Don't Listen to Quacks, Lindsay -- And That Includes Many People who Claim to be Experts on Addiction

The New York Post ran a full page ad today for an addiction rehab program, with the banner headline, "Don't Die, Lindsay," suggesting that "It's time to try a medical treatment" for her addictions.

What the ad doesn't mention is that this so-called "medical" treatment has actually not been proven effective and is experimental. For more on the exaggerated claims coming from the Prometa method that the ad promotes, see here.

This is just one more example of why we need some sort of "FDA' for behavioral health care. Right now, anyone can say anything about the effectiveness of their treatments for medical and psychiatric disorders so long as they aren't using medications. Right now, any behavioral treatment -- whether it be standing on your head or being whipped, chained or starved -- can claim "80 percent success rates" and get enthusiastic media support as soon as it presents a few anecdotes of success.

Patients need to beware: nothing in the addictions field (other than the medications buprenorphine and methadone) has had to prove itself safe and effective to any kind of medical authority before it was foisted on unsuspecting addicts and sold to them and their families as a sure thing. And many of these alleged cures have been harmful, even fatal.

The 2000 book I co-wrote with Dr. Joseph Volpicelli, Recovery Options: The Complete Guide: How You and Your Loved Ones Can Treat Alcohol and Other Drug Addictions and Anne Fletcher's Sober for Good (which only covers alcohol) remain the only two books that actually use the research to guide patients to the best treatments for them. All the rest continue to promote the same old, same old -- either 12 steps are the only way or 12 steps suck, without giving a full perspective on the data.

Unfortunately, caveat emptor is key in addiction treatments -- so don't believe anything unless someone can show you peer-reviewed, replicated data to back that claim.

Comments

[Dap]

Psychological dependence is the most important part of understanding recovery.

[Halsey]

One has to truly truly throw in the towel of addiction..and be willing to do whatever it takes to stay sober...the so=called hitting bottom is a given (and yes..some "bottoms" seem light..while others..the abuser loses almost everything)... I find it absurd that when one gets DUI they are "forced" to attend AA meetings. I had to..and thought it was a cult..still do..BUT..also KNOW it helps a lot of people..so it's an okay cult in my book..

Luxury rehabs..what a joke!...eating from dumpsters..now THAT's a wake up call...

I'm certain Bill W is turning in his grave at the commericalization of an anonymous program..my gawd...papparazzi waiting outside meetings...

[Maia Szalavitz - Huffpost Blogger]

See Maia Szalavitz's Profile

Note to the anti-methadone person: you are not going to solve the problem of methadone-related deaths by restricting take-home medications from addiction clinics. You will actually make it worse because if people cannot get take-homes, they often cannot work. If they cannot work, they are more likely to use additional drugs, increasing their risk of death.

Imagine having to ask a clinic for permission to go on a business trip, for permission to go on vacation, etc-- it's just making what should be healthcare into chemical probation and it's not fair.

Besides, most methadone diversion to the street occurs not from clinics prescribing to addicts, but from people receiving it for pain treatment and from things like drug store robberies, not addiction treatment.

The vast majority of methadone-related deaths are due to people deliberately misusing the drug in combination with alcohol and other "down" drugs like benzodiazepines. Eliminating take-homes for clinic patients penalizes the wrong people and won't stop the deaths. And it could increase crime-- the harder it is to get methadone, the more likely addicts are to commit crimes in support of their opioid habits. Places that have added methadone clinics have seen crime drop; those which cut them have seen it increase.

This is why Rudy Giuliani-- not a man known for admitting he was wrong-- changed his mind about trying to cut methadone treatment in NYC.

What *could* potentially reduce methadone-related deaths is research on which genetic factors predispose people to certain heart conditions that may be precipitated by methadone but not other opioids. What also would help is educating doctors and patients about proper dosing and about its long half-life. More restrictions will only cause hassles, not reduce harm.

[WorkingClass]

Maia:

If your numbers are good then the situation regarding AA is worse than I thought. I stopped going to meetings long ago. Many of my old friends are still sober and also stopped going to AA meetings. Some of us "formers" agree that anecdotal evidence suggests that if you make three years your remission is relatively safe.

When I went to my first meeting I naturally wanted to know who was in charge. I was told that we are guided by tradition and there are no professionals in AA. I was 35 and it was generally thought that mid-thirties was the average age of newcomers. No one was yet "assigned" to AA.

Our most worn out slogan after "one day at a time" was "keep coming back". Some people took many months to get their first 90 day chip and several years to get their first year of continuous sobriety. How would you arrive at a "success rate" in such an environment. And yet I was successful and in five years providing shelter for homeless persons in recovery I meet many others who were successful mostly by the power of the AA program.

I hope that AA will be allowed to become anonymous again. AA doesn't work when its not voluntary. If there are treatment modalities that are effective without AA then I hope the professionals will stop cramming it down peoples throat. The 12 steps are a spiritual program and should be regarded and respected as such.

[Melis11577]

We (the families of methadone victims) are requesting new laws surrounding who can prescribe Methadone, clinic rules and regulations as well as stiffer penalties for those caught selling their take home doses. We cannot continue to allow a legal medication to be killing more people then the illegal drugs. Our government cannot be allowed to use tax dollars to fund their legal drug dealing operations.

We are asking government agencies to enact stricter guidelines in prescribing methadone for any reason. It must be mandatory that all doctors be certified and trained in the pharmacology of methadone; inpatient stays must be required during induction to methadone; all staff be extensively trained in monitoring methadone patients for symptoms of toxicity. Clinic patients should be tested weekly for legal and illegal drugs that are taken with methadone to get " high" or experience "euphoria" such as benzodiazepines, alcohol, cocaine, heroin, marijuana etc¦ and face severe consequences or mandatory detoxification from the methadone program after 3 dirty urines. Selling of take home doses must result in termination from methadone program permanently throughout the U.S. When presenting inebriated at clinic, clinic should also document such activity as well as prevent client from driving. Take home doses for all patients receiving methadone should be eliminated thus preventing the risk of diversion or precautions such as pill safe should be implemented.

Current statistics show that nearly 4000 people a year die from methadone. These deaths are mostly happening to pain management and detoxification patients" within the first 10 days of taking initial dose. Most of these deaths are related to methadone prescribed with other medications that react as additives with the methadone. Statistics also state that methadone is contributing to more deaths nationwide then heroin and only second to cocaine deaths.

The potential of abuse, diversion, and overdose to new patients being prescribed methadone is overwhelming. The unique properties of methadone, it's long half life, and it's negative interaction with numerous drugs make it an optimal choice as a last result treatment for chronic pain and addiction.

Melissa Zuppardi
www.HARMD.org

[Melis11577]

Methadone is now the #2 Killer Drug in the U.S. This is a legal drug that has been thought to be safe for the past 40 years. Only recently when its use became approved for pain management patients has the cardio toxic risks emerged. Previously methadone has been used exclusively for replacement therapy for heroin patients and death was thought to be an effect of the accumulation of many years of drug abuse. With the surge in pain medication misuse and abuse more patients are being referred to methadone clinics and physicians treating pain who believe the myth that methadone is safer or non addictive because of it"s use with weaning addicts from heroin. Methadone is more addictive then any other pain medication including heroin and because of it"s extremely long half life, cardio toxic risks, numerous fatal drug interactions, dosages based on tolerance, and small margin of error.

Every day 10.9 people die from Methadone (according to 2004 stats, not
including car accident deaths caused by drivers under the influence of Methadone)


www.HARMD.org

[Maia Szalavitz - Huffpost Blogger]

See Maia Szalavitz's Profile

There's actually lots of research showing that most addicts and alcoholics recover without 12 step programs and that most people who start 12 step programs do not stick with them and stay clean and sober. AA's own surveys find that only a a tiny proportion-- something like 5%, I don't recall the exact number but it's not large-- stick with it for more than 90 days.

Search "natural recovery" or just look at the epidemiological research studying addiction and alcoholism in community samples as opposed to treatment samples. Some examples are the research on the National Comorbidity Survey and NESARC or the Epidemiological Catchment Area research. Sober for Good also looks at this.

Another great source is Reid Hester and William Miller's Handbook of Alcoholism Treatment Approaches, which is a huge meta-analysis of the treatment research on alcohol. My book Recovery Options also summarizes a lot of this.

George Vailliant's work is also instructive-- his conclusions often favor AA but his data doesn't support them.

This is not to say that 12 step programs aren't extraordinarily helpful for some people-- it's just that they work for some and not for others, and that, as people above note, when coercion and commerce comes into to play, it can destroy the essence and the spirit of AA.

AA's traditions warn against "professional 12 stepping" and yet we have an entire rehab industry in which many counselors' *only* skills are 12-step knowledge. This is a serious problem and I think both AA and the treatment industry would benefit from an amicable divorce in which AA does what it does best and treatment is based on evidence-based things like specific relapse prevention skills and cognitive-behavioral therapy and offers referrals to AA, but not force or instruction or any sense that this is the "best."

People in recovery do often benefit from social support and those who *choose* AA do better with it-- but if you simply randomly assign people to AA it is not superior to other methods.

[zaneblue]

Good luck getting a non-pharmaceutical approach to treating drug addiction studied. Everybody wants patent money.

I've said it before here and I'll say it again--drug and alcohol addiction are caused in part by omega-3 fatty acid malnutrition. High dose fish oil can help. Check with your doctor about drug interactions and health risks of taking high dose fish oil. By high dosage, I mean approximately 1800 mg of EPA and 1200 mg of DHA per day for a 130-pound person.

[WorkingClass]

I got sober in AA (12 steps) back in 1979. I subsequently ran a half-way house for about five years. The steps were intended as a way out of alcohol addiction for white american males who had suffered from their addiction long enough to be "sick and tired of being sick and tired". AA is not nearly as useful as it was before it was "discovered". A 20 year old who may or may not be an addict is arrested for drunk driving. A judge sentences him/her to AA meetings. By the time (probably at least ten years later) that our 20 year old is actually ready for AA it is long associated with punishment and is not seen as a possible help.

Alcohol addiction for most of us starts as use, becomes abuse, and finally addiction. To benefit from the 12 steps you must actually be an addict. Not just some hapless shmuck who go busted for DUI. If you really are an alcoholic and you really want to get sober and you really WORK the steps your chances are pretty good. But even then not everybody will get sober.

In my experience it seems the AA formula can be stretched and tweaked to accommodate addiction to other drugs and other genders and other races of people. But the further you get from Bill and Bob (AA founders) the weaker the result.

I know there are other ways to get sober but I cant speak for them from experience. I hope that this writers book will be helpful and I hope that everyone will find peace.

[jomamah1]

12 steps have worked for millions since 1940, why act like it is an outdated mode. It does work when people are supported and committed--it is offensive to see this altruistic movement turned into a multi-billion dollar corporate money pit.

[larry278]

There are people for whom 12 step programs don't work. Do you have a ball park estimate of those who left 12 step programs "uncured"? How about those who recovered from chronic substance abuse sans a 12 step program?