Does Rehab Work?

Excerpted from, The Truth About Addiction and Recovery, by Stanton Peele, Ph.D., et al.  Fireside division of Simon & Schuster, 1991.  Page 29 from Chapter 1 of the paperback edition.

Treatment is no panacea.  Contrary to all the advertising we hear, treatment for addictions is often no more effective than letting addiction and recovery take their natural course.  The vast majority of people who have given up addictions (beginning with more than 90 percent of the forty-four million Americans who have quit smoking) have done so on their own.  This does not mean that treatment for addictions cannot work – research has shown that some forms of treatment are effective.  But the ones that are more effective are not the ones that have become popular in the United States8.  You can outgrow an addictive habit on your own or in therapy, but either way the principles are the same.   ...

What about joining support groups such as Alcoholics Anonymous?  Here, too, research reveals the opposite of what we have been led to believe.  A.A. is a valuable community resource for those who find support in a certain type of religiously oriented group ritual.  But the best we can say about A.A. is that it works for those for whom it works.  Meanwhile, there are plenty for whom it doesn't work.  There is no scientific evidence that A.A. works better than other approaches when randomly selected alcoholics are assigned to A.A. or other treatments.  In fact, the evidence is that the people who are now often compelled to attend A.A. – after being arrested for drunk driving or being sent by a company Employee Assistance Program – do worse than those who are left on their own.9

How can we reconcile this finding with the glowing testimonials we hear about A.A.?  The people we see in A.A. are the ones who like it, find it helpful, and stick it out.  But there are many others who don't go to A.A. or who don't like it and drop out.  And as we show below, those who seriously try to stop drinking on their own are more likely to maintain their abstinence than those who attend A.A.  In addition, since many more people try to quit on their own than through therapy or joining a group, the number of self-curers is triple or more the number of successful treatment or A.A. cases.10  But such self-curers are not very visible, because they are individuals without an organized group to publicize their success.

Footnotes:

8.  W. R. Miller and R. K. Hester, “The Effectiveness of Alcoholism Treatment:  What Research Reveals,” in W. R. Miller and N. K. Heather, eds., Treating Addictive Behaviors:  Processes of Change (New York: Plenum, 1986), pp. 121–74.

9.  J. M. Brandsma, M. C. Maultsby, and R. J. Welsh, The Outpatient Treatment of Alcoholism:  A Review and Comparative Study (Baltimore, Md.: University Park Press, 1980); K. S. Ditman, G. G. Crawford, E. W. Forgy, H. Moskowitz, and C. MacAndrew, “A Controlled Experiment on the Use of Court Probation for Drunk Arrests,” American Journal of Psychiatry 124 (1967): 160–63; P. M. Salzberg and C. L. Klingberg, “The Effectiveness of Deferred Prosecution for Driving While Intoxicated,” Journal of Studies on Alcohol 44 (1983): 299–306.

10.  G. E. Vaillant, The Natural History of Alcoholism:  Causes, Patterns, and Paths to Recovery (Cambridge, Mass.: Harvard University Press, 1983).

See also:  www.peele.net.

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