For generations in the United States and all across the world, people have been suffering from drug addictions and alcohol dependencies. There is no question that consumption of alcohol and use of other drugs can have a debilitating and disastrous effect on the quality of life of those who partake. However, the remedies for such disorders have evolved differently in various countries over the past seventy five years or so. In fact, the entire landscape surrounding drug addiction and alcohol dependency has taken different trajectories within the scope of treatment and the legal systems around the world.
In the United States, prohibition created a counterculture around the use of alcohol that encouraged secrecy, excitement, and binge drinking. Additionally, the illegality of alcohol caused less savory elements of society to take over the production and distribution and consequently made drinking more dangerous. At the time of prohibition, the political climate of the United States was skewing heavily toward conservative religious morality in a strict and restrictive fashion. This dichotomy between cultural morals and the countercultural alcohol phenomenon, created a landscape that was perfectly suited to support one form of treatment for drug and alcohol dependency; the abstinence based approach.
A little over 80 years ago, Alcoholics Anonymous was formed. Bill Wilson, who was a chronic alcohol abuser and disgraced stockbroker, had been hospitalized yet again for his alcohol problem. He had undergone countless treatments and attempts to quit drinking and had been unsuccessful for years. During this final hospitalization, Wilson was given an experimental treatment and experienced what he described as a “white light” moment wherein he was freed from the desire to drink, and seemingly cured of his alcohol dependency. Later, Wilson connected with another chronic drinker, Dr. Bob, and the two of them commenced on their journey forming Alcoholics Anonymous which was based on the tenets of the Oxford Group. The two continued their journey finding other chronic drinkers in hospitals and sanitariums and brought their newly formed 12-step program of recovery. They were incredibly well received as there were no other viable treatments for alcohol dependence and their 12-step program was working.
Over the years, Alcoholics Anonymous has grown to well over 150,000 groups worldwide with more than 2 million members. In the United States specifically, the treatment industry has grown exponentially as well. Countless treatment programs have been established and the vast majority of them are completely based on the 12-step model. The industry has grown to well over a billion dollars in annual revenue and the success rates are staggeringly low. The recidivism rate for abstinence based treatment is well over 90{f0f83215e3a095c91961cae50e74e4c56a4e3ecffad82a95e0597cc8123511be}. This means that of all the resources spent on treatment, only 10{f0f83215e3a095c91961cae50e74e4c56a4e3ecffad82a95e0597cc8123511be} are successful the first time. Over 90{f0f83215e3a095c91961cae50e74e4c56a4e3ecffad82a95e0597cc8123511be} of the people who spend their money on treatment will either be unsuccessful and continue their destructive addictive behaviors, or will have to spend more money for treatment again before changing the pattern. This would be like someone who needs glasses going to the optometrist, purchasing a pair of glasses, and knowing that only 10{f0f83215e3a095c91961cae50e74e4c56a4e3ecffad82a95e0597cc8123511be} of the time would the prescription be correct, then going back until they finally get the right pair of glasses. It seems incredibly wasteful and damaging to the consumer. Other countries around the globe do not approach treatment in the same way, and many of them are reporting much higher success rates.
The harm reduction, or moderation management models have proven much more successful than abstinence based treatment. The markers for success are quite different, and they take into consideration the spectrum of drug and alcohol abuse rather than using a “one size fits all’ approach. Not all drug and alcohol abusers are chronic. One of the fundamental differences between moderation management and abstinence theories, are that people can learn through a variety of methods to decrease the use of drugs or alcohol to safe levels rather than needing to completely abstain. So many who are diagnosed with drug addiction or alcohol dependency are done so based on a set of behaviors, and a pattern of use. However, people go through phases of their lives, some with more stressors and outside influences and some with less. Inherently someone with a propensity to self soothe using drugs or alcohol will do so more frequently when outside stimuli are creating additional anxiety and stress.
The other major component to moderation management and harm reduction treatment is the inclusion of scientific and medical information. There are a number of advancements in the medical field related to addiction that have occurred since the inception of Alcoholics Anonymous that are widely used throughout the world but very rarely in the United States. Because the abstinence based treatment model has been so deeply engrained in the culture of the United States, few resources have been allocated for research and pharmaceutical testing for drug addiction and alcohol dependence. In other countries around the world, England, Spain, France and many others, scientific progress has continued and there are now a number of medical and pharmaceutical interventions that aid in the treatment of drug addiction and alcohol dependence.
The notion that there is more than one way to treat and cure drug and alcohol addiction is prevalent around the world but for some reason has been shunned in the United States. Take as an example, the forty year old man who has been drinking to excess every day for twenty years. In the United States, the measure of his success would simply be if he has stopped drinking or not. If he were able to drink moderately only 3-4 days per week would that not also be success? If drinking no longer monopolized his thoughts, behaviors and action, would he not be a success? If there were a medication he could take that aided in curbing his cravings, and when he did drink, allowed him to drink moderately, would that not be a dramatic change in circumstance and quality of life? Quite simply stated, yes to all of the above. Generally speaking, reducing the impact that drugs or alcohol has on the quality of life of any individual suffering is a success. There are countless therapeutic, medical, and pharmacological tactics that are employed in treatment centers in countries other than the United States that are used specifically to reduce the impact of drugs and alcohol and help patients to attain a normal quality of life while integrating moderate use. This form of treatment has led to a much higher “success” rate than that of abstinence based treatment in the United States.
Moderation management and harm reduction doesn’t necessarily work for everyone, much like abstinence based treatment doesn’t work for everyone either. Generally speaking, abstinence based treatment is considered more effective for chronic drug users and alcohol abusers. Drug abusers and individuals with alcohol dependence who are slightly less severe on the spectrum with less debilitating use are prone to respond well to harm reduction or moderation management treatment. There are no two individuals who are exactly the same, no two substance abusers who have the same exact behaviors, and there is no singular method of treatment that will work for every single person. Harm reduction and moderation management approaches allow for a wider range of success than does abstinence based treatment.
With all the money spent each and every year in the pursuit of treatment from drug addiction and alcohol dependence in the United States, providers would do well to offer a wider range of options. There are some harm reduction treatment programs that exist in the United States, but they are far fewer and further between than those that employ the abstinence based model. As a society, the relatively blind faith placed in 12-step recovery must be examined more closely and room needs to be made for other approaches and definitions of success. Unfortunately, the problem of drug/alcohol addiction is not waning, in fact more and more people are being diagnosed every year. Treatment providers, the medical field and even the legal system must look closely at alternative treatments so that all individuals have a better chance of success, rather than focusing all the energy on strictly abstinence based recovery which is proven to be most effective in the most chronic of cases.
Advancements are being made every single day in the United States in the fields of medicine, technology, industry and countless others. Why not in the field of addiction treatment as well? The information is out there. The research and methodology is in practice right now. It’s all available and can be put into practice anytime. Let the United States move forward the cause of addiction treatment and begin to help countless people that have been lost by the wayside or disheartened because the common, “one size fits all approach” hasn’t helped them. The time is now. People are suffering.