Abstract
Research shows that the majority of people who overcome an addiction do it on their own through planning and effort.
There have been exactly four controlled studies of the effectiveness of 12 step programs in treating addictions, Ditman (1967), Brandsma (1980), Vaillant (1995), and the National Longitudinal Alcohol Epidemiologic Survey (Stinson, 1998). In none of these four studies did individuals undergoing 12 step treatment show better outcomes than an untreated control group; both treated subjects and controls got better at the same rate.
Moreover, data from the NIAAA show that whereas only 7% of people with an Alcohol Use Disorder (AUD) ever receive treatment (NIAAA, undated), the prevalence of Alcohol Use Disorders (AUDs) drops dramatically from 18.4% for people aged 18 – 24 to only 1.5% of people over the age of 65 (NIAAA, 2008). It is clear from studies like that of Vaillant (1995) that only a tiny fraction of people with AUDs die from them by age 65, rather what this tells us is that nearly 92% of people with AUDs recovery from them by age 65 whether they receive treatment or not.
If we view this data from the perspective of the disease theory of addiction we are forced to say that the rate of spontaneous remission for Alcoholism is extremely high and that progression into deeper addiction and death is the exception rather than the rule, just as in the case of the common cold spontaneous remission is the normal outcome and progression to pneumonia and death is the exception.
However, when we start investigating how people actually overcome addictions we are forced to conclude that the disease theory of addiction is totally erroneous because people do not overcome addictions in the same manner that they overcome the common cold. In the case of the common cold, antibodies do the work for the person and the best thing that the person can do is to rest and let the antibodies do their work.
Just the opposite is true in the case of an addiction. People who just sit around and wait for an addiction to go away by itself will find that it only gets worse. Those who are successful in overcoming their addictions are the ones who decide that they have a bad habit, that they do not like their bad habit, and that they are determined to eliminate their bad habit. Having made a decision, these people then make a specific plan with specific strategies to combat the bad habit and then expend a sufficient amount of effort to make this plan succeed. Not everyone succeeds on the first try, but people who “try, try again” have far greater success rates than those who just give up.
Although the evidence suggests that 12 step treatment programs are no better than the rate of spontaneous remission, the evidence also suggests that there are treatment modalities which are able to boost the rate of spontaneous remission quite a bit by facilitating the natural recovery process. Modalities such as Cognitive Behavioral Therapy (CBT) and Psychodynamic Therapy show success rates about twice that of spontaneous remission (Brandsma, 1980). This is because these therapeutic modalities bolster people’s sense of self-efficacy and help them to believe that they are more powerful than the bad habit which they are attempting to overcome.
12 step treatment programs which state that “addictions which are untreated are 100% fatal” are merely spreading a self-serving lie in order to take credit for the rate of spontaneous remission which would occur even without the treatment. Hazelden will run you about $30,000 (thirty thousand dollars) for a month’s stay and they don’t give a money back guarantee (Hazelden, undated). Frankly I would never check into any rehab that didn’t give a money back guarantee and I would surely avoid the 12 step rehabs (95% of US rehabs are 12 step-based) since they are no more effective than no treatment at all.
In addiction to the value of Cognitive Behavioral and Psychodynamic therapies we also wish to emphasize the essential importance of harm reduction. As the saying goes, “Dead addicts don’t recover.” Since we know that the normal outcome of treatment is relapse, and that total abstinence immediately on the end of treatment is the exception and not the rule, it is nothing short of murder to fail to teach drug or alcohol users about safe drug and alcohol use in their treatment programs. For example, the tolerance of opiate users drops very sharply after they have been detoxified for a period of time. If an opiate user leaves treatment and attempts to shoot their accustomed dose of heroin then death is very likely. Any treatment program which has failed to warn heroin users of this drop in tolerance should be held accountable for this death. Yet the standard operating procedure is to tell opiate users that they never need to use again and that their “higher power” will save them–and then send them out to die. All users of drugs or alcohol–present or past–should learn about harm reduction. The life you save may be your own.
For more information about harm reduction for alcohol please read our book How to Change Your Drinking: a Harm Reduction Guide to Alcohol. For information about drugs harm reduction please visit the Harm Reduction Coalition.
REFERENCES
Brandsma, J.M., Maultsby, M.C., & Welsh, R.J.. (1980). Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.
Ditman, K.S., Crawford, G.C., Forgy, E.W., Moskowitz, H., & MacAndrew, C. (1967). A controlled experiment on the use of court probation for drunk arrests. American Journal of Psychiatry, 124(2), 160-3. http://www.ncbi.nlm.nih.gov/pubmed/4951569
Hazelden (undated). Hazelden Rate Card http://www.hazelden.org/web/public/document/centercityratecard.pdf
NIAAA (undated). 5 Year Strategic Plan. http://pubs.niaaa.nih.gov/publications/StrategicPlan/NIAAASTRATEGICPLAN.htm
NIAAA (2008). Alcohol Alert 76: ALCOHOL AND OTHER DRUGS http://pubs.niaaa.nih.gov/publications/AA76/AA76.htm
Rehm J, Gmel G, Sempos CT, Trevisan M. (2003). Alcohol-related morbidity and mortality. Alcohol Res Health.;27(1):39-51. http://pubs.niaaa.nih.gov/publications/arh27-1/39-51.pdf
Stinson, F.S., Yi, H., Grant, B.F., Chou, P., Dawson, D.A., & Pickering, R. (1998). Drinking in the United States: Main findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism. http://pubs.niaaa.nih.gov/publications/NESARC_DRM/NESARCDRM.htm
Vaillant, G.E. (1995). The natural history of alcoholism revisited. Cambridge, MA: Harvard University Press.
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