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addictions

DRUG REHAB: Does it Work? Statistics are vague
DRUG REHAB: Does it Work? Statistics are vague I’m not drinking any more.
Of course, I’m not drinking any less.”

- Henny Youngman


Last year Congress passed the mental health parity law requiring for the first time that insurers cover mental health, including addiction treatment, at parity with physical illness. The yearly cost to state and federal governments of substance abuse treatment has been more than $15 billion, and to insurers another $5 billion for over four million people. Thanks to this new law, the cost will rise precipitously.

Rehabilitation programs, both in- and outpatient, run by governmental, county, state and federal, along with private agencies represent a thriving growth industry, particularly in the private sector. Many clinics across the country have long waiting lists, and researchers estimate that up to “20 million Americans” (sic!) could benefit from treatment. I assume many of these patients are suffering from depression with or without drug dependency, but the definition of those who “could benefit” is murky, if not opaque. Enormous sums of public and private, as well as tax-supported government money, are lavished on these highly promoted programs, yet few dollars are spent on critically important studies of the comparative effectiveness, if any, of various approaches to addiction, whether conventional alcoholic group therapy, medical/psychiatric, faith-based, or voodoo.

The 12-steps of Alcoholics Anonymous (AA), one of the first and most widely respected and copied peer support therapies, are based on the philosophy that it is the responsibility of recovering groups of people to help others like themselves overcome drug and alcohol dependency. AA and its founders are largely opposed to institutionalized or inpatient treatment of addiction. (No one, however, denies the occasional medical need for short-term detoxification of addicts in an institutionalized setting.)

Many of these patients are suffering from depression with or without drug dependency, but the definition of those who “could benefit” is murky. No standards exist for the long-term management of various forms of addiction, particularly to drugs and alcohol; each of the thousands of programs has its own philosophy and methods of implementation. Although most treatment programs have borrowed or plagiarized from AA, no one knows what is best for the individual patient, how long treatment should last, and virtually no statistically reliable long-range data is available on the outcomes of treatment. Even Alcoholics Anonymous and Narcotics Anonymous (NA), the most well known of all substance abuse programs, to my knowledge, have never published or collected data on its participants’ success rate.

The National Institute on Drug Abuse (NIDA) initiated studies in 1992 with the Drug Abuse Treatment Outcome Studies (DATOS). The baseline data used currently was gathered from only 10,010 adult clients entering ninety-six drug abuse treatment programs during 1991-1993. Although “treatment progress” data were collected at three and six months, follow-up data were collected only from a sample of approximately 3,000 clients at twelve months post treatment. Three-thousand patients! An extended follow-up gathered data on these 3,000 clients over a 5-year follow-up period. The resulting publication gave un-interpretable, vague data on outcomes. I wonder how much money the NIH and NIDA spent on these incomplete and unsatisfying studies. (Some “cost-benefit analysis” was attempted, however.)

The resort-and-spa private clinics in particular almost never allow outside researchers to verify their published success rates—when those rates are indeed collected. According to this source “The majority of treatment programs do not have success rates higher than seen from those who quit without professional help; which translates to a 10%-15% success rate.”

An excellent article in The New York Times (Dec. 23, 2008) in an important series on “The Evidence Gap in Medicine,” quotes A. Thomas McClellan, CEO of the nonprofit Treatment Research Institute in Philadelphia: “What we have in this country is a washing-machine model of addiction treatment...You go to Shady Acres for thirty days or to some clinic for sixty visits for sixty days...And then you’re discharged and everyone’s crying and hugging and feeling proud-and you’re supposed to be cured.” He added, “It doesn’t really matter if you’re a movie star going to some resort by the sea or a homeless person. The system doesn’t work well for what for many people is… a chronic, recurring problem.”

I am strongly in favor of AA, or any other sensible outpatient treatment program that can supply plenty of convincing anecdotal endorsements. If indeed there are programs that can offer some two-five year data on relapse and/or success rate, I invite them to contact me. So far, I have searched for this data in vain.

I am highly skeptical of inpatient or institutionalized rehab usually lasting for one to several weeks—whether private or Government-sponsored. These programs cost hundreds to thousands of dollars a day for little more than a promise and a primrose. Hugs and kisses on graduation hardly seem appropriate for a future filled with relapse and remorse for so many.

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"DRUG REHAB: Does it Work? Statistics are vague"
   authored by:
INTERNAL MEDICINE
Dr. Sturman has practiced internal medicine and endocrinology for eight years in New York City and seven years in Connecticut, where he was Chief of Endocrinology at the Bridgeport Hospital and subsequently assistant Professor of Radiology and Associ...



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