The very word “rehabilitation” brings a smile to everyone’s face. We want addicted people to be rehabilitated. We want them clean. If only we had more rehab, we could eradicate the horrors of drug addiction. It’s that simple. So I’ve decided to start a new drug rehab program. You click your heels three times, say “I’m not addicted,” and we I give you a diploma and send you on your way.
What? You don’t think it will work. So what, it makes as much sense as many of the rehab programs that receive the $20 billion spent on it each year, according to the New York Times. As a lawyer or judge, we really have no clue whether these programs offer any empirically proven help to a very serious problem, but we do know that we would much prefer to help addicts. Someone asks, “is there a program” and when a spot comes open, we all clap. Hooray! We’ve cured another one. We mumble about how they have to “want” to be helped. We give a stern lecture. Then we send them on their way with our best wishes.
What no one ever asks is how they do that voodoo that we hope they do so well. We don’t care all that much about which program it is, as long as it’s a “program”. That’s the magic word. He went into a “program”, and we all expect that he will magically come out the other side cured of whatever ails him.
Every year, state and federal governments spend more than $15 billion, and insurers at least $5 billion more, on substance-abuse treatment services for some four million people.
Yet very few rehabilitation programs have the evidence to show that they are effective. The resort-and-spa private clinics generally do not allow outside researchers to verify their published success rates. The publicly supported programs spend their scarce resources on patient care, not costly studies.
The truth is, any program that serves as an alternative to incarceration is a good program. Sure, we hope that addicted clients are cured, but that’s not in our hands. That’s up to the program, for better or worse. We don’t dabble in the therapy, just getting our guy into a bed. That’s where out involvement stops. We’re really not qualified to judge whether the program is evidence based or total crap. Certainly the official women at intake think they doing something important, and we’re nice to them as long as they agree to take our guy in.
But I’ve long had doubts that most of these programs are self-promoting money machines that don’t actually do much of anything other than provide an alternative to prison. I remember one client calling me from his program and telling me that there were more drugs there than on the street. I asked him if he would rather be in prison, and he decided that the program wasn’t all that bad. It was the lesser of two evils.
Like so many of the silver bullet solutions to society’s problems, the word “rehabilitation” has come to capture our uncritical belief that it actually works. There are always anecdotal stories about people whose lives were turned around by rehab, and we extrapolate that into the belief that all rehab is good rehab, and that any failure is attributable to the “patient” not really wanting to be cured badly enough.
It would be nice if rehab served a purpose beyond simply keeping a client out of prison. Most of us really want to see drug addicts change their lives. But whether these programs actually do anything useful is beyond our knowledge. It’s just another leap of faith.
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When I ask my friends in the alcohol and drug treatment field about success rates they always say there are similar to those for diabetes. No doubt this is because there is no cure but instead the problem is controlled by a change in life-style.
In the case of tobacco, alcohol and drugs this means total abstinence and in the case of weight control a change in eating habits. In all these cases including diabetes there are relapses. Just because there has been a relapse does not mean the treatment program should be abandoned.
My guess is that most people that no longer smoke had more than one relapse. My problem is I will lose ten pound and then discover a few months later that I regained the weight and I am not the only one with that problem.
To wrap this up drug and alcohol treatment are not cures they are life-style changes and for a motivated person they can make a big difference but they need aftercare in order help them to maintain their new life-style.
Drug and alcohol treatment programs in jails & prison usually do not have follow-up aftercare in the community after the person is released and as a consequence they have high relapse rates.
My initial assumption would be that addicts fall into three groups:
* Those who can be usefully helped by minimal and inexpensive intervention
* Those who cannot be helped by any amount of effort
* Those for whom expensive treatment programs are the one and only effective treatment method.
I suspect the last group may be much, much smaller than is generally assumed.
Ahhh, yes. This is what I’ve taken to referring to as the “Judicial-Therapeutic Complex”.
My issue isn’t so much with the programs that are alternatives to incarceration–they don’t work either, but at least the client gets some benefit from them. Where I really have heartburn is when they are tacked on as probation requirements and become in effect a continuation of the sentence (and fodder for probation violations.)
Way back in the day, when I was working on my degree in Psychology, the texts were agreement that there was no quantifiable difference in the success rate of people who underwent treatment vs. people who just decided to stop on their own. In other words, people who WANT to quit badly enough will, regardless of whether they get treatment. People who don’t, won’t; again regardless of whether they get treatment.
As a “recovering” alcoholic, that has been my personal experience as well. I quit when the costs of drinking reached a level that was unacceptable to me. I did the treatment thing and found it to be a total farce–internally inconsistent, patronizing and generally a waste of time and money. The only benefit I received from it was legal, not therapeutic.
But we’ve created a wonderful cottage industry, which employs many people who might otherwise have great difficulty obtaining gainful (if not productive) employment–and the costs are borne by defendants. It’s win-win as far as the courts and the legislatures are concerned.
Did you go public on purpose, GB?
Yes, my first act of freedom as a soon-to-be former PD. We were underbid by a group that entered into a facially unethical contract (Bar complaint already in the mail). Amazingly, while I have what I believe to be a reasonable amount of trepidation about becoming a general practice attorney, i.e., getting the phone to ring; there is also a wonderful feeling of liberation.
As to the recovering bit..that’s not anything that embarrasses me at all.
Congratulations? At least welcome. Sorry that it came from an underbid, but you’re still you.
And did I mention great comment?
Beware the Demise of the Rockefeller Laws
The New York Times has been broadcasting the imminent death of the Rockefeller Laws for the past couple of weeks, claiming the Assembly Bill spells the end of the draconian laws that compelled judges to sentence defendant accused of sale or possession of drugs to absurdly long mandatory minimum sentences.