You would think that insurance companies, who sink millions of dollars every year into drug and alcohol recovery programs, would be anxious to put their money where it would be most treatment-effective as well as cost-effective. Not so, apparently, since they continue to support expensive 30-day programs that clearly do not get results.

“Results,” of course, can be defined in many ways by many people. When I think of “results” in addiction recovery, I think of clients who can and will remain clean and sober for the rest of their lives, not just while they’re in a treatment center. One could argue that relapse can be a necessary and vital part of some clients’ recovery. Often it takes “going out” before someone can really learn and appreciate what it means to “stay in.” Still, as a recovery industry, I believe we have to measure our success statistically by the number of clients who finally, successfully avoid any relapse at all.

From all the studies I have read, the success rate for 30-day treatment centers leaves much to be desired. Less than one third of all clients remain clean and sober in the first year after “graduation,” much less for the rest of their lives. The irony is that addicts who stop on their own without any organized treatment support seem to do better. It appears the insurance industry would actually get slightly more bang for its buck by giving that $30,000 directly to an alcoholic or addict than to the treatment center!

According to their own statistics, Alcoholics Anonymous also has a poor success rate, if you measure it by those who remain clean and sober without relapse.

I had the honor of being President of a men’s “sober living” house in Prescott, Arizona. The theory was simple: provide a safe and supportive family environment that was conducive to a clean and sober lifestyle; make everyone attend at least two 12-Step meetings each day; and hope something worked. Although I have no double-blind studies to prove it, I believe that this approach has some merit and produces some results, compared to people who stay in “normal” life and attend AA meetings on the side. The simple process of living inexpensively with others in recovery (compared to pricey treatment centers), having a safe environment with supportive friends, and benefiting from their experience, strength, and hope on a daily basis has to count for something. But that “something” is still way too small a statistical improvement.

I then had the opportunity to travel to the other end of the spectrum and create a full-blown treatment program; and while it will take a few years to collect enough statistics to be meaningful, the immediate results were unquestionable. The relapse rate while in the program plummeted within a matter of a few months, for example.

Why? What did we do that made a difference? Again, I can’t objectively prove that one thing had more of an impact than another, so I will present the whole picture in hopes that this success can be duplicated and substantiated by others in the future....

Anyone who wants to create an effective treatment program has to start with the question: Alcoholism and Addiction: Disease or Choice?

Why does it have to be either/or? Isn’t that simply the continuation of the black-and-white thinking we so often criticize in our addicts? There’s no question in my mind that there are people who have some kind of physical susceptibility to alcoholism and addiction — the “genetic factor.” I don’t happen to the one of them, even though my father was clearly an undiagnosed alcoholic, and probably my mother as well. But my body does not experience the obsession, the compulsion to drink or use (I’ll talk later about why I still say I’m “in recovery”) while other people have uncontrollable physical reactions to alcohol and drugs. In this sense, addiction is a disease, in the same way that allergies are a disease, over which many people have no conscious control. Again, similar to an allergy, once triggered, alcoholism and addiction can be self-generating and self-perpetuating.

But if alcoholism were strictly a physical disease, there would be no hope for recovery other than through physical treatment. True, Dr. Joan Mathews Larson has apparently had some real success treating alcoholism as a disease, from the strictly physical viewpoint, and I’m sure that her combination of abstinence from physical triggers and vitamin and supplement support can have a profound effect on the alcoholic caught up in their “allergic” or “genetic” reaction.
And I don’t doubt Dr. Larson’s statistics of some 74 percent who remain sober a year after leaving her program. The question I would ask Dr. Larson is this: now that you’ve removed the physical aspect of their addiction — the cravings for alcohol — how many of them switched addictions and are now overeaters, or gamblers, or love and sex addicts instead? Where are the statistics on that?

My experience says that addiction to alcohol or any other drug is hardly ever just physical — like a disease — but involves a psychological component as well. Yes, we need to recognize and treat the physical aspect with proper nutrition, abstinence from caffeine and nicotine and sugar, regular exercise, enough sleep, and even Chiropractic and Acupuncture and Yoga. All of those things must be part of any successful treatment program. But if we stop there — if we consider and talk about and label alcoholism and addiction as simply a disease — we will severely limit our chances of getting any meaningful recovery results.

Addiction must be a choice as well. Just as any individual has the choice not to put their hand on a hot stove, we all have the choice not to do those things that we have learned will injure us. Some people are injured by alcohol — most are injured by drugs. Those injuries will not occur on their own, like other diseases such as cancer. We must take some action, like drinking or using, for the injurious physical effects to manifest. It may not be our choice whether the physical “disease” symptoms appear in many people as a result, but it is always — always — our choice whether or not to drink or use.

Successful addiction recovery will have two parts. One is addressing the physical addiction — the “disease” component. The second major part is addressing the individual’s psychology — their “choice” — which triggers the disease in their bodies.

And insurance companies expect all this to happen within 30 days?

We’re not going to make much progress in the recovery field until the insurance companies wake up to the fact that it will be more cost-effective for them — not to mention more treatment-effective for the addict — to take their $30,000 and spread it over a six-month treatment program; and they have done the public a great disservice by suggesting that any kind of effective long-term treatment can occur in the first 30 days.

It can’t. About the only thing that can be accomplished in the first 30 days of treatment is to let the body go clean and sober and recover from the disease component of addiction — and that’s stretching it. Even Dr. Larson says it takes “Seven Weeks to Sobriety” with her nutritional program. What ends up happening is that insurance companies pay for 30 days, the client and their family assume that’s all that’s needed for a successful recovery, the client relapses within a matter of a few days or weeks or months, the client is further shamed and the family heart-broken, the insurance company plunks down another $30,000 for another 30 days of treatment, and then the dwindling spiral continues.

Fact is that the insurance companies would be better off — would most likely save money in the long run — taking $50,000 and spreading it over a 6-month program, rather than wasting $30,000 at a time, relapse after relapse.

Why six months? I found the time table broke down this way, on average:

The first thirty days were spent physically detoxing. Unfortunately, many addicts, now that they feel better, will think they’re done at this point. The truth is that they haven’t really started. One of the biggest challenges is to help someone past this 30-day threshold. There’s a good reason why the 30-day AA sobriety chip is red — it’s a very dangerous point in recovery. What the alcoholic and addict have to understand is that their thinking and their decisions were what got them into trouble to begin with, and they need more time in treatment before they are able to think and decide on their own again.

The next thirty days is the roughest. In a well-designed, effective treatment program, this is the time when all the feelings, the thoughts, and the memories come up that led to the addiction in the first place. This is when real treatment starts, and is the single most important idea to understand about recovery.

Apparently all addictions have one common purpose: we use them to medicate our feelings. When someone has a thought or a feeling that make them uncomfortable, they find some way to escape or change that sensation, in the same way that we’ve been taught to take a pill to get rid of uncomfortable physical sensations. This can take the form of alcohol, drugs, eating, love, sex, gambling, and literally a myriad of other panaceas. Personally, I didn’t drink or use to escape my feelings of depression. But I ate for pleasure and relief rather than nourishment; I looked to love and sex to help me banish the blues; and I ran as fast as I could, changing jobs and homes to try to stay one step ahead of the pain. The key to long-term recovery is to become able to feel what we’re feeling, when we’re feeling it, without having to medicate it, escape it, change it, or disown it. When we can learn to accept who we are, including what’s going on inside of us, we no longer need something from the outside to make us feel differently.

It is true that a small percentage of people can stay clean and sober without looking at the feelings that made them an addict in the first place. Apparently they do it through sheer will power, often with the help of a Higher Power and the 12 Steps, and lots and lots of meetings. The statistics prove, however, that the vast majority of us aren’t going to succeed that way. I have met far too many “dry drunks” who are clean and sober and yet intolerable to be around because they never faced the feelings that led to their addiction, and they continue to run from those feelings by switching addictions or developing other obnoxious behaviors to continue to cover them up.

A well-designed and effective treatment program is going to encourage and support the client to allow those feelings and thoughts to arise that led to their addiction — and will lead to their relapse again if not identified, differentiated, examined, and dealt with. It requires lots of group therapy — trauma therapy, art therapy, grief therapy, and process groups — as well as good one-on-one with an experienced counselor. This stage will take at least thirty days.
The last 30 days of a 90-day intensive treatment program allows the client to develop new behaviors and new ways of thinking to deal with the feelings they’ve uncovered. The fact is that we will encounter many of these feelings and thoughts again in the future as we go through life, and there’s no suggestion that we can change what happens outside of us. But what we can change is the way we respond to life, by discovering and implementing different choices to deal with our feelings that are no longer habit-forming or life threatening. At this point — 90 days into treatment — the average client can take a big step back toward normal life. This transition out of the cocoon of intense treatment should include a change in living environment, including roommates, and a marked decrease in the organized schedule. The client should begin weaning themselves off the therapy and start looking for a job. Assuming that this process takes about a month, the client then needs 60 more days working in the real world and living in a “sober house” for continued support, where they can practice their new-found ways of dealing with life and their feelings without needing their former addictive behaviors. It’s a six-month program; but by the time these six months are over, anyone should have about an 85 percent chance of staying clean and sober for the rest of their lives.

Some people will require more than six months. Some people take longer to allow the feelings to emerge that led them to become an addict. Some people will have more feelings to deal with than others, requiring more time. Others will miss this opportunity, or refuse to look at a particularly difficult feeling, and relapse during the last few months of sober living when it comes up to overwhelm them again. They’ll need another 30 days of intensive treatment, no doubt.

But thinking about anything less than spending six-months in active recovery is virtually useless. Someday someone will file a lawsuit against the insurance companies for refusing to pay for the proper kind of treatment, or perhaps file a suit because individual premiums are forced higher than necessary as the insurance companies continue financing worthless 30-day programs. Until that time, it is incumbent on the recovery industry to educate the public about the truth of treatment - what works and what doesn't. I realize that's tough in a society where it's easy to collect $30-50,000 for one month, send the client out to relapse and come back again for another 30 days. But it's time to give up the greed and do the right thing.

Stephen Davis is a grateful member of Al-Anon, a former Arizona State Senator, former President of The Last House on the Block Foundation and Executive Director of A Sober Way Home, Inc.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2005, v.6, n.2, pp. 36-38

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Carl D.,Miami, Florida   |65.2.180.xxx |2008-04-18 21:18:44 58 years old. 6 yrs,3 weeks sober 12-Steps AA. From plethora of alternatives, nothing else worked. I treasure and value my new life in sobriety. 4/18/08. Reply 0   0

Orange   |207.224.27.xxx |2007-03-27 12:30:31 The author, Stephen Davis, has a lot of great things to say, but makes some large false assumptions, too. I don't have the space to argue with all of them, but I will do one item: He wrote: "It is true that a small percentage of people can stay clean and sober without looking at the feelings that made them an addict in the first place. Apparently they do it through sheer will power, often with the help of a Higher Power and the 12 Steps, and lots and lots of meetings." No! Mr. Davis assumes that 12-Step groups and 12-Step religiosity do something good, like help alcoholics to quit drinking. They do not. They increase the rate of binge drinking in alcoholics and also increase the death rate. See: http://www.orange-papers.org/orange-effectiveness. html#Brandsma and: http://www.orange-papers.org/orange-effectiveness. html#Vaillant_deaths Mr. Davis also assumes that people who quit on their own without treatment (... Reply 0   0

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