Drug Treatment Centers, Counseling, and Alcoholics Anonymous:  The Pros and Cons

I get asked all the time, which treatment should I get for my addiction?  Well, the one that works.  I am not trying to be facetious in saying this, but we ultimately want to help people get sober to stay sober.  How many times have we heard about the person who completes a $12,000 treatment program and as soon as they leave the hospital they run out and get drunk.  It seems like a waste of money.  We also hear stories of people who were forced into treatment through a family intervention or a legal consequence went to treatment, got sober and it changed their life.  It’s amazing that people can begin the process of recovery reluctantly and come through it very grateful and committed to sobriety.  Most any kind of treatment program that works includes Alcoholics Anonymous and the 12 steps.  So how do we make the choice of where to send ourselves or our loved ones for treatment?  The article will address the pros and cons of each path of healing.

Residential Alcohol treatment

Before AA, people who had addiction problems went to a hospital and were given medication to help them stay sober.  Mistakes were made, like giving alcoholics Librium, another addictive substance, to help them stay off of alcohol.  This sounds like Methadone maintenance which is supposed to help Heroine addicts.  Somehow, using chemicals to stay away from chemicals doesn’t sound like the best of ideas, but it was what was done.  People were operating in the dark.  The movie, “My Name is Bill W.,” which describes the process Bill Wilson went through until he co-founded AA, shows him in treatment hospital which really didn’t do anything other then lock him up away from alcohol.  Times have changed.  Schick Shadel Hospital in the 1970’s used a form of aversion therapy, which was to make the alcoholic sick of alcohol.  In-patient treatment worked and was the original form of treatment for alcohols and addicts.  Taking people out of their “using” environment, away from their families, and giving them lots of information about addiction was helpful.  It gave them a safe, confidential way to detox physically and emotionally.  The atmosphere allows for the person to start to feel all the feelings that they used to self-medicate.  People let down their guards with caring staff and other addicts.  They could get a lot of information in a short amount of time.  People didn’t drink or use in the hospital setting for the most part because they were not free to do so.  Insurance companies paid big bucks for treatment.  I remember hearing a comedian talk about the racket that alcohol treatment hospitals had, that they charged thousands of dollars so that they could load the patients into a van and take them to a free AA meeting down the street.  It made people wonder, especially the insurance companies.

The problem with addiction treatment is that people relapse and that they run back out as soon as the leave the hospital and drink again.  Insurance companies began to see that they were not getting a big return for their investment and in fact people were returning to the hospital repeatedly.  This led to the evolution of a day treatment program.

Day Treatment Programs

This type of program had the benefit of education, group support and caring staff but with less cost, because you didn’t sleep there and there weren’t as many medical people, but more drug/alcohol counselors.  Not surprisingly, some people used alcohol at night and go to the treatment during the day.  How were they going to monitor sobriety.  Drug tests became popular and so did ways of scamming them.  In fact, a basic search on the Internet for drug tests reveals the top of the list are links to you beat drug testing.  Random drug tests were used which is where a person doesn’t know when they are going to be tested, causing it harder to have to be erased with herbal drinks.  You would be surprised how many parents give their teens a drug test “randomly” by first telling them that they are going to give them the test tomorrow or this afternoon.  Addiction is sneaky and insidious.  Everyday, addiction kills people and messes with their lives.  Treatment has to be direct, consistent and has to outsmart the addict to be effective. 

Day treatment programs then evolved into treatment programs that include group meetings once, twice or three times a week.  In addition, the addict may meet with a certified drug and alcohol counselor.  A weakness of treatment programs is that their staff are usually overworked, underpaid and there is high turn over.  Many of my clients, report that the person who they were working with left last week and that their class has a new instructor.

Alcoholics Anonymous or other 12 step programs of NA (Narcotics Anonymous), MA (Marijuana Anonymous) are in the treatment program and are required.  The person goes to AA and gets a member to sign off on a sheet of paper.  The programs are structured and include drug and alcohol testing.  Today, alcohol can be tested with strips that are placed in the mouth.  Antibuse, a medication that makes one violently ill if one consumes alcohol is also used.  The weakness of this type of treatment really comes down to the question of “does it work?”  Well, for some, “yes.”  But what about when it doesn’t work?  Many people can skate through the program that is more educational and structured and is not really tailored to the individual. Many addicts have heard a lot about the effects of alcohol and drug abuse, but it doesn’t deter them to stop.  Programs also educate the clients on how to live life without the use of chemicals.  In treatment programs, you may be recovering with many people who are motivated.  Many people are court ordered because of a DUI (Driving under the Influence) charge and their motives for the program are less than honorable.  Programs can be inundated with clientele that is court ordered rather than people who are walking in wanting some real change in their life.  How successful would we expect this treatment to be with people who are there just to get the driver’s license back or to avoid jail time.  Are there any programs that don’t take court ordered people?  Well, perhaps.  But realistically, how many addicts do you think, all of a sudden wake up one day, admit that they are drinking too much and say, “ya’ know, I think I should get some help, that this addiction is beyond me now, and I want out of it.”  I haven’t seen that during my 15 years as a professional counselor.  Many people are arm-twisted by courts, spouses and parents to go get help, before they actually do it for themselves. 

Another problem is do we want our teenage son or daughter mixing with other “professional addicts” who know how to beat the system and where to find the “best drugs.”  I was practicing next door to a treatment facility for teens for 5 years.  Within 100 yards in different directions there were three heroin suppliers to sell to those going for treatment.  The police did little to stop this as they could at “least keep an eye on them,” as they put it.  To do something, would “push them back into the neighborhoods bringing the drive-by shootings with them.”  The police felt that at least it was more out in the open.  Any treatment center that exists in a city or town is likely to have some pushers nearby.  Treatment centers in the middle of nowhere tend to have better luck at keeping the drug suppliers away. 

Teen addiction is a specialty all it own.  There are treatment programs specifically for women, like Residence XII.  Women’s alcoholism is different than men’s alcoholism, as so treatment to be designed to fit the needs of their clients. 

Treatment programs are not therapy.  They are educational in nature.  The original thought is that if people were well educated about the effects of alcohol and drug abuse,  they will not do it.  Educating them on what the addictive personality is, the denial, the lying, the games, the minimizing, the lack of emotional connection and the distancing from family members is also addressed.  The education is helpful and good, but is oftentimes not enough to promote lasting sobriety.  Another benefit of treatment programs is that there is a group dynamic where addicts see their disease first in other addicts.  They are more likely to drop their defenses when surrounded by other addicts and hearing each other’s stories.  How is it that a group of people who all have the same disease can help each other by seeing their own disease in the person sitting across from them, while they can’t seem to listen from well-intended family members who have been pointing out their disease for years?  Well it does seem to have a profound effect and many in recovery have made life-long friends with those they met in treatment.   

Education also involves “relapse prevention” which is very helpful in understanding why a person would ever go back.  Treatment shifted from focusing on getting people sober to helping them stay sober.  I hear of stories where alcoholics were on the brink of death, the doctors had given up hope, and family members were making funeral arrangements because major organs are shutting down.  Their liver was close to 11% functioning.  Well as fate would have it or in some cases God has given them a second chance.  They begin to stay away from the alcohol, they go to AA, start to connect with a sponsor and start working the steps.  Over time, say like three months, they don’t feel the urgency to go to meetings, they feel that they have all the information they need from AA.  Unfortunately, they think that they are working a program when in fact they have scratched the surface.  They become over confident and really have worked any of the steps.  As stressors appear in their life, they begin to doubt that they were ever an alcoholic in the first place.  Amazing!  They forget that they were at death’s door and refused to talk with anyone who want to remind them of it was like.  [I do believe in video taping the experience for them at the hospital]  They begin to skip meetings, the really think that maybe one drink won’t hurt.  They hang around people, doctors, and even pastors, who don’t really know the severity of their drinking because of the own personal denial, perhaps, or that the addict is so good at hiding it, who even entice them with the thinking that they may be a little overboard on the AA meetings.  Even more surprisingly, spouses who didn’t know what to do with them while they were using, have more difficulty with them when they are not using and unconsciously are jealous of their time spent in AA meetings.  They sabotage their recovery.   You would be amazed at how many household where one of the family members is in treatment and there is alcohol in the refrigerator or the cupboard.  Thus, the cycle begins again.   Education alone doesn’t appear to be the answer.  Treatment centers know this and require that people go to AA and often see the value of people working the steps.  Many programs get the person through the first five steps of Alcoholics Anonymous before they are discharged.  AA is the only program where doctors agree that it takes a spiritual self-help program to solve what appears to be a physical problem.   How ironic that this program is free and is spiritually based and yet the medical community realizes it works enough to have as part of their own program.  Treatment centers have also learned the value of good family counseling as well as after care following the main treatment

Professional Counseling

Professional counselors, who usually have a Masters degree in the general field of mental health, marriage and family counseling and are specifically trained to help people with addiction, assist the person in looking at underlying issues surrounding their addiction.  They often work with couples and families that have become accustomed to living with an addict and now need help to live with them a different way—a life of sobriety.    Sobriety really is about staying in touch with reality, staying in touch with feelings and having new coping mechanisms for crises.  Sobriety is hearing clearly what is being said, seeing what is really there to see and feeling what there is to feel.  It is not running or avoiding problems but having a way to work on them.  Counselors work closely with treatment centers and communicate directly with the staff.  Professional therapist work closely with physicians and sometimes monitor the mood while a person maybe taking antidepressants or mood-stabilizers.   Counselors in private practice use AA and the 12 steps as part of their working in helping their clients. There are certain exercises and specific treatment goals that can be done after people have completed certain steps of AA, like the 4^th and 5^th steps.  Couples therapy works much better after a person has had a least a year of sobriety and has made formal amends in steps 8 and 9.  Addicts are too vulnerable to do much relationship work, until they really can understand what their own character flaws are.   The down fall of professional therapy is when the therapist does not have a good understanding of addiction.  Inadvertently, they try to help the addict help themselves with better thinking and in essence, try to help the person stop their drinking through their own efforts.  It is very subtle.  Telling them to try harder, or insinuating that they can somehow stop is contrary to the philosophy of AA.  There are paradoxes in recovery.  Managing the disease makes it more unmanageable.  Surrendering kills it.  Addicts are very good at hiding and lying.  The average therapist will not know how to interview in such a way that challenges the client and taking everything they say not at face value, while still maintaining rapport.  Professional counseling can help in many ways, but treatment centers can educate a person much faster and provide other addicts to learn from.  A good situation is when people can use professional counseling combined with the rigors of AA. 

So how do we go to therapy, treatment or AA?  Well, one could see the benefit of all three at certain times, but it also depends on the individual and what is happening.  If they cannot stay sober in out-patient treatment programs, individual therapy is not likely to help.  One counseling hour a week will not cut it.  People who have a good connection with their therapist, may go to treatment on an out-patient basis due to a recommendation from their therapist.  Many times, a counselor will not work with someone if they don’t commit to working a program in AA.  Residential treatment programs can really be helpful when a person is in crisis, needs to get away, is suicidal, their mood is all over the place and relapse is likely.  Inpatient treatment can “force” a person who is lying to get the substance out of the system long enough so they can see what it is doing to them.  There are many good programs.  The days of 21 to 30 days of inpatient therapy is a thing of the past.  Insurances don’t cover residential as much as out-patient.

Sooner or later the person is going to come back to their home and have to face the issues waiting for them?   Many families like the idea of sending people to hospitals so that they will come back fixed.  Well, this is unrealistic and good residential programs have family counseling which help them understand that this disease affects everyone in the family. 

The option of having a person to a day treatment or treatment center approach with AA meetings is that they have really no big adjustment from the hospital back to their homes.  For those hospitalized, they go from being sober in a caring, supportive atmosphere back to their life at home where all their problems are waiting for them.  This adjustment can cause relapse.  Those who are already at home feel more stable about their recovery, because they got sober while living their life.

What about AA alone or AA with counseling? Those that have a lot problems with  relapse need a sponsor who is pretty structured and keeps the sponsee working the steps.  Addicts without this will not do well without the structure.  A counselor, can work with the client to make sure they get a good sponsor as well.   Addicts will go to “90 days, 90 meetings” this means they go to a meeting every day for 90 days.  In a way, this is mimicking the hospital or day treatment program by using the 12 steps.   There is a lot a pros about this.  One saves a lot of money doing a program this way.  There are no treatment costs.  How many addicts have wasted money on treatment that there were not ready to commit to.  AA’s requirement for membership is a desire to stop drinking.  They longer one is in the program, the more they see their need for “working the steps” and “getting a sponsor.”  There is no confrontation or arm twisting in the 12 step program.  There is no cross talk, that is, any advice or feedback given.  They “carry the message, not the addict.”  Treatment centers and some counselors are in some ways, “paid codependents” in that they try to “help” the addict get sober.  They want their treatment to work—to have success stories.  But these are real people and addicts need to want to recover themselves.  One cannot really force another to recover.  AA doesn’t seemed to be concerned about measuring success, doesn’t think of itself as “treatment” and is not concerned with trying to make people sober.  They say, “if you want what we have and are willing to go to any length to get it, then you are ready to take certain steps.” [Chapter 5 of Alcoholics Anonymous]  In essence, AA is a fellowship for people who want to get sober.  Another positive about using a lot of AA is that there is less transition from a treatment center to AA, because they have AA as their primary structure. 

There are some people where AA is not enough.  They go to meetings but are very depressed and need more support than the program can offer.  One can argue that if they were in fact working the steps of AA, they would not be depressed and would be not only sober but psychologically healthy.  But, they are not at a place where they can do that.  There are too many issues and things that are happening all at once for them.  Counseling can be the stepping stone to get them healthy enough to connect with AA.

 Summary of the Pros and Cons of Different kinds of Treatment

Conclusion

In over 16 years of private practice, I have seen people do well in AA alone with counseling.  I have seen people do well in hospital and residential settings.  They come back and say that the experience was life changing.  I have also seen people waste a lot of money.  I have seen some people get sober after the second time around in treatment. After three treatment centers and not really do the steps of AA, people come to me in counseling and work the steps and get sober at a fraction of the cost.  I have seen people do all three.  I haven’t seen people do well, that have committed to working the steps of AA.  They may be abstinent from drinking and drugging, but they are controlling, angry, resentful, self-pitying and still numb themselves, just in other ways.  Hopefully, this will be helpful in making your decision regarding treatment.