Alcoholics Anonymous is the most widely used treatment for alcoholism. It is mandated by the courts, accepted by mainstream medicine, and required by insurance companies. AA is generally assumed to be the most effective treatment for alcoholism, or at least “an” effective treatment. That assumption is wrong.

We hear about a few success stories, but not about the many failures. AA’s own statistics show that after 6 months, 93% of new attendees have left the program. The research on AA is handily summarized in a Wikipedia article. A recent Cochrane systematic review found no evidence that AA or other 12 step programs are effective.
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The 1992, the National Institute on Alcohol Abuse and Alcoholism’s National Longitudinal Alcohol Epidemiologic Survey studied 42,000 Americans. 4500 had been dependent on alcohol at some time in their lives. Of these, only 27% had had treatment of any kind, and one-third of those who had been treated were still abusing alcohol. Of those who had never had any treatment, only one-quarter were still abusing alcohol. George Bush is a well-known example of someone who stopped drinking on his own without attending AA and without admitting that he was an alcoholic.

To me what matters is finding solutions that work. It is known that the success rates for treating addiction are not great no matter what treatments are used. We certainly should be doing more study of the effectiveness of various treatment methods to improve the success rates people experience. The impact on people’s lives is too large to rely on whoever markets better to end up being the deciding factor.

Related: How Effective is Drug Addiction Treatment? from the NIH – Combination Strategy to Treat Alcohol Dependence – Results of 4 Year Study of Women in Drug Treatment

Although part of the trend was offset by rising numbers of cocaine and crack addicts seeking
treatment over the same period, the numbers of women entering treatment in the under 30 age
group fell by nearly nine per cent in four years.

The study also showed that at the same time the numbers of women problem drug users
successfully leaving treatment having overcome their addiction almost doubled. In addition, the
number of women dropping out of treatment has fallen by well over a third in four years.
The study by the National Treatment Agency for Substance Misuse (NTA) also highlights:

• While women start using drugs at the same age or slightly older than men, they are more adept at seeking help for themselves and tend to come into treatment earlier
• Cocaine is the fastest growing treatment need among women drug users, accounting for a 55 per cent increase in new entrants since 2005
• The number of women entering treatment for crack dependency has increased by 14 percent since 2005
• Almost two-thirds of women entering treatment are mothers, nearly half of whom have a child living with them. The data indicates that treatment outcomes for mothers are stronger than those who were not parents.

“These findings demonstrate how thousands of women have successfully obtained drug treatment and recovered through it,” said Rosanna O’Connor, NTA director of delivery. “Treatment is the first step on the road to recovery, so it is encouraging that women tend to seek help of their own volition, enter treatment earlier before their drug misuse has become entrenched and frequently achieve better outcomes sooner. Treatment provides the opportunity for individuals to get better, for families to stabilise, and for children to be looked-after at home.”

Related: Research on the Brain and Behavior on Addiction – University Research on Improving Addiction Treatment – Alcohol is a Major Cause of Drug Rehab Admissions

Drug addiction is a complex illness characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person’s ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning. Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.

Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual’s life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.

Too often, addiction goes untreated: According to the National Survey on Drug Use and Health (NSDUH), 23.2 million persons (9.4% of the U.S. population) aged 12 or older needed treatment for an illicit drug or alcohol use problem in 2007. Of these individuals, 2.4 million (10.4%) received treatment at a specialty facility (i.e., hospital, drug or alcohol rehabilitation or mental health center). Thus, 20.8 million persons (8.4 % of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive it.

Scientific research since the mid–1970s shows that treatment can help patients addicted to drugs stop using, avoid relapse, and successfully recover their lives. Based on this research, key principles have emerged that should form the basis of any effective treatment programs:

• Addiction is a complex but treatable disease that affects brain function and behavior.
• No single treatment is appropriate for everyone.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
• Remaining in treatment for an adequate period of time is critical.
• Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment.
• Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
• An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
• Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long–term drug abuse.
• Treatment does not need to be voluntary to be effective.
• Drug use during treatment must be monitored continuously, as lapses during treatment do occur.

When looking for drug rehab centers it is valuable to keep these facts in mind. Even the best rehab centers have many failed attempts to beat drug addiction. By finding centers that have adopted scientifically tested strategies success rates can be improved.

Related: How Effective is Treatment for Drug Addiction? – Methods to Treat Drug and Alcohol Addiction – Drug Rehab Centers in Los Angeles – University of Wisconsin-Madison Program Aims to Improve Drug Treatment

The annual NSDUH report also indicated that progress has been made in curbing other types of the illicit drug use. For example, past month methamphetamine use among those aged 12 and older dropped sharply from approximately 529,000 people in 2007 to 314,000 in 2008. Similarly, the level of current cocaine use among the population aged 12 and older has decreased from 1.0% in 2006 to 0.7% in 2008.

Promising results from the latest survey also were also found for the most part among youth (12 to 17 year olds). Among youth there was a significant decline in overall past month illicit drug use, from 11.6% in 2002 to 9.3% in 2008. The rate of current marijuana use among youth has remained level at about 6.7% over the past few years while there have been significant decreases in the current use of alcohol, cigarettes and non-medical use of prescription drugs since 2007.

Historically, young adults have had the highest rates of substance abuse, and for most types of illicit substance abuse the levels have remained steady over the past year. However, over the past three years there has been a steady drop in the rate of heavy alcohol use by full time college students aged 18 to 22 – from a high of 19.5% in 2005 to 16.3% in 2008.

“The survey findings are important because they often point to emerging patterns of substance abuse,” said Gil Kerlikowske, Director of National Drug Control Policy. “Although we see some success reversing trends in prescription drug abuse, there are indications that progress in other areas may be at a standstill, or even slipping back, particularly among youth.”

The NSDUH continues to show a vast disparity between the number of number of people needing specialized treatment for a substance abuse problem and the number who actually receive it. According to the survey 23.1 million Americans need specialized treatment for a substance abuse problem, but only 2.3 million (or roughly 10 percent of them) get it.

The complete survey findings are available on the SAMHSA web site.

Related: Prescription Drug Abuse: Pain Killers Can Lead to Addition – Methamphetamine Abuse Costs U.S. $23.4 Billion – Drug Rehab Centers in Los Angeles

Early experiences with drugs, whether in the womb or as an adult, have ineradicable effects. Drug users often describe a wish to recapture the bliss of their first high. But this goal proves elusive because once the brain has neuroadapted to drugs, it is physiologically and structurally changed. The director of the National Institute on Drug Abuse and many others argue that voluntary drug consumption alters the brain in ways that lead to involuntary drug consumption. The question of whether drug habits are voluntary or not leads us to ask how people get over their addictions, and raises some of the moral issues surrounding compulsive behavior.
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Addiction is not all pharmacology, neurotransmitters, and intrapsychic states; the social settings of drug consumption have powerful effects. They can influence basic brain chemistry–which is one reason Gene Heyman rejects the notion that “addictive behavior is insensitive to persuasion, that there’s an irresistible urge to take the drug.” Heyman agrees that drugs alter the brain, but disputes the idea that they change the brain in ways that make choice impossible–he does not believe, in other words, that neuroadaptation makes drug use involuntary. Exhibit A, he says, is 50 million ex-smokers who have voluntarily ended their intake of nicotine.
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One reason people believe drug use is involuntary is that recovery rates for addicts treated at clinics are quite bad. Within one year of treatment, relapse rates of 67 to 90 percent are common for alcohol, opiate, cocaine, and tobacco users. “But most of the people who become addicted to drugs don’t go to clinics,” says Heyman. “Actually, only 30 to 40 percent go to clinics. Yet this clinic population has greatly influenced our vision and concept of addiction.”

It turns out that addicts who don’t go to clinics have much higher recovery rates.

This is an interesting article with interesting data. Remember the different recover rates for those that go to clinics and those who does not mean going to a clinic reduces the odds of success. It seems reasonable to guess most of those that go to clinics are drawn from the subset that failed to quit without going to a clinic. So it could be that fail to quit on their own then will fail only quit on their own 3% of the time and quit in a clinic 10% of the time (these numbers are not based on anything just an example of what you must consider about the above statistics).

Even though cigarette smoking is the direct cause of 400,000 American deaths annually, while alcohol directly causes only 100,000 deaths, “alcoholism is a major reason that people don’t stop smoking,” says Vaillant. “Those who keep on smoking after age 50 tend to be alcoholics.” In hospitals, alcoholics cost six times as much as other patients. Half of all people who show up in emergency rooms with severe multiple fractures are alcoholics. “But the emergency rooms treating multiple fractures ignore blood alcohol levels,” Vaillant says. “The causal link isn’t made.”

“No other drug of addiction impairs one’s aversion to punishment the way alcohol does,” he continues. “Yes, compulsive gambling impairs your aversion to being poor, and heroin use impairs your aversion to being arrested. But alcoholism goes across the board. When drinking, people are much more likely to engage in all kinds of dangerous, life-threatening behavior–wife beating, child abuse, unprotected sex with strangers, smoking, drunk driving. You can be five foot two and willing to take on anyone in the bar.”

Related: Alcohol is a Major Cause of Drug Rehab Admissions – How Effective is Drug Addiction Treatment? – Methods to Treat Addiction – Why Can’t Drug Addicts Quit on Their Own?

Green-Milon’s apparent success in overcoming her addictions is all too rare, experts say. Only about a tenth of the 24 million Americans who need drug treatment get it, according to the National Institute on Drug Abuse, and at least half of them relapse.

Part of the challenge, scientists say, is that addiction, like heart disease, high blood pressure and diabetes, is a chronic condition; it changes the chemistry of the brain. But there’s another hurdle that’s getting attention: treatment programs, with their voice-mail systems and multiple forms to fill out, aren’t very patient-friendly, especially to people whose lives present many barriers to staying in treatment.

A national program, based at UW-Madison, is trying to change that by bringing process improvements to drug treatment. The Network for the Improvement of Addiction Treatment, or NIATx, attempts to get addicts into treatment quicker and retain more of them by making the programs more appealing.
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24 million Americans need treatment for illicit drug or alcohol problems.
2.5 million get the treatment they need.
The economic cost of substance abuse exceeds $500 billion a year (including alcohol and tobacco; for just illicit drugs, it’s $181 billion).

The NIATx (formerly know as the Network for the Improvement of Addiction Treatment) at the University of Wisconsin – Madison is focused on improving the success of addition treatment.

Use what you learned in Walk-through exercises (See the NIATx Conducting a Walk-through guide for guidance) to identify problems in processes within your organization from the clients’ point of view. Consider changes to test based on that experience. Prior to starting, you should decide the parameters of the change project, including where (e.g., location) you wish to introduce the change, as well which clients (e.g., level of care, population) you expect to impact.

The PDSA Cycle is an efficient way to learn what will work in your organization, and should be the foundation of every change you make. The PDSA Cycle begins with a Plan, and ends with Action based on the learning gained from the Plan, Do, and Study phases of the cycle

They also offer many case studies on improvement successes by treatment centers.

Related: How Effective is Drug Addiction Treatment? – Center for Substance Abuse Treatment – Methods to Treat Addiction

McLean Hospital researchers, along with colleagues from 11 other study sites nationwide, report that the medication naltrexone and up to 20 sessions of alcohol counseling delivered by a behavioral specialist are equally effective treatments for alcohol dependence when delivered with structured medical management in the Journal of the American Medical Association.

Results from the National Institutes of Health-supported Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study show that patients who received naltrexone, specialized alcohol counseling, or both demonstrated the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management, an intervention that consisted of nine brief, structured outpatient sessions provided by a health care professional. Contrary to expectations, the researchers found no effect on drinking of the medication acamprosate and no additive benefit from adding acamprosate to naltrexone.

“This was the largest clinical trial looking at the effectiveness of pharmacologic and behavioral treatments for alcohol dependence ever conducted and the results are promising,” said Roger Weiss, clinical director of the Alcohol and Drug Abuse Treatment Program for McLean Hospital, a Harvard Medical School affiliate. Weiss was also the principal investigator of COMBINE for the McLean study site.

Related: Why Can’t Drug Addicts Quit on Their Own? – Methods to Treat Addiction

The Narcotic Farm: The Rise and Fall of America’s First Prison for Drug Addicts is a book exploring an experiment to deal with addicted criminals.

The farm was the first place to look at drug addicts as patients that were in need of treatment instead of criminals in need of punishment. The farm did experiments to learn about addiction including on methadone (which is commonly used to try and ease the transition from narcotic addition today). Certainly the methods practiced on the farm were of debatable ethical ground however there was a great deal of learning and desire to learn and treat drug addition.

From 1935 until 1975, just about every junkie busted for dope went to the Narcotic Farm. Equal parts federal prison, treatment center, farm, and research laboratory, the Farm was designed to rehabilitate addicts and help researchers discover a cure for drug addiction. Although it began as a bold and ambitious public works project, and became famous as a rehabilitation center frequented by great jazz musicians among others, the Farm was shut down forty years after it opened amid scandal over its drug-testing program, which involved experiments where inmates were being used as human guinea pigs and rewarded with heroin and cocaine for their efforts.

Published to coincide with a documentary to be aired on PBS, The Narcotic Farm includes rare and unpublished photographs, film stills, newspaper and magazine clippings, government documents, as well as interviews, writings, and anecdotes from the prisoners, doctors, and guards that trace the Farm’s noble rise and tumultuous fall, revealing the compelling story of what really happened inside the prison walls.

Listen to an NPR podcast on America’s First Drug-Treatment Prison

Related: How Effective is Drug Addiction Treatment? – Drug Rehabilitation Centers in California – Why Can’t Drug Addicts Quit on Their Own?

Nearly all addicted individuals believe in the beginning that they can stop using drugs on their own, and most try to stop without treatment. However, most of these attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs. These drug-induced changes in brain function may have many behavioral consequences, including the compulsion to use drugs despite adverse consequences – the defining characteristic of addiction.

Long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs.

Understanding that addiction has such an important biological component may help explain an individual’s difficulty in achieving and maintaining abstinence without treatment. Psychological stress from work or family problems, social cues (such as meeting individuals from one’s drug-using past), or the environment (such as encountering streets, objects, or even smells associated with drug use) can interact with biological factors to hinder attainment of sustained abstinence and make relapse more likely. Research studies indicate that even the most severely addicted individuals can participate actively in treatment and that active participation is essential to good outcomes.

Source: NIH Publication No. 00-4180 July 2000

Related: Methods to Treat Addiction – statistics on binge drinking – Drug Treatment Success Rates in England

According to several studies, drug treatment reduces drug use by 40 to 60 percent and significantly decreases criminal activity during and after treatment. For example, a study of therapeutic community treatment for drug offenders (See Treatment Section) demonstrated that arrests for violent and nonviolent criminal acts were reduced by 40 percent or more. Methadone treatment has been shown to decrease criminal behavior by as much as 50 percent. Research shows that drug addiction treatment reduces the risk of HIV infection and that interventions to prevent HIV are much less costly than treating HIV-related illnesses. Treatment can improve the prospects for employment, with gains of up to 40 percent after treatment.

Although these effectiveness rates hold in general, individual treatment outcomes depend on the extent and nature of the patient’s presenting problems, the appropriateness of the treatment components and related services used to address those problems, and the degree of active engagement of the patient in the treatment process.

Generally, for residential or outpatient treatment, participation for less than 90 days is of limited or no effectiveness, and treatments lasting significantly longer often are indicated. For methadone maintenance, 12 months of treatment is the minimum, and some opiate-addicted individuals will continue to benefit from methadone maintenance treatment over a period of years.

Good outcomes are contingent on adequate lengths of treatment.

Related: Center for Substance Abuse Treatment, HHS – Drug Treatment Success Rates in England – Methods to Treat Addiction