The serious problem of addiction to prescription and illegal drugs is on the increase.
The most common recommended solution to this problem is one or another of variious anti-adiction programs.
The assumption, of course, is that such programs are successful.
But, in fact, how successful are they?
It varies. Widely.
Just like the programs themselves!
It’s been quipped that Alcoholic Anonymous works by shifting your addiction from drinking alcohol to going to meetings.
From drinking to coffee and/or cigarettes.
I remember reading a Washington Post piece on this subject some years back. To my surprise, I was able to find it. It points to research done as part of Project MATCH (Matching Alcoholism Treatments to Client Homogeneity):
[Bolding mine.]
The author of the piece expresses hope that neuroscience research would lead to better approaches. That was 7 years ago. Addiction seems to be much more complex than previously thought.
I’m having a hard time coming up with a definition for “success” here. Do you have to stay 100% sober to be a success? If so, for what length of time? Does it count if you give up one addiction for another (e.g. quit cocaine and start taking meth)? Are you a success if you merely reduce your consumption? If so, how much of a reduction qualifies?
FWIW, Alcoholics Anonymous asked 6,000 members if they’d been sober for more than a year and AA claims 73% said yes. But many others dispute the accuracy of this statistic. For one thing, lots of them could be lying. For another thing, the survey might have suffered from selection bias, being more likely to ask people who attended multiple meetings and less likely to ask people who only attended a few. And AA might have fudged the numbers to make themselves look good. Critics say AA’s real success rate is in the single digits.
The biggest advantage to AA and other similar 12-step programs is that they are free, and everywhere, and there are no waiting lists; you just show up.
How well do programs work? It depends on the person and the program. A near-perfect fit for one person would be a disaster for another, and there are some people for whom 12-step programs alone are not appropriate. For example, detoxing from alcohol often requires hospitalization, and can be fatal if not medically managed. Even cold-turkey detoxing from opiates is not as dangerous.
I’ve spoken with a few people who said they didn’t go to AA or any other treatment program; they no longer wanted to drink and/or do drugs, or gamble, or whatever, so they just stopped. Good for them, because that’s not always possible.
A friend of mine used to drink a half bottle a day drinking all day every day. If a bottle is 26 oz, that is less than an oz every hour and, indeed, he never seemed drunk. But his doctor said his liver was diseased and, unless he stopped, he wasn’t long for this world. That was 35 years ago and he is still going, although not strong. He couldn’t hack AA because of its religious undertone (“you gotta give yourself up to a higher power” or some such BS) and went to a dryout camp. It worked. He didn’t drink for several years and then tentatively tried to drink some wine for dinner. He did not relapse and now drinks a bit but very moderately. When my wife and I and his wife and he took vacation rentals together, he bought a 40 oz bottle of rum at the beginning, made frozen daiquiris for us every evening and gave the remains of the bottle to the housekeeper at the end. I guess his liver can stand this level of drinking.
A majority of addiction treatment programs in the US are based on the Alcoholics Anonymous 12-step program. It’s deeply unscientific and utterly unhelpful to many, though it obviously works very well for some.
That’s not inherently problematic; different addicts will be best served by different programs. The problem is that an overwhelming majority of people with drinking problems aren’t presented with any treatment options beyond AA.
Here’s a fabulous article describing some of these issues and some of the alternatives:
That article addresses a drug called Naltrexone, which I’ve seen work wonders.
(Naltrexone blocks opiate receptors, preventing the user from feeling that warm-fuzzy-buzzed feeling most people get after a drink or two. They still feel buzzed, but not especially good or bad. The idea is that by breaking the association between alcohol and endorphins, the drug helps the user stop drinking to feel better).
Just a few months ago, I met a board-certified internist who refused to prescribe naltrexone because she believed that it was a schedule II drug (like oxycodone and amphetamines). Uh, it’s not. Besides, no one seeking to get high would ever take Naltrexone, yet the Puritan impulse in the US leads to such suspicious, ill-informed reactions from clinicians; those reactions do a great disservice to their patients.
I’ve referred mostly to alcohol-related specifics, but the same attitudes produce ugly outcomes with opiates as well:
Basically, there are a ton of expensive “rehab programs” out there run by people with no qualifications and, even among the ones run by people with training, there’s massive resistance to using medication that has been proven to be effective. Addiction treatment in the US is largely medieval, and it has the success rate one would expect. It’s ugly out there.
Yep that’s my experience too! I used to work in a hospital that had weekly meeting in an auditorium. The amount of coffee and cigarette smoke (this was obviously a long time ago) was astounding! :eek:
I think it’s also widely known (proven?) that addiction is very very difficult to overcome. AA works for some people; but even the AA people I know will tell you that you have to hit rock bottom.
In my experience with the addicts/alcoholics I know is that they can’t break the addiction because they can’t follow one of the principles (either by choice or circumstance) of getting out of the environment that supports their addiction. i.e. your spouse/family member is an addict; it’s not like people are going to leave their spouses, etc. It’s hard. Good luck to you or to whomever inspired to write this post.
Measuring success is very difficult because most people who are eventually successful in overcoming an addiction tried to quit many, many times before they were finally able to quit for good. So if Joe went to rehab (followed by AA) and was sober for two months, then went to another rehab two years later followed by AA and was sober for six weeks, then six months later went to AA on his own for a year and was sober, then relapsed for another year, then started seeing a therapist to deal with some underlying issues and was sober for 8 months, then relapsed for two months, and finally went back to AA and has been sober for the past 10 years, is AA successful? Was therapy? If Joe had not done anything but joined AA 10 years ago, would he have been successful (maybe that was just the point at which he was ready to quit)? What if he attended AA meetings for the first two years, but has been sober without AA for the remaining eight? What role did his previous treatment attempts and periods of sobriety play in his eventual recovery? If he relapses again tomorrow, does that mean that AA is not successful?
I wrote this using AA as the primary treatment approach, but it applies equally to other treatment approaches. I have certainly read about people trying naltrexone and then relapsing.