoking, and how much is due to smokers dying and not being replaced. I had considerable difficulty finding out how many alcoholics there are in the US, and whether this number is increasing, decreasing, or is undeterminate.

Thanks again to all who are responding.

Merry Christmas/Happy Hanukkah/Ramadan Kareem/Happy New Year!

8

I can only speak from my own experience, as relates to alcohol, drugs & smoking.

AA is by far the most successful program for alcoholics who want to quit drinking. Now, about “success rates”- most if not all are educated guesses at best, as most programs or treatment facilities can’t keep track of all their graduates, and AA doesn’t keep statistics.

Rates generally will be for continuous sobriety for 1 year, 5 years or 10 years. It may be surprising to some people to learn that even in AA, staying sober 1 year or 5 years does not guarantee that an alcoholic will stay sober forever. It is a program of constant maintainance, and those who slack off often relapse. The shorter the length of time used, the higher the “success rate” will be.

It has long been bandied about that about 1 in 12 alcoholics who tries the 12 step program will stay sober. The other 11 will either stay sober for a while then relapse, or not get sober at all. I have no idea what the percentage is of alcoholics who try AA at all. Probably not more than 40-50%, but that’s a WAG.

Shodan, you may never find information about #'s of alcoholics in the US, because it is for the most part a self-diagnosis, which goes untreated in lots of people.

In my somewhat-informed opinion, based on what I have seen in almost 10 years of sobriety, maybe 1 in 15 will stay sober the rest of their lives, but it could very well be less than that. Sad but true.

Drugs & smoking- a whole other ballgame, because many people seem to smoke & use drugs with impunity. Generally, once you are addicted to a hard drug, you can probably never go back to recreational using. And it is damn hard to kick heroin, the recovery rate is abysmal. Nicotine addiction tends to vary in severity from person to person- hubby quit easily, whereas I thought I was gonna die.

No real answers I guess, but it’s not a topic that lends itself to pat answers!