You know what's great? The Affordable Care Act covers treatment for addiction:
The ACA includes substance use disorders as one of the ten elements of essential health benefits. This means that all health insurance sold on Health Insurance Exchanges or provided by Medicaid to certain newly eligible adults starting in 2014 must include services for substance use disorders.You know what's bad? Current substance abuse treatment fails most of the people it is supposed to help. That's people, as in real human beings with addiction, not just statistics, unfortunates that can't or won't "get it", self-centered defectives who refuse to do the work; but people.
I read a book yesterday, it is "Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry", by Dr. Lance Dodes and Zachary Dodes. Dr. Lance Dodes has an impressive background, he retired as assistant clinical professor of psychiatry at Harvard Medical School, to name just one. He is not a light-weight.
The Sober Truth goes into great detail in its discussion of various scientific studies on the effectiveness of current addiction treatment (nearly all 12-step based) and the sad truth revealed in the least biased of these is that there are many people that are failed by this system, yet the system is so self-perpetuating that it is virtually immune to new ideas. AA is used as an example of how 12-step does not work for everyone in the quote below (keep in mind that it is recommended that an addicted person attend a 12-step group for the rest of their lives in order to maintain sobriety):
Even though AA does not conduct scientific studies on its success rates, a number of clinicians have tried to audit the figures. The National Longitudinal Alcohol Epidemiologic Survey, a 1992 review by the US Census Bureau and National Institute on Alcohol Abuse and Alcoholism (NIAAA), included a survey of AA members. It found that only 31 percent of them were still attending after one year. AA itself has published a comparable figure in a set of comments on its own thirteen-year internal survey, stating that only 26 percent of people who attend AA stay for longer than one year. A third study found that after eighteen months, between 14 and 18 percent of people still attended AA.In examining the rehab industry this book discusses what lots money can buy; beautiful scenery, reiki treatments, equine therapy, AA/NA meetings, and group discussion, to name some. But one particular point, quoted below, stood out to me and I believe it applies to everything from the opulent treatment centers catering to the rich, to the dreary, publicly funded centers attached to homeless shelters:
Many staff members at rehabilitation centers have extremely limited training. Although every program boasts the presence of psychologists and psychiatrists in a consulting capacity, many of those who provide direct treatment are qualified mainly by being in recovery. This is not a terribly difficult credential to attain: Hazelden's own group setting website invites visitors to become and addiction counselor in as little as one year. Training to be a clinical social worker, psychologist, or psychiatrist, by contrast, requires from three to eight years, and to be an excellent therapist takes years beyond the end of formal training.Can this really be the best way to approach addiction treatment? Train people up in a year to treat others with a major problem? Consider someone a specialist because they have suffered the same problem they are treating? If addiction treatment ever goes beyond the 12-step system, which was developed from a religious movement called The Oxford Group in 1938, there are going to be a lot of people with job security problems. I believe this is one of the reasons that new ideas are rarely implemented. Someone trained in a year is also a lot cheaper to pay than a person who studied years and had to pass various tests in order to get a license.
Then there is the religious issue, many courts in our country have declared the 12-step model to be a religion and said that it isn't even constitutional to require people to attend (as many courts do for drug and alcohol offenses). But even beyond that, all the God talk in 12-step can cause someone who is an atheist or one who has been badly damaged by Religion in some way to turn around and walk right back out of the only option that is readily available. That's nowhere in the ballpark of fair.
So far as what does work in the treatment of addicted people; Dr. Dodes opinion is that addicts respond better to psychotherapy that gets down to the deeper issues that trigger each individual person's addiction. Whether one agrees with his assessment of what causes addiction (he feels it is a sense of helplessness in most cases) or not, it is very hard to dismiss the fact that a lot of money is being spent on ineffective treatments (for most people anyway) in this country with a lot of people suffering as a result.
I am sure to many people this book is an outrage since even in its title it attacks the '12-step system that has saved millions and millions and......and who is this very uneducated 'get the red out' person that would even read a book like this and diary about it?
In the fall of 1992 I was in the process of drinking myself to death. I went to detox, treatment, and long term treatment. I have been sober in a 12-step program for 21 years and still attend a group. I have had a sponsor, done the steps, done the service; so I must be a dry drunk!!!!!! I guess that depends on each individuals assessment of whether there is such a thing (I don't believe there is). I don't drink and I was helped by being given a community that did not hate me at a time that I needed it. I was also given a culture, the 12-step culture, which most of my fellows within it will defend against any perceived slight. Am I grateful? Yes, that was the only help available to me, but I was offered it, and I needed a way out of a terrible place in my life, I needed support, and I needed social interactions. But it took many, many years for me to realize and admit that I needed more. I suffered from anxiety and depression as a child, before I ever tasted alcohol; that did not go away when I put down the bottle. I was very scared I would lose my standing in the fellowship if I addressed that problem through medication, or by even speaking up about it. 12-step isn't cut out to deal with mental health issues, nor should it be. But a lack of holistic or comprehensive treatment let my life-long mental health issue fall through the cracks when I sought help. I should have had the courage to address it sooner, but I didn't. Not every person suffering from addiction has this sort of a duel diagnosis issue. But some do, and in the current immovable system all kinds of issues can be neglected by the current one size fits all approach.
I had a friend that I was in that long-term treatment center with who was simply a lovely woman, she never had a harsh word to say about anyone, she was NOT selfish, self-centered, resentful, angry, or any other commonly held assumption regarding people with addiction. She prospered in sobriety for a while, but she told me one time she just never felt that 12-step was really a good fit for her and she was not comfortable with it. She began drinking again after 5 years, went in and out of the rooms, as we say, for a number of years afterward not getting it, but trying again and again. Then she didn't turn up one day at the local recovery club, she was found hanging by the neck in her apartment later that afternoon. She's one of many I have seen die from not getting it. With the advent of more availability (supposedly) of treatment for addiction via the ACA I hope more people will be helped. But I've come to the conclusion that there needs to be more than one "it" that our society will find acceptable to get. I'm tired of hearing that others died so that I might live. I'm tired of the death.
I recommend this book to anyone with any interest in addiction, and I don't think I am an ingrate or traitor for that. I am of the opinion that when it comes to information, more is much better than less.