This is a question that I think about quite a bit: Are we any closer to curing drug addiction and alcoholism?
For all of the advances in medical science that we have in today’s world, it almost seems like addiction should have been “solved” by now. But obviously that is not the case, as evidenced by the sheer amount of negative data, poor success rates among recovering alcoholics, and so on.
So what is the real deal? Are we any closer to a cure? What has medical science and/or psychology come up with lately?
Current treatment methods and where a cure might come from
There are a number of ideas when it comes to addiction recovery:
1) 12 step programs like AA and NA – this is the dominant solution today that is most likely to come up if you are seeking help. Most treatment centers adopt a 12 step model (though not all do). The success rate of this model is up for debate. Most would put it between 10 and 40 percent successful. My experience and observations would suggest that 40 percent is very generous.
2) Religious based recovery. Most treatment centers that are not 12 step based are based on a religion. Just like with AA and NA, religious based recovery works for some people but obviously not all. It would be quite a stretch to try to implement this as a “cure” for everyone, because religion is such a personal choice.
3) Medications. Currently this is nothing like a real “cure.” There are different medications for different chemical addictions, and they aim to do different things. Some pills attempt to replace the drug of choice, others try to fight cravings, and some try to modify behavior through negative reinforcement. New medications are slowly being developed in this area, though nothing sounds like a quantum leap forward in my opinion. It would be nice to have a magic pill that cures addiction, but we definitely aren’t there yet.
4) Therapy/psychology. I don’t know of any breakthroughs in this area lately. Cognitive behavioral therapy has similar success rates to other solutions (like the 12 step program). Could this area lead to a cure some day? I suppose it could. But right now, definitely not a “cure.”
I think when most of us think about a cure for addiction we are imagining something that doesn’t require much work or effort. So a medication would be a natural candidate for this. But I believe it is unlikely that such a magic pill will ever be developed (wouldn’t we just get addicted to that? goes the old joke.).
Perhaps one day they may even have a physical implant in the brain that can regulate addiction. This sort of thing might be coming quicker than you think, and it might be far more likely than any of the other possible solutions. Most medications that are used to treat addiction are completely worthless without behavior modification and therapy added in to the mix.
Defining what a cure would really be and what it would look like for alcoholism
Before you can answer these questions, you have to define your measurement of success. What would success really look like when it comes to treating addiction?
It is a surprisingly tricky question when you really think about it. Pretend for a moment that you are a drug and alcohol treatment center. How would you measure your success rate after people leave your rehab?
Obviously you have to follow up with people and see how they are doing. Would you call them up after 30 days? After 3 months? After 6 months? How long do they have to remain sober in order to be considered “successful?”
And do you just call them up? Or do you actually ask them to come back into treatment so that you can drug test them and find out for sure if they have been completely abstinent? This may sound like an extreme measure, but not if you put yourself in the shoes of someone in recovery. Think about it: You go to treatment, you try your best to get and stay sober, then you go home from treatment and attempt to remain sober on your own. At some point in the future someone from the rehab follows up with you and wants to know how you are doing. There is a pretty big shame factor when it comes to this moment. Most of us would sit here and tell you right now that we would never lie about this, but when you are actually in the situation and you feel ashamed that you relapsed, you would be surprised. This is one of the major reasons that it is nearly impossible to get accurate success rate data from treatment. The most accurate data we can get, therefore, is when people are ordered to be drug tested and breathalyzed on a regular basis, so there is no question at all if they are telling the truth or not. And the numbers we get from that sort of situation is almost always very depressing and negative.
I think when you are throwing around the word “cure” in relation to drug and alcohol addiction, you have to be talking about total and complete freedom from addiction. Now whether that means you can drink socially in the future, or whether it means that you have achieved complete abstinence is up for debate. Maybe it could mean either of those things. But the measure of success implied by the word “cure” is that the person will NEVER have a problem with chemicals again in the future. Therefore, measuring abstinence after 3 months, 6 months, or a year seems like cheating in some ways. Unfortunately though if you want results from recent treatments then long term data is not going to be available.
Are current treatment methods good enough? Can we expect to do better with medical advances?
One thing that you can see some longer term data on is through AA census figures, which date back several decades. They released their numbers at one point and showed the recidivism rate among AA members and it was not overly encouraging, at least in my opinion. Something like 87 percent of all AA attendees have left the program within a year and they never come back. That was published by AA world services (their numbers, not mine). To me that is not an encouraging statistic considering that we pretty much take anyone who is struggling with drug or alcohol addiction and push them towards the 12 step program as their primary solution.
Does it work? Proponents of the program would say “it work if you work it.” They will further say that their program works for anyone who is making a serious effort. But the numbers, at least as told by AA World Services, are not necessarily that encouraging.
The program today has not changed from the past. The basic text remains the same as it has for decades.
Arguing that the program works perfectly so long as someone “works it” is not good enough, in my opinion.
I can design my own program and make the same exact claim. For example, take this hypothetical program I just designed right now:
1) Don’t drink alcohol or take addictive drugs no matter what.
2) Strive for personal growth and positive action each day.
3) Try to help others to live a better life along with yourself.
That is a complete recovery program in 3 steps. It would be very, very difficult (impossible?) to argue that this does not work. It does work, so long as you follow those three steps.
And this is the same logic by which most people defend the 12 step program of Alcoholics Anonymous. It works for some people, so long as they really work at it.
Well, duh. So does my imaginary 3 step program listed above. If you honestly work at it and follow those 3 steps, you will remain sober. But that does nothing to prove how effective the program actually is, how many people it actually helps, whether it is worth spreading such a program to the masses, etc.
In order to prove one program’s effectiveness over the others we need to look at data. If one person can get sober with AA, that is great. I don’t begrudge them their success. Sobriety is the goal, recovery programs are just the means to get there. I don’t care how you get sober so long as you do it.
But does this have anything to do with how effective 12 step programs really are? Not really.
Let me give you a bit of background on me.
I went to rehab three times. Each treatment center was 12 step based.
I lived in long term rehab for 20 months. I have been clean and sober since then, over 13 years now.
I worked in a drug and alcohol treatment center for over 5 years.
So I would like to think that I have a pretty good handle on the treatment industry and what the 12 step based rehab model is capable of.
Now before I go any further, don’t get me wrong here…..I believe that ANY treatment is better than nothing. Going to AA is certainly better than doing nothing at all. If there is no alternative, then any treatment is better than nothing.
But I have worked in the industry for long enough and I have watched enough people go in and out and I still have to wonder:
Is this really the best that we can do?
In general, the treatment industry might have about a 10 percent success rate. That is a very rough estimate but if you dig through enough data and you work at a rehab for half a decade you will probably reach a similar number. Maybe your number will be slightly higher or lower but you aren’t going to be far off from that, you will not declare the success rate to be 40 percent or anything like that. It’s not even close to that, I can tell that just through observation while working in rehab. I also lived in long term treatment and attended meetings for about a year or two. I watched a whole lot of people try to get clean and sober. The success rate of treatment in general is depressingly low. I don’t know what the exact figure is, but I know that it is closer to 10 percent than it is to 40 percent. And that is really upsetting. Can’t we do better?
Big pharma companies and incentives to cure addiction
Here is something that I never realized:
There is no money in curing addiction. That sounds like a really negative thing to say, but I believe it to be true.
The reason I stumbled on this was based on drug sales. There are big pharmacy companies out there and they are all spending research dollars to try to come up with a new pill to sell.
Now I never thought of it this way before, but if you are the drug company then you have to look at what your potential revenue might be from selling a new drug before you can decide how much money you are going to put into the research. Seems obvious, right? But I never thought of it that way before.
So what are the numbers?
Well, it could be as high as something like 22 million in the United States who abuse drugs and about 7 percent of all adults who have drinking problems or alcoholism.
But if you are a drug company you are not just going to here those numbers and immediately get dollar signs in your eyes. First you have to wonder how many of those people are actually going to seek help for their problem. That is generally something like 10 to 15 percent over an entire lifetime, depending on the data you believe.
And then, out of all of those remaining who will actually seek help, how many of them are going to actually go to a doctor, get a prescription, and take this new drug you are developing? Obviously not all of them. Some people will just go to rehab, AA meetings, etc. and never seek any medication at all. Even if it is supposedly a “cure.”
This is why the numbers do not look so great. Sure, there are “million of addicts and alcoholics.” But compared to something like heart disease or obesity, the market is really not all that big. And it is much, much smaller when you consider that most never seek help or treatment at all, and those who do may not went a pharmacological solution.
So when someone first suggested that drug companies should spend millions on finding a cure for addiction, it makes perfect sense. But when you actually look at the numbers and compare those numbers to other more popular diseases (and also consider that other diseases have people more willing to get help for it!) then it starts to paint a different picture.
So the incentives for drug companies to research better addiction treatments are not very strong. There is still some incentive there, but it is not likely to be nearly as big as you might think at first. There are at least two disincentives that cannot easily be overcome (relatively small amount of potential patients and a surprisingly unwilling group of candidates for new medications).
Striving to find better treatments and higher success rates
I don’t know what the solution is necessarily. I try to find better solutions through my own addiction recovery journey, and by trying to help others.
I am not sure what the future holds. I am not sure that AA will survive and thrive unless they update their somewhat archaic literature (ever read the Big Book chapter “To wives?” Appalling). I believe that medical science will continue to make advances in this area, but unfortunately they are doing so fairly slowly.
New medications have slowly rolled out in the past decade, but none of them have really been revolutionary from what I have seen. I watched a number of opiate addicts try to overcome their addiction with a mixture of therapy and Suboxone, but from a purely subjective and observational basis these results seemed like a disaster. From what I witnessed, nearly everyone who tried to use Suboxone maintenance to kick an opiate addiction ended up coming back in for more rehab later on. Again, that was purely subjective observation on my part and I was not looking at raw numbers or anything. It just didn’t look like it was working from my perspective.
There are other medications that attempt to reduce cravings or modify behavior, but none of them are anywhere near what you could label as a “cure.” As in: Just take this drug every day, and it will cure your addiction! I haven’t seen anything even close to that.
I am not sure that we will ever have what amounts to a “real cure” for addiction and alcoholism. The problem is that it is self destructive disease, and people do not always act rationally. It is a bit like asking if there is a cure for suicide or not. Well….no. You can’t really cure something like that, because some people are just going to behave in ways that you cannot predict or control.
That said, I am hopeful for the future. I am hopeful that medical science can make significant advances both in therapies as well as in medications. But I don’t really have my fingers crossed that a miracle pill will come out anytime soon that will completely cure addiction.
And in the meantime, I really believe that a holistic program of recovery makes the most sense. If 12 step programs help you, then by all means, attend them and follow them. But if not, I think you can get similar results through your own self motivation. The key is to surrender, take positive action, and consistently work to turn your life around. It is a daily struggle at first and that is true no matter what recovery program you follow. Given enough sober time and enough positive change in your life you can overcome any addiction. It takes real work though and there is no magic bullet out there that can dress this up and pass for a “magic cure.”
What do you think? Are we any closer to curing addiction and alcoholism these days? Or are we basically at the same point we were at when AA first started out? I tend to think it is the latter, but I would love to hear your opinions. Let us know in the discussion forums. It only takes a second to register!