Soberr Tr uth : Debun Debun ki ng th e Bad Science Science Behin d 12-Ste 12-Step p Progr ams and Excerpted from Th e Sobe by Lance Dodes, MD, and Zachary Dodes. Copyright 2014. Excerpted the Rehab Rehab I ndustry by Lance with permission by Beacon Press.
THE BUSINESS OF REHAB AND THE BROKEN PROMISE OF “AA -PLUS”
“The great thing about the Steps is they can be incorporated in so many facets of our lives, and working the Steps day after day makes us even better at it, too. The other great thing about the Steps is that they work. If they didn’t work, then doing them over and over again would be insanity.” BETTY FORD CENTER WEBSITE — BETTY
The era of the modern American addiction rehabilitation center officially began in 1949, when Hazelden Treatment Center opened its doors in Minnesota. Hazelden took the dictates of Alcoholics Anonymous and turned them into an inpatient model. It promised visitors and patients immersion in a version of the popular program that was more refined, without the interruptions present in regular 12-step meetings. It was, in a very real sense, an extension of AA into the twenty-four-hour day. Today, Hazelden still says that its program is “grounded in Twelve Step philosophy.” (Notably, although Hazelden also lists remaining “open to innovation” as a value, it has apparently not found ideas worthy of replacing the Twelve Steps over the past sixty-five years.) Hazelden quickly became a tremendous financial and cultural success. Today, it commands fees in the range of $30,000 for a one-month stay. Its impact emboldened similar rehab centers to open across the nation, with a notable boom in the 1980s that birthed famous entries like the Betty Ford Center (1982) and Sierra Tucson (1983). As it happened, there was a large ready-made market for these programs, since millions of people were failing to stay sober in AA. The new “Cadillac” rehabs offered alcoholics a way to double down on the 12-step model — trying more, not less, of the same approach with which they were struggling. This was a — trying seductive idea that felt entirely consonant with the theme of spiritual cleansing and purity, and it rekindled the hope first created by Alcoholics Anonymous. Almost immediately, a fierce competition began among the major rehab programs to add more and more “enhancements” to their treatment. Sure, these features added more cost, but what the programs were offering was practically priceless. Who would not be willing to spend a small fortune for a life free of the agony of addiction? For many addicts, the only question became: where to spend that fortune? Sierra Tucson quickly developed what it calls the Sierra Model, which includes education about the disease model, recovery education, relapse prevention, “equine-assisted therapy,” “adventure therapy,” grief and spirituality sessions, and psychodrama. The Betty Ford Center has added meditation, fitness, educational lectures, relapse-prevention group, and therapeutic duty assignments. Hazelden offers, among other things, meditation, educational lectures, leisure skills groups, anger groups, stress management groups, relaxation, exercise, recreational activities, and biofeedback.
Rehabs also became increasingly opulent to compete for clientele. Playing into the idea that alcoholics needed a tranquil and beatific place to contemplate their problem or achieve spiritual fulfillment, many programs began to market themselves as spas. Betty Ford notes that its twenty-acre gated campus is “surrounded by serene mountains” and patients are housed in “spacious, double occupancy rooms.” Sierra Tucson boasts that its 160-acre campus sits in the shadow of the Santa Catalina Mountains; patients can move into “rustic and elegant lodges with cozy fi replaces, high beamed ceilings, outdoor balconies and patios.” The Menninger Clinic, previously justly famous as a psychiatric center, moved into the rehab business and released a flyer promising “outdoor terraces for each unit and a meditation labyrinth in the expansive courtyard.” And Promises Malibu, well-known redoubt of many A-list celebrities, entices its potential clients with descriptions like this: The property includes a garden, swimming pools, Jacuzzis, a tennis court, and numerous meditation areas for quiet reflection. Sun streams through the beautifully decorated residences, bringing a feeling of warmth and healing comfort to the private roo ms and common areas. With the mountains and ocean in your backyard, there are countless opportunities opportunities for outdoor, experiential activities including rock cli mbing and hiking. The beauty of the natural surroundings inspires a sense of awe and gratitude that encourages the recovery process. Inside the facility, guests will be treated to gourmet meals, a fireplace, phone and internet access, and numerous patios and sitting areas.
Today, as a result of this aggressive marketing, and helped along by a credulous media, rehab centers enjoy a reputation as the ultimate facilities for the treatment of addiction, the biggest and most comprehensive solutions the human mind can imagine. Hit TV shows like Celebrity Rehab Celebrity Rehab and Intervention further the cause by continually preaching the gospel of rehab, often subtly equating “success” with mere admission. “Going to rehab” appears regularly in music and fi lm as the ultimate hope ho pe for treating addiction. Yet a surprisingly small number of these people have asked: Is this industry actually helping people? In this chapter I‟ll attempt to answer this question, beginning with an overview of the ways that rehab is both like, and unlike, Alcoholics Anonymous and other 12-step programs. REHABS AND AA
Most rehab programs that borrow their philosophy from AA do so explicitly and do not attempt to hide their affiliation. If anything, it is generally a badge of pride within the rehab community that their methods have been adapted from a model that is widely seen as the best addiction treatment in the world. According to Hazelden‟s website, “The „Minnesota Model‟ [is a] Twelve Step facilitation model [that] utilizes the philosophy of Alcoholics Anonymous as a therapeutic tool for recovery from addiction.” Betty Ford informs us, “All our programs are based on the 12 steps of Alcoholics Anonymous,” adding, “If, with courage and with total truth, you take the steps with absolutely no reservation, and eliminate those things from your life which, in good conscience, can‟t be reconciled with living the steps, you will stay sober.” Sierra Tucson describes the Sierra Model as reflecting “a deep commitment to treating the whole person with integrated, individualized psychiatric and non-traditional therapies rooted in the Twelve-Step recovery process.” The Kaiser Permanente Chemical Dependency Recovery Program that I
mentioned in chapter 3 requires two 12-step meetings in the community each week plus an onsite 12-step meeting, and says that the 12-step philosophy is incorporated into some of its group sessions. Of course there are some treatment centers that are explicitly non-disease-model and non12-step. New York‟s St. Jude Retreats describes itself this way:
First and foremost we are an alternative to traditional alcohol rehabs which means that we do not teach the disease concept of addiction (which has been proven in countless studies t o be patently false for more than seventy years), we do not tell our guests they should feel guilty for their problems, and most importantly we do not tell people they will be in recovery for the rest of their lives. Saint Jude Retreats was the first non-disease based and non 12-step based program in America. We are working hard to educate individuals on the importance of knowing that addiction is and never will be a legitimate disease.
However, St. Jude‟s is an outlier in this regard (and the program is unfortunately limited by employing a purely educational model, staffed by teachers rather than therapists).
Nearly all other rehab programs have some allegiance to the 12-step method. Even somewhat more psychologically sophisticated programs, such as Promises in California and the Fernside Center in Massachusetts, still incorporate the Twelve Steps into their philosophy. All this begs the question: given that virtually every rehab is an elaborate expansion of 12-step meetings, why do people spend a fortune for programs that aren‟t fundamentally different from what they could find for free in a church basement?
Soberr Tr uth : Debun Debun ki ng th e Bad Science Science Behin d 12-Ste 12-Step p Progr ams and Excerpted from Th e Sobe the Rehab Rehab I ndustry by Lance by Lance Dodes, MD, and Zachary Dodes. Copyright 2014. Excerpted with permission by Beacon Press.
