We recently returned from a conference on alcohol treatment called “New Perspectives.” The conference, hosted by Edgewood treatment center in Nanaimo, Vancouver Island, British Columbia, was, indeed, as advertised. Presenters echoed the same theme: the usual methods of “treating” alcohol abuse and dependence don’t work. While this isn’t news to some of us who’ve looked at the statistics for over twenty years, it is the first time we’ve ever attended a conference that wasn’t hyping the same old failed models. Perhaps being Canadian – a country not quite as enamored with the Minnesota 12-Step Model – helped. Whatever the case, it was a refreshing change.
Happily, the conference’s focus was on differentiating between clients engaging in alcohol abuse and those suffering from true dependency, and differential treatment based on the individual’s condition, not a monolithic “one-size-fits-all” regimen. The presenters’ stats paralleled our own experience – 85% of people with alcohol problems are abusers and only 15% are the dependent ones for whom a “disease” label may be warranted. That estimate correlates with our experience, but we go a step further and suggest that the very few in the “dependent” category ever seek treatment and that the perspective client population is more like 95% alcohol abusers and only 5% dependent.
What difference does that make? For starters, it means that 95% of current treatment practices are only applicable to 5% of the client population, if that. Frankly, current practices serve no one but the industry that employs them – a revolving door business dependent on promoting ineffective methods and relapse in order to keep profitable beds filled.
Since current practices aren’t effective, what is? The research is clear, and has been for a long time: motivated clients with outside support and a belief in their ability to change their alcohol abuse have an excellent prognosis. Clients especially benefit from intense, short-term, outpatient treatment with support from anti-craving medications and the use of Cognitive Behavioral Therapy.
So why are we still stuck with ineffective programs? There really are two major reasons – first, treatment is a multi-billion dollar industry with no financial incentive to change. The marketing of the “powerless, disease, forever-recovering, 12-Step” model has been spectacularly successful and no one has any incentive to prune that money tree simply because it doesn’t help clients.
Secondly, effective treatment is hard work and requires staff with actual skills, knowledge, and expertise – something beyond merely having stopped drinking last month or last year. But residential programs require huge numbers of low level staff and have hundreds of hours to fill. How better to accomplish that than by employing “lifers” who can’t stay dry outside of continuous treatment, and an endless repetition of the “Steps” as “doing something,” and meetings passed off as group therapy?
Are things changing? Not really. Twenty years ago we were told that our research based methods were “twenty years ahead of the times.” Two decades later we’re still eighteen years ahead. The problem is that providers have no incentive to change, the public has been effectively brainwashed, and most programs start off based on false premises which even the best intentioned reinforce.
For now, the real message is clear – if you want help with your alcohol problem, be very, very careful where you get it. Most programs will not only take your money, but will also leave you drinking more within a few months, and frequently within a few hours, of discharge. Sadly, treatment centers have no motivation to do what actually helps – quite the opposite. Remember that when you look for help for yourself or someone else.