A reader recently chastised me about denigrating the conventional recovery methods (see my response here), but they also went on to say:
Different people find their solutions in different ways and it really doesn’t matter what rehab method they use, if it works for them then it is effective.
I’ve heard this many times, and I must respond to it on a few different levels to set the record straight. First of all, the context in which I hear this always implies that I have some ill will towards the people who have sobered up while/after going through the channels I disapprove of. I don’t have any ill will for these people, I’m happy for them. I am happy that they were able to find success in a set of conditions where the vast majority of people would fail. I think their success is a testament to their own inner strength and fortitude. These people went to programs which taught them to struggle, to fail, to expect defeat, to doubt themselves – and they succeeded. Many of them sat in a room at a treatment program where a counselor said to them “look to your left and look to your right, only one of you will still be sober next week” (in reference to the common treatment program success rate of 30%), yet they decided, “I will be the one who succeeds”. They made a decision to succeed and they followed through on it. To all of the people who survived this, my hat goes off to you.
But what about the other 2 out of 3 people? Should we just forget about them, or chalk their failure up to the nature of addiction, blame it on the “chronic relapsing disease? The counselor up at the front of the room, the one who knows that the treatment program they’re offering is ineffective, the one who accepts the low success rate as a given, the one who writes off the failures by saying “they didn’t want it enough” or “they need to hit rock bottom”, or worse yet, assumes that they need more time in this crappy program – that is the person I have ill will and disdain for.
Here is a list of the people I do have disdain for in the recovery culture: anyone who has a college degree and works in treatment, the counselors, doctors, psychiatrists, administrators, researchers, scientists, and heads of the various government agencies such as the NIDA, NIAAA, SAMHSA, and NIMH – who promote the disease theory and conventional treatment paradigm even though there is a wealth of research and evidence which disproves the disease theory and any claims that treatment is effective. These people are often educated in the scientific method, they should be aware of the problems with treatment and the disease theory, and they certainly have access to the information which disproves the conventional views on addiction – yet they continue to keep the status quo in a system which hurts people instead of helping them. These are the people I rail against in this blog.
I do not have any problems with the minority of people who attribute their success to the conventional programs. We live in a division of labor society, not everyone can be an expert on addiction, so when we have a problem with it, we go to experts and believe what they say. It is reasonable to do this, it is reasonable to believe what doctors tell you. I don’t hold this against these people. I do however believe that these people solved their substance use problems in spite of what they were taught, whether they realize it or not. I attribute their success to a personal commitment to build a better life for themselves. I believe the same factors which have been shown to be important for self-changers, are the same factors which helped these people. They probably went through a process of cognitive evaluation, and moved on to new life roles – they decided to grow up, change, and follow powerful new life goals. I don’t believe the treatment programs were responsible for this in any significant way other than offering them a chance to see what they didn’t want to become. Some of them possibly built good friendships in their 12-step groups, and this may have been extra incentive, but without the cognitive evaluation which can only happen within the mind, these friendships would have been of no consequence.
What I’m trying to say is that superficially, different people may take different paths to ending their substance use problems, but the core principles of how and why they find long-term success are very much the same. One heroin abuser may go through 10 days of medical detox and a 28 day treatment program, another may take a replacement drug prescribed by a doctor and attend no treatment or meetings, and then there’s me, I detoxed cold turkey during a short stay in jail and then attended the St Jude Retreat House which is not treatment, but rather an educational program. But I believe that each one of these people made a choice to weigh the situation, saw that this lifestyle didn’t work, decided they wanted something better, and worked to make their vision of a new life a reality. The core principles of how each of us changed are the same. The question then becomes, how should we approach new people presenting themselves for help with substance abuse problems?
Should we waste time leading people on a wild goose chase where they expect a treatment program to solve their problem, should we give them excuses to fail, should we teach them they have a disease that they will struggle with for the rest of their lives? Should we continue to use the same methods which are proven to fail for most people? Or should we cut to the chase and teach them that they can choose to end their problem at any time. I choose the latter. If you’ve found stability and success, I’m happy for you, but I’m focused on those who haven’t found that. I don’t want them to become the failures sitting “to the left and to the right” of you at a treatment program.
Statistically, if only 1 in 3 program graduates succeed, the program is a failure. I would rather shake up the treatment world and ruffle some feathers so that all 3 of those people succeed, than tiptoe around people who believe the disease theory myth. In retrospect, for a person who had the strength of personality to get well in spite of the self-defeating messages fed to them at rehab, it didn’t matter that they went to a bogus program, but to the majority who failed, and continue to fail, in no small part due to the fact that they’ve been taught to fail, it does matter what rehab method they use. The difference is that when I succeeded at The St Jude Retreat house I did not have to survive the program, and I did not have to be the exception. Likewise, a self-changer’s success is not the exception, it is the rule. But in the conventional recovery culture, successes are the exception.
