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We're addicted to rehab. It doesn't even work.
Many proponents of AA cite Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a study completed in 1996 by the National Institute on Alcohol Abuse and Alcoholism that seemed to find that 12-step treatment works. The study randomly assigned alcoholics to one of three behaviorally based treatments with marked differences in philosophy and practice: a 12-step therapy based on the principles of Alcoholics Anonymous, cognitive behavioral therapy and motivational enhancement therapy.
After eight years and $27 million, the study concluded that the techniques were equally effective. More to the point, a 2005 article in the journal BMC Public Health that reanalyzed the data from Project MATCH reported that almost all of the effect of treatment was achieved after attending a single session. In other words, it was the initial decision to try to get better that determined a person's chances of succeeding; what followed made little difference.
Although AA doubtless helps some people, it is not magic. I have seen, in my work with alcoholics, how its philosophy can be harmful to patients who chronically relapse: AA holds that, once a person starts to slip, he or she is powerless to stop. The stronger an alcoholic's belief in this perspective, the longer and more damaging relapses can be. An evening of drinking turns into a month-long bender.
Equally troubling, AA maintains that when an alcoholic fails, it is his fault, not the program's. As outlined in the organization's namesake bible, "Alcoholics Anonymous" (also known as "The Big Book"): "Those who do not recover are those who cannot or will not give themselves completely to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates . . . they seem to have been born that way." This message can be devastating.
In the end, there is simply no need to remove alcoholics from the support of relatives and friends and shut them away for the customary month in rehab. There is no need for alcoholics to be led to expect a miracle, only to be judged a failure if one does not occur. And there is no need to spend tens of thousands of dollars, again and again and again, on an approach that keeps landing people back where they started.
Alcoholism is an illness. But although those in the rehab business sometimes use that word, the 12-step approach they advocate is weak medicine. When any other illness causes great suffering, our society devotes time and money and effort to studying it and to developing treatments that are empirically found to work.
Alcoholism and drug addiction should be no exception. Recent advances in neuroscience have led to a greater understanding of how alcohol and other drugs affect the brain. They have, in turn, allowed medical researchers, myself included, to begin to approach alcohol dependence as we would any other disease: by searching for effective medicine.
Bankole A. Johnson is chairman of the department of psychiatry and neurobehavioral sciences at the University of Virginia and has served as a paid consultant to pharmaceutical companies developing medications to treat alcoholism. His book "The Rehab Myth: New Medications That Conquer Alcoholism" will be published in January.