And another response to Dr. Johnson

From The Huffington Post

Deni Carise

Chief Clinical Officer, Phoenix House
Posted: August 16, 2010 12:00 PM

Examining the Viability of Substance Abuse Treatment Today

Earlier this week, I was more than a little put off by Bankole Johnson's Washington Post editorial, "We're Addicted to Rehab. It Doesn't Even Work." It's interesting to note that this piece comes just six months before the release of his new book on medications that "conquer alcoholism," which will join countless other tomes that also claim to have the cure.

In his searing op-ed, Johnson, chair of psychiatry and neurobehavioral sciences at the University of Virginia, argues that there is little empirical evidence to suggest that substance abuse treatment programs are effective. Making sweeping generalizations, he points a finger at our country's treatment centers, including nonprofit providers, calling them both "ruinously expensive" and "divorced from state-of-the-art medical knowledge."

I take issue with these charges first and foremost as a scientist who has dedicated her career to studying the effectiveness of substance abuse treatment. In equal measure, I disagree with Johnson's allegations as a person in long-term recovery who might not be here were it not for the treatment I received.

Johnson calls substance abuse a devastating disease, yet he fails to acknowledge the limitations of treating a condition that is chronic by nature, like diabetes and hypertension. When evaluating the effectiveness of a particular medication for diabetes, treatment providers don't expect their diabetic patients to be "cured" after one treatment, nor do they define success as never having another sugar crisis. Similarly, defining successful substance abuse treatment as one that produces 100 percent abstinence for the rest of a person's life is a naïve and useless benchmark. However, if we define success as learning to manage your condition and gaining the support needed to do so, there are literally hundreds of controlled studies documenting the effectiveness of various forms of treatment. And they meet FDA levels of effectiveness.

As for Johnson's claim that substance abuse treatment is "too costly for most people," this is simply not the case. The two programs he mentions, Promises and Hazeldon, are geared toward individuals of higher socioeconomic status. However, there are many programs in our country that serve those with more modest means. When I entered substance abuse outpatient treatment in 1984, I paid just five dollars for each counseling session I attended. I later found out that the remainder of my treatment costs had been covered by the federal block grant. At Phoenix House, where our programs receive both state and federal funding, some clients stay with us even when they have no funds to cover their care. Many other non-profits do the same. Listing two expensive programs as if they are representative examples does not convey the wide range of treatment options available to people from all walks of life.

Johnson primarily aims his criticism at AA and it's true that not every substance abuser who enters AA will achieve long-term recovery. Likewise, not every diabetic who tries a particular medication will achieve long-term recovery from diabetes. As with other chronic conditions, there are many evidence-based treatment methods for substance abuse--not just the 12-step model. To discredit an entire spectrum of care that has worked for hundreds of thousands of people--and has been backed by scientific research--is to ignore the facts. It says to those of us who work with substance abusers each day that our efforts to help them are futile. And it says to those who need treatment that there is no real help available. That's inaccurate and irresponsible.

I'm certainly not dismissing the benefits of incorporating medication into substance abuse treatment. That would be irresponsible as well. But research has shown that meds alone will not produce a cure and traditional "rehab" components such as group counseling are equally important. Dr. Johnson himself runs a treatment program that includes cognitive behavioral therapy in addition to pharmacology. So why can't he acknowledge that any and all empirically-proven methods of helping people with this disease need to be included in their treatment options?

Maybe it's simply the fact that presenting a more balanced op-ed piece wouldn't sell as many books.