A Los Angeles DUI arrest and/or conviction can be a wakeup call for many people. It forces them to confront the fact that they may have a problem with addiction to alcohol or drugs and need to seek treatment.
The problem is finding a treatment program that will be effective in helping them fight and overcome their addiction.
Is AA really effective?
While many people think of Alcoholics Anonymous(AA) and similar organizations founded on the 12-step program as one of best methods of dealing with addiction, that may not be the case. Back in March 2014, Atlantic Monthly published an article, “The Surprising Failures of the 12 Steps,” that claimed that the program’s success was overrated.
In making his argument, writer Jake Flanagin cites a book co-written by Dr. Lance Dodes, a retired professor of psychiatry at Harvard Medical School. In “The Sober Truth: Debunking the Bad Science behind 12-Step Programs and the Rehab Industry,” Dodes noted that the success rate of AA is somewhere between five and 10 percent, meaning that only one of every 15 people who enters the program actually becomes and stays sober.
AA, by contrast, claims that 33 percent of its members say they’ve been able to stay sober for more than 10 years, 12 percent for five to 10 years, 24 percent for one to five years and 31 percent for under a year. But Flanagin points out that these numbers don’t include the people who never make it through the first year of the program, which is how long it takes to complete the 12 steps. (He refers to the 12 steps as TSF, short for 12-step facilitation.)
Flanagin also questions “AA’s barefaced religious affiliations,” noting that “AA is a self-identified Christian organization with a significant portion of its methodology rooted in prayer.”
In his book, Dodes maintains that AA has actually controlled the discussion of alcoholism by creating “an establishment for addiction scholarship and advocacy that did not previously exist.” While AA gained favorable press over the years, there were actually no independent scientific studies that tested the program’s efficacy.
Nevertheless, TSF today is “the law of the land,” Flanagin says. “Any suggestion that AA might be a flawed program, or not right for every addict, is met with scandalized looks and harsh retorts.”
Defining addiction as a disease is not helpful?
Many treatments for addiction work from the assumption that it is a disease. But a paper in the July 8, 2013 issue of the American Journal of Bioethics Neuroscience questions whether that approach is valid or helpful. The authors note that “Many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma. We conclude that it is not necessary, and may be harmful, to frame addiction as a disease.”
The authors write that those who want to classify addiction as a disease believe that looking at in this objective manner “debunks the moralized argument that addiction is a problem for weak-willed people.” But those who oppose the idea of addiction as a disease say that this approach gives patients a crutch, removing the idea of personal responsibility and moral culpability in addiction.
The authors interviewed 63 patients undergoing addiction treatment, and most were in favor of the alcohol as disease concept. But there were a few who worried about how this would affect people’s perception of them and their families. If addiction is a disease, does this mean that the people who have addiction problems have weak genes, or something else wrong that makes the susceptible to the disease? Under the disease model, society is still making judgments about the addicts, just as it makes judgments about people with mental illness.
In addition, while most diseases have some kind of biological markers, scientists have been unable to find or develop any kind of objective test that can indicate the presence of the “disease” of addiction.
The authors suggest that one of the main reasons the idea of addiction as a disease has found favor among scientists is that this model enables them to attract more money for research. The authors note that “Congress allocates funds to disease-based institutes; currently, there is a strong focus on the rapid translation of basic science research into clinical practice.” This goes hand-in-hand with the presumption that if addiction is a disease, there must be some means of treating it using pharmaceuticals, just as medicines have been used to conquer or control other diseases.
But the authors see more pitfalls than possibilities in classifying addiction as a disease. They write that “diseases, by definition, are impairments, sicknesses, conditions that we know to be abnormal or harmful…The persons with a disease carry with them the baggage of their culture’s associations for what a disease is, literally and figuratively.” They add that “addiction is not a pathology limited to the organ contained within a human skull, but rather a biopsychosocial phenomenon, a dynamic entity with variable narrative arcs particular to periods of time, population and location.”
Finding effective treatments
So what does work? If you struggle with an addiction after a DUI, what kind of treatment program should you seek out for the greatest chance of success in controlling the problem?
In its “Principles of Drug Addiction Treatment,” The National Institute on Drug Abuse (NIAD) says that “No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patient. Matching treatment settings, interventions and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family workplace and society.”
NIAD offers several principles to identify effective treatment for drug abuse and addiction. An effective program:
• Addresses multiple needs of the individual, not just his or her drug abuse
• Is appropriate for the person’s age, sex, gender, ethnicity and culture
• Addresses any medical, psychological, social, vocational and legal problems as well as the drug abuse
• Must be available for an appropriate amount of time (at least three months of treatment)
• Often include medications that can help addicts stabilize their lives
• Must assess an individual’s treatment and services plan continually and modify that plan to ensure that it meets the individual’s changing needs.
NIAD recommends asking any treatment program these five questions:
1. Does the program use treatments backed by scientific evidence?
(Effective treatment ideally combines behavioral therapy and medications.)
2. Does the program tailor treatment to the needs of each patient?
(Does it also address other medical service needs, family therapy, parenting support, job training, social or legal services?)
3. Does the program adapt treatment as the patient’s needs change?
(Can it adjust to a patient’s relapses, for example?)
4. Is the duration of the program sufficient?
(Recovery is a long-term process that usually requires several episodes of treatment and ongoing family and/or community support.)
5. How do 12-step or similar recovery programs fit into drug addiction treatment? (NIAD believes that self-help groups can complement and extend the effects of professional treatment.)
When you’re searching for a program, a good place to start is with your primary care physician, who should be able to provide referrals and recommendations for some programs in your area. If you prefer to seek help anonymously, the Substance Abuse and Mental Health Services Administration (SAMHSA, an agency within the U.S. Department of Health and Human Services, has a webpage where you can find addiction treatment programs by zip code. (https://www.samhsa.gov/find-help)