We're addicted to rehab. It doesn't even work.
Last week, Lindsay Lohan left jail and entered a drug and alcohol rehabilitation facility. If the scene inspired deja vu, it wasn't just because it was the fourth time she had headed to rehab in four years. It was because the spectacle of a celebrity entering a drug and alcohol treatment center, relapsing, then heading to rehab again -- and again and again -- has become depressingly familiar.
For decades, Americans have clung to a near-religious conviction that rehab -- and the 12-step model pioneered by Alcoholics Anonymous that almost all facilities rely upon -- offers effective treatment for alcoholism and other addictions.
Here's the problem: We have little indication that this treatment is effective. When an alcoholic goes to rehab but does not recover, it is he who is said to have failed. But it is rehab that is failing alcoholics. The therapies offered in most U.S. alcohol treatment centers are so divorced from state-of-the-art of medical knowledge that we might dismiss them as merely quaint -- if it weren't for the fact that alcoholism is a deadly and devastating disease.
And the way we attempt to treat alcoholism isn't just ineffective, it's ruinously expensive: Promises Treatment Centers' Malibu facility, where Lohan reportedly went for her second round of rehab, in 2007, has stunning vistas, gourmet food, poolside lounging and acupuncture. It costs a reported $48,000 a month.
Even nonprofit facilities that don't cater to Hollywood types are too costly for most people. At the 61-year-old Hazelden center in Minnesota, which bills itself as "one of the world's largest and most respected private not-for-profit alcohol and drug addiction treatment centers," a typical 28-day stay costs $26,000.
These prices might be justified if these programs worked. But finding out the success rate of a given program is extremely difficult. Controlled studies of specific treatment centers are rare; compounding the problem, many programs simply don't follow up with former patients. And when they do report a success rate, be it 30 percent or 100, a closer look almost always reveals problems. That 100 percent rate turns out to apply only to those who "successfully completed" the program. Well, no kidding. The 30 percent rate applies to patients' sobriety immediately after treatment, not months or years later.
It's understandable, if unfortunate, that treatment centers that have a financial stake in recruiting patients might be reluctant to aggressively track -- much less publicize -- data on their patients' success down the road. But the problem is more fundamental than that: There is little compelling evidence that the AA method works, inside or outside a rehab facility.
Although AA's emphasis on anonymity makes it difficult for outside researchers to determine its success rates, some have tried. What they have found doesn't inspire much confidence in AA's approach. A recent review by the Cochrane Library, a health-care research group, of studies on alcohol treatment conducted between 1966 and 2005 states its results plainly: "No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [12-step facilitation] approaches for reducing alcohol dependence or problems."
AA itself has released success rates at times, but these numbers are based only on voluntary self-reports by alcoholics who maintain their ties to AA -- not exactly a representative sample.
Even taken at face value, the numbers are not impressive. In a 1990 summary of five membership surveys from 1977 through 1989, AA reported that 81 percent of alcoholics who began attending meetings stopped within one month. At any one time, only 5 percent of those still attending had been doing so for a year.
Many health conditions resolve themselves through what's known as spontaneous remission -- that is, they improve on their own. In the case of the common cold, for example, nearly everyone gets over the virus without medical intervention. In a 2005 article in the journal Addiction, Deborah A. Dawson and her colleagues calculated a natural recovery rate for alcoholism of 24.4 percent -- that is, over the course of a year, 24.4 percent of the alcoholics studied simply wised up, got sick and tired of being sick and tired, and quit. Without treatment and without meetings.
When AA's retention numbers are compared with alcoholism's rate of spontaneous remission, they look even worse.