The Success Rate of AA is Only 5-10%

The treatment of drug addiction continues to be difficult. Even finding data on success rates is hard. And analyzing that data is difficult (the data is not straight forward and leaves open many possible questions or criticisms). This study calls into question the effectiveness of a 12-step recovery method to treat addiction.

With Sobering Science, Doctor Debunks 12-Step Recovery

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don’t seem to know that because it’s not widely publicized. … There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It’s not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we’d say OK. But it’s harmful to the 90 percent who don’t do well. And it’s harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it’s you that’s failed.

The reason that the 5 to 10 percent do well in AA actually doesn’t have to do with the 12 steps themselves, it has to do with the camaraderie. It’s a supportive organization with people who are on the whole kind to you and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood, rather than a treatment.

image of the Sober Truth book cover

Dr. Lance Dodes has written a book looking at the data behind the results of AA. The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.

Related: Looking at the Evidence of Treating AlcoholismHow Effective is Drug Addiction Treatment?, NIH studyImproving Addiction Treatment with The University of Wisconsin, MadisonMethods Used to Treat Addiction

Drug Treatment Funding Can More Than Pay For Itself With Reduced Crime Costs

Some interesting details and data from Texas government web site.

Drug users constitute a large and growing proportion of the criminal justice population. Drug users not only commit a substantial amount of crime, but as the frequency of drug use increases, the frequency of crime increases and the severity of crimes committed also increases.

Drug use in the general population appears to have declined over the past decade, yet the number of drug-involved offenders is increasing. The number of convictions for drug violations in Texas has increased from 8,103 in 1980 to 23,126 in 1988, a 185 percent increase in less than ten years.

Estimates of lifetime drug users among the nation’s incarcerated population range from 80 to 87 percent.

The American Correctional Association notes that more than 95 percent of drug and alcohol offenders will be discharged from prison, most without receiving any treatment. Because of the high association between drug abuse and recidivism, it is in the public interest to place offenders in the kinds of treatment programs that have been found effective. A noticeable reduction in drug use and criminality can occur with an alliance between the criminal justice system and drug abuse treatment.

Public expenditures for drug abuse treatment are wise and prudent investments. Treatment works to reduce crime, drug abuse, and recidivism. Sustained reductions in recidivism can be achieved up to six years after treatment. With appropriate drug abuse treatment more than 75 percent of offenders with chronic substance abuse histories can reenter the community and lead socially acceptable life styles.

For every dollar spent for drug treatment, $11.54 is saved in social costs, including law enforcement costs, losses to victims, and government funds for health care.

Research has shown that funds invested in drug treatment reduces future criminal justice costs for treated offenders. Every dollar spent on residential drug treatment in probation saves $2.10 in future criminal justice costs. Every dollar spent on outpatient drug treatment in probation saves $4.28 in future criminal justice costs.

This is an old report, from 1997 but the basic model doesn’t change. A large amount of criminal activity is driven by drug addiction. To reduce crime in society drug addiction needs to be reduced. While success rates of drug addiction treatment centers are far from perfect the results more than pay for the cost – just in reduced crime costs (without even considering the better lives these people lead and the benefits to their children and loved ones).

Related: The Rise and Fall of America’s First Prison for Drug AddictsResults of 4 Year Study of Women in Drug TreatmentAlcohol is a Major Cause of Drug Rehab AdmissionsHow Effective is Drug Addiction Treatment?

Russell Brand’s Testimony on Dealing with Drug Addiction

Celebrity Russell Brand makes very intelligent comments to a UK government inquiry on how to deal with drug addiction problems. He was an addict and has been drug free now for years.

His main point seems to be that we need to take a pragmatic approach to what is a primarily a health problem not a criminal problem. Abstinence (all all drugs – including legal ones such as alcohol) based recovery is what he has succeeded with and he believes in. “I think what we need is love and compassion… because it deals with the problem and reducing crime”

Russell’s book, My Booky Wook, discusses this life including his drug use and recovery.

Related: Eminem’s ‘Relapse’ Explores His Drug Addition and RehabilitationPrinciples of Effective Drug Treatment and RehabilitationHow Effective is Drug Addiction Treatment?

New Jerusalem Now

“You cannot fully recovery unless you help the society that made you sick, recover.” New Jerusalem Now, a community of former addicts helping each other achieve a “fullness of life” formerly prevented by drug and alcohol abuse. From the residents’ narratives, you learn how they run their community within a community in one of the poorest neighborhoods in North Philadelphia, PA.

New Jerusalem Now was started by The Simple Way, a web of subversive friends conspiring to spread the vision of ‘Loving God, Loving People, and Following Jesus’ in our neighborhoods and in our world.

They are not just treating the people but building up the community. This is an important activity. Creating a healthy community will not eliminate drug and alcohol abuse but it will help both reduce the amount and reduce the impact of the abuse. Just as a healthy body can get sick and recovery quickly a healthy community can help people recovery more quickly than a sick community.

Related: Shane Claiborne: Interview with a New MonasticBetty Ford CenterFinding Rehab CentersNew Owner Updating Celebrity Rehab Center, Promises

Principles of Effective Drug Treatment and Rehabilitation

Principles of Effective Treatment from the United States National Drug and Alcohol Treatment Service

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 AddictionDrug Rehab Centers in Los AngelesUniversity of Wisconsin-Madison Program Aims to Improve Drug Treatment

Improving Addiction Treatment with The University of Wisconsin – Madison

University of Wisconsin-Madison based program aims to better drug treatment

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.

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 TreatmentMethods to Treat Addiction

The Rise and Fall of America’s First Prison for Drug Addicts

cover of the Narcotic Farm

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 CaliforniaWhy Can’t Drug Addicts Quit on Their Own?

Why Can’t Drug Addicts Quit on Their Own?

From the United States National Institute of Health, Principles of Drug Addiction Treatment: A Research Based Guide – 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 Addictionstatistics on binge drinkingDrug Treatment Success Rates in England

Rehab Reality Check

Rehab Reality Check by Jerry Adler, Newsweek, provides a good, very cursory, overview of rehab treatment options.

residential treatment programs for the middle and upper classes have proliferated across both the geographic and the therapeutic maps. Heated disputes have erupted between proponents of different treatment models. This is exacerbated by a growing rivalry between old-guard institutions like the Ford Center, with its comparatively austere campuslike ambience, and the new class of superluxury rehab centers in ocean-view mansions that supplement the traditional 12-step approach with acupuncture, massage, equine therapy and Native American Talking Circles.

To John Schwarzlose, president and CEO of the Betty Ford Center in Rancho Mirage, Calif., the blurring of lines between “spa” and “treatment center” is disheartening. “They say, ‘We have 500-count sheets.’ It trivializes what we do.”

In fact, with a few exceptions most residential programs run along broadly similar lines. The typical stay is a month, which might not be optimal but is as much as most insurance plans covered back in the 1980s when the programs were designed.

The exact form of therapy, he says, is less important than just the fact of seeking treatment. A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed

I discussed some of my thoughts on this in Should Rehab be Enjoyed?

Related: Top 10 Luxury Rehab CentersBetty Ford CenterDrug Rehab Centers in Los Angeles

Center for Substance Abuse Treatment

The Center for Substance Abuse Treatment is part of the United States Department for Health and Human Services. CSAT promote the quality and availability of community-based substance abuse treatment services. CSAT also supports free treatment referral service to link people with the community-based substance abuse services they need.

The treatment locator includes more than 11,000 addiction treatment programs, including residential treatment centers, outpatient treatment programs, and hospital inpatient programs for drug addiction and alcoholism. Listings include treatment programs for marijuana, cocaine, and heroin addiction, as well as drug and alcohol treatment programs for adolescents, and adults.

CSAT offers a list of questions to find answers to when looking for a rehab center, including:

  • Is the program run by state-accredited, licensed and/or trained professionals?
  • Is long-term aftercare support and/or guidance encouraged, provided and maintained?
  • Is there ongoing monitoring of possible relapse to help guide patients back to abstinence?
  • I think it also makes sense to learn about the success of those using the center and how the rehab center’s treatment matches your needs.

    Related: Methods to Treat AddictionStudy: Drug Treatment Success Rates in EnglandAging of the Population in Rehab