Jabberwocky
Frumious Bandersnatch
Great post! I'm very pleased to finally see someone write as un-succinctly (and if I may say thoughtfully 
) as me and I'm doing great. I was probably happiest in life three or four years ago, but I recognize that after all I've going through in the last five years has led me to a point where I can honestly say I love to be alive.
I mean, think about how minor or major depression or general anxiety disorders are treated? At the least, individual therapy with a qualified clinician and often medicine under the supervision of such a professional.
Another problem I have to AA is that, since when is admitting one's defects, turning one's self over to god (or whatever), admitting we are powerless over drugs and alcohol, etc. etc. in any way a recognized as an effective form of treatment - let alone as any form of treatment - for ANY other disease, psychological, neurological or whatever?
And yet, despite the fact "addiction" has become widely recognized for over a decade as a legitimate disease among the medical community, the vast, vast majority of so called treatment for addiction/substance (ab)(mis)use problems involve little, if any, individual counseling.
And yet those providing this so called treatment rarely have anything other than a bachloer's degree, if that at all. Whereas treatments for disorders recognized as legitimate like addiction is now, such as GAD for example, involve working with someone with AT LEAST a masters in their specific field, with required clinical experience and much more often than not a PHD specializing in the specific disorder or disease in at hand.
Instead, the norm in the recovery industry seems to be some more along these one-size-fits-all approach. More often than not, those providing the "addiction treatment" are people who got sober through the "program." With little, if any, clinical experience in the field of addiction treatment, these coucelors have merely become certified in their state as an addiction and substance abuse councelor, a designation akin to an assosiates degree plus an internship with a, again more often than not, 12 Step based rehab.
And don't even get me started on the financial and economic shit. In almost all cases, when one goes in for an "assessment" to see what sort of "treatment" they need, the person doing the assessment works for a rehab center. In almost all cases, the assessment ends with the individual being "assessed" being deed fit for the rehab center's services, the same one the "assessment worker" is employed by. In almost all cases, the most expensive and intensive (in tensive in terms of coercive and expensive) treatment offered - in-patient residential treatment (where as, in reality, only a very few minority of those susspected or known to have a drug or alcohol problem actually benefit most from residential treatment; rather the vast majority would really benefit more from an outpatient program and individual therapy, possibly medication, with the intensity of the treatment determined solely on their specific, individual needs).
But yea, I could go on and on. Anne's book is a must read for anyone interested in the recovery industry. Fuck man, as things stand at present the recovery industry and addiction treatment at large has more in common with the military industrial complex and prison industrial complex than any sort of field of medicine that it's supposedly recognized as.
However, in my humble opinion, she doesn't go quite far enough in her criticism of the present state of addiction treatment in America. The CASA Columbia study, which essentially covered the same subjects as Inside Rehab, with a nearly identical focus and very similar conclusions, is a much more important read than anything published about addiction and the treatment of addiction in America in a long time.
Regardless of whether you got sober and have improved the quality of your life through a 12 Step based approach or more evidence based courses of treatment, do yourself a favor and give this study, entitled Addiction Medicine:
Closing the Gap between Science and Practice a read. As the pdf (which is linked in the previous sentence is) too intimidating at over 400 pages or you're not inclined towards reading scholarly research (which there is nothing wrong with), the 37 slides accompanying the report should be easier to digest (also in pdf form). But if that too is more than you want to look at right now, at the very least, give the study's recommendations, at a mere five pages, a glance over (again as in pdf format).
And, frankly IMO, even the CASA report wasn't as scathing in its critique of the recovery industry as it might have been, I mean, given the paternalistic harm it has done our communities and our nation. Given the damage it has done, especially to those who are most vulnerable, but not only them. We must not forget that the people the recovery industry hurts the most. To those, whom under a public veil of benevolence and good will, treatment facilities, programs and practitioners have exploited economically, socially, politically, culturally and physiologically.
Not saying everyone who works for all sort of treatment centers and program are evil demon span. Far from the contrary, as it was an evidence-based, out-patient program, one which included medication and individual counseling, saved me from an untold suffering if not premature death. But... What I am saying is that my experience, described in the paragraph directly above, is far, far from the norm within the recovery industrial complex.
Just like how, within the context of the so-called "War on Drugs," where any positive outcome will be the result in a paradigm shift, from operating within the framework of public safety to that of public health (e.g. harm reduction) - eventually resulting in it's inevitable demise (no war can be fought infinitely) - so to will any positive outcome in the field of addiction treatment will likewise be a paradigm shift, from one based primarily and largely limited to the 12 Step model of "treatment" to one driven by evidence based practices, treatment in the true sense of the word.
This would be a world in which the addiction treatment isn't focused primarily on sobriety and abstinence as the primary objective. No, this would be a world where the addict's enviroment, especially when it comes to their treatment, instead is primarily concerned with nurturing and empowering individuals, geared first and foremost towards the ongoing realization of their capacities and potential.
Sobriety, while necessary certainly for many, would be a secondary priority. A world where treatment is first and foremost about maximizing the potential and quality of life of addicts, focusing on total abstinence to the degree it - as it often it must - is necessary in the course of one's treatment in achieving said primary objective.
) as me and I'm doing great. I was probably happiest in life three or four years ago, but I recognize that after all I've going through in the last five years has led me to a point where I can honestly say I love to be alive. I mean, think about how minor or major depression or general anxiety disorders are treated? At the least, individual therapy with a qualified clinician and often medicine under the supervision of such a professional.
Another problem I have to AA is that, since when is admitting one's defects, turning one's self over to god (or whatever), admitting we are powerless over drugs and alcohol, etc. etc. in any way a recognized as an effective form of treatment - let alone as any form of treatment - for ANY other disease, psychological, neurological or whatever?
And yet, despite the fact "addiction" has become widely recognized for over a decade as a legitimate disease among the medical community, the vast, vast majority of so called treatment for addiction/substance (ab)(mis)use problems involve little, if any, individual counseling.
And yet those providing this so called treatment rarely have anything other than a bachloer's degree, if that at all. Whereas treatments for disorders recognized as legitimate like addiction is now, such as GAD for example, involve working with someone with AT LEAST a masters in their specific field, with required clinical experience and much more often than not a PHD specializing in the specific disorder or disease in at hand.
Instead, the norm in the recovery industry seems to be some more along these one-size-fits-all approach. More often than not, those providing the "addiction treatment" are people who got sober through the "program." With little, if any, clinical experience in the field of addiction treatment, these coucelors have merely become certified in their state as an addiction and substance abuse councelor, a designation akin to an assosiates degree plus an internship with a, again more often than not, 12 Step based rehab.
And don't even get me started on the financial and economic shit. In almost all cases, when one goes in for an "assessment" to see what sort of "treatment" they need, the person doing the assessment works for a rehab center. In almost all cases, the assessment ends with the individual being "assessed" being deed fit for the rehab center's services, the same one the "assessment worker" is employed by. In almost all cases, the most expensive and intensive (in tensive in terms of coercive and expensive) treatment offered - in-patient residential treatment (where as, in reality, only a very few minority of those susspected or known to have a drug or alcohol problem actually benefit most from residential treatment; rather the vast majority would really benefit more from an outpatient program and individual therapy, possibly medication, with the intensity of the treatment determined solely on their specific, individual needs).
But yea, I could go on and on. Anne's book is a must read for anyone interested in the recovery industry. Fuck man, as things stand at present the recovery industry and addiction treatment at large has more in common with the military industrial complex and prison industrial complex than any sort of field of medicine that it's supposedly recognized as.
However, in my humble opinion, she doesn't go quite far enough in her criticism of the present state of addiction treatment in America. The CASA Columbia study, which essentially covered the same subjects as Inside Rehab, with a nearly identical focus and very similar conclusions, is a much more important read than anything published about addiction and the treatment of addiction in America in a long time.
Press Releases: 2012
Addiction Medicine: Closing the Gap between Science and Practice
Printed from http://www.casacolumbia.org/absolutenm/?a=680
FIVE YEAR NATIONAL STUDY REVEALS: ADDICTION TREATMENT NEGLECTED BY U.S. MEDICAL SYSTEM
SIXTEEN PERCENT OF THE U.S. POPULATION HAS THE DISEASE OF ADDICTION; 90 PERCENT OF PEOPLE WITH ADDICTION RECEIVE NO FORM OF TREATMENT AT ALL
NO NATIONAL TREATMENT STANDARDS TO ASSURE QUALITY CARE
NEW YORK, NY, June 26, 2012 – Forty million Americans ages 12 and older have addiction involving nicotine, alcohol or other drugs, a disease affecting more Americans than heart conditions, diabetes or cancer according to a five-year national study released today by The National Center on Addiction and Substance Abuse at Columbia University (CASA* Columbia). Another 80 million people are risky substance users – using tobacco, alcohol and other drugs in ways that threaten health and safety.
The report, Addiction Medicine: Closing the Gap between Science and Practice, reveals that while about 7 in 10 people with diseases like hypertension, major depression and diabetes receive treatment, only about 1 in 10 people who need treatment for addiction involving alcohol or other drugs receive it. Of those who do receive treatment, most do not receive anything that approximates evidence-based care.
The CASA Columbia report finds that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they rarely are employed. The report exposes the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services.
“This report shows that misperceptions about the disease of addiction are undermining medical care,” said Drew Altman, PhD, President, The Henry J. Kaiser Family Foundation who chaired the report’s National Advisory Commission. The report finds that while doctors routinely screen for a broad range of health problems like high blood pressure or high cholesterol, they rarely screen for risky substance use or signs of addiction and instead treat a long list of health problems that result, including accidents, unintended pregnancies, heart disease, cancers and many other costly conditions without examining the root cause.
This landmark report examines the science of addiction--a complex disease that involves changes in the structure and function of the brain--and the profound gap between what we know about the disease and how to prevent and treat it versus current health and medical practice.
Few Patients with Addiction Receive Quality Care
The CASA Columbia report found that while almost half of Americans say they would go to their health care providers if someone close needed help for addiction, less than six percent of all referrals to addiction treatment come from health professionals.
The report also found no clearly delineated, consistent and regulated national standards that stipulate who may provide addiction treatment in the U.S.; standards vary by state and by payer. Addiction treatment facilities and programs are not adequately regulated or held accountable for providing treatment consistent with medical standards and proven treatment practices.
Most providers of addiction treatment are addiction counselors who are not required to have any medical training. CASA Columbia’s analysis of minimum state requirements found:
Physicians and other medical professionals who make up the smallest share of providers of addiction treatment receive little education in addiction science, prevention and treatment. In fact, CASA Columbia’s report cites other research that found that of patients who had visited a general medical provider in the past year only 29 percent were even asked about alcohol or other drug use.
- 14 states do not require all addiction counselors to be licensed or certified;
- 6 states do not mandate any educational degree to become credentialed;
- 14 states require only a high school diploma or GED;
- 10 states require an associate’s degree;
- 6 states require a bachelor’s degree; and
- 1 state requires a master’s degree.
“Right now there are no accepted national standards for providers of addiction treatment,” said Susan Foster, CASA Columbia’s Vice President and Director of Policy Research and Analysis, who was the principal investigator for the report. “There simply is no other disease where appropriate medical treatment is not provided by the health care system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards. Neglect by the medical profession has resulted in a separate and unrelated system of care that struggles to treat the disease without the resources or knowledge base to keep pace with science and medicine.”
A Costly Disease
The CASA Columbia report reveals that addiction and risky use of tobacco, alcohol and other drugs constitute the largest preventable and most costly health problems facing the U.S. today, responsible for more than 20 percent of deaths in the U.S., causing or contributing to more than 70 other conditions requiring medical care and a wide range of costly social consequences and accounting for one-third of all hospital in-patient costs. Research suggests that effective health care interventions to prevent and treat addiction would significantly reduce these costs.
In 2010 only $28 billion was spent to treat the 40 million people with addiction. In comparison, the United States spent:
“As our nation struggles to reduce skyrocketing health care costs, this report makes clear that there are few targets for cost savings that are as straightforward as preventing and treating risky substance use and addiction” said Commission Chairman Altman.
- $44 billion to treat diabetes which affects 26 million people;
- $87 billion to treat cancer which affects 19 million people;
- $107 billion to treat heart conditions which affect 27 million people.
Other Notable Findings
Recommendations
- Although addiction is often a chronic disease, treatment typically addresses it as an acute condition and does not include the necessary long term disease management.
- Public perceptions do not distinguish between risky substance use and the disease of addiction.
- Costs to federal, state and local governments amount to 11 percent of total spending; 95 cents of every dollar pay for the consequences and only 2 cents go to prevention and treatment.
The report offers a comprehensive set of recommendations to overhaul current intervention and treatment approaches and to bring practice in line with the scientific evidence and with the standard of care for other public health and medical conditions.
“It is time for health care practice to catch up with the science. Failure to do so causes untold human suffering and is a wasteful misuse of taxpayer dollars,” noted Director Foster.
For this study, CASA Columbia conducted a thorough review of more than 7,000 publications; in-depth analysis of five national data sets; focus groups and a nationally representative survey of 1,303 adults; state-wide surveys of addiction treatment directors and staff providers in New York State; an online survey of 1,142 members of professional treatment associations involved in addiction care; an online survey of 360 individuals with a history of addiction who are managing the disease; and an in-depth analysis of state and federal governments’ and professional associations’ licensing, certification and accreditation requirements. CASA Columbia also obtained comments and suggestions from 176 leading experts in a broad range of fields relevant to the report.
The report was funded by grants from The Annenberg Foundation; The Diana, Princess of Wales Memorial Fund and The Franklin Mint; The New York Community Trust; and the Adrian and Jessie Archbold Charitable Trust.
CASA Columbia is a science-based, multidisciplinary organization focused on transforming society’s understanding of and response to the disease of addiction. Founded in 1992 by Former U.S. Secretary of Health, Education, and Welfare Joseph A. Califano, Jr., CASA Columbia assembles the professional skills needed to research, prevent, treat and eliminate this disease in all sectors of society. CASA Columbia conducts research and utilizes the scientific findings of others to inform Americans of the economic and social costs of substance use and addiction and their impact on each of our lives. By doing so, CASA Columbia aims to reduce the stigma attached to this disease by replacing shame with hope and give people the tools they need to prevent, treat and eliminate addiction.
CASA Columbia has issued 77 reports and white papers, published three books, conducted demonstration programs focused on children, families and schools in 37 states and Washington, DC, held 19 conferences, and has been evaluating addiction treatment and prevention programs to determine what treatment models work best for individuals.
Regardless of whether you got sober and have improved the quality of your life through a 12 Step based approach or more evidence based courses of treatment, do yourself a favor and give this study, entitled Addiction Medicine:
Closing the Gap between Science and Practice a read. As the pdf (which is linked in the previous sentence is) too intimidating at over 400 pages or you're not inclined towards reading scholarly research (which there is nothing wrong with), the 37 slides accompanying the report should be easier to digest (also in pdf form). But if that too is more than you want to look at right now, at the very least, give the study's recommendations, at a mere five pages, a glance over (again as in pdf format).
And, frankly IMO, even the CASA report wasn't as scathing in its critique of the recovery industry as it might have been, I mean, given the paternalistic harm it has done our communities and our nation. Given the damage it has done, especially to those who are most vulnerable, but not only them. We must not forget that the people the recovery industry hurts the most. To those, whom under a public veil of benevolence and good will, treatment facilities, programs and practitioners have exploited economically, socially, politically, culturally and physiologically.
Not saying everyone who works for all sort of treatment centers and program are evil demon span. Far from the contrary, as it was an evidence-based, out-patient program, one which included medication and individual counseling, saved me from an untold suffering if not premature death. But... What I am saying is that my experience, described in the paragraph directly above, is far, far from the norm within the recovery industrial complex.
Just like how, within the context of the so-called "War on Drugs," where any positive outcome will be the result in a paradigm shift, from operating within the framework of public safety to that of public health (e.g. harm reduction) - eventually resulting in it's inevitable demise (no war can be fought infinitely) - so to will any positive outcome in the field of addiction treatment will likewise be a paradigm shift, from one based primarily and largely limited to the 12 Step model of "treatment" to one driven by evidence based practices, treatment in the true sense of the word.
This would be a world in which the addiction treatment isn't focused primarily on sobriety and abstinence as the primary objective. No, this would be a world where the addict's enviroment, especially when it comes to their treatment, instead is primarily concerned with nurturing and empowering individuals, geared first and foremost towards the ongoing realization of their capacities and potential.
Sobriety, while necessary certainly for many, would be a secondary priority. A world where treatment is first and foremost about maximizing the potential and quality of life of addicts, focusing on total abstinence to the degree it - as it often it must - is necessary in the course of one's treatment in achieving said primary objective.
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and on the topic of these values you speak of, I'd argue that the core foundational values to AA are universal, normative values. Problem is how people interpret and act upon their, often misguided, interpretation.