by Lisa Frederiksen
One of the most difficult aspects about trying to find a treatment center and/or program that is “right” for you and/or your loved one is the frustration over the inability to actually “measure” how one program works vs. another. This Opinion, by Bankole A. Johnson, Chairman of the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia, appearing in the August 8, 2010 The Washington Post and titled, “We’re Addicted to Rehab. It Doesn’t Even Work,” does an excellent job of presenting the issues. I’ve included an excerpt below:
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….
To finish reading the Opinion piece by Bankole A. Johnson’s piece, click here…
From a response posted this week (http://addictionandrecoverynews.blogspot.com/2010/08/rehab-doesnt-work.html)
I’ve posted about Cochrane before, the most germane is a summary of a Sara Zemore presentation last year:
She very effectively rebutted the Cochrane Review from a few years ago by making the following points. (These are based on notes I took and are incomplete. Hopefully they post video so that you can see her complete rebuttal for yourself.)
* It was limited only to randomized trials and ignored the overwhelming observational evidence.
* It included one of Zemore’s studies which was NOT a randomized study of AA.
* She acknowledged that the randomized evidence is ambiguous.
* Randomized trials of AA are hard to do because some subjects in other groups end up participating in AA. This happened in Project MATCH.
* The Cochrane Review did not find Twelve-step Facilitation ineffective. It found it no more effective that CBT and MET. (The summary from the abstract says, “The available experimental studies did not demonstrate the effectiveness of AA or other 12-step approaches in reducing alcohol use and achieving abstinence compared with other treatments, but there were some limitations with these studies.”)
* Finally, she cited 4 randomized studies of Twelve-step Facilitation: The outpatient arm of Project MATCH, a study by her colleague Kaskutas, and two others that I missed.