Medical DirectorMark Leeds, D.O. | Podcast: The Rehab

How well do 12-step programs work to treat alcoholism and drug addiction?

When we consider that most rehabs in the U.S. are based on the 12-step philosophy of Alcoholics Anonymous, we should look at the effectiveness of 12-step programs. Do they work? How well do they work? Is going to a 12-step program better than not going?

Typhoid fever killed Prince Albert.

Prince Albert was husband to Queen Victoria of England. He died of typhoid fever at the age of 42 in 1861, the same year the American Civil War began. At that time, there were no antibiotics to treat infectious diseases. The chance of dying from typhoid was about 20%.

The Sober Truth About Alcoholics Anonymous and 12-Step Recovery.

Dr. Lance Dodes is a psychiatrist who wrote a book titled, “The Sober Truth”. In his book, Dr. Dodes discusses studies that have demonstrated that Alcoholics Anonymous has a success rate between 5% and 10%. It almost seems like it could be worse to go to AA than doing nothing at all. In fact, Dr. Dodes concludes in his book that AA may do more harm than good.

Typhoid Anonymous would have been more successful than Alcoholics Anonymous.

Imagine that, in the 19th century, there was an organization named Typhoid Anonymous (TA). People who were diagnosed with typhoid fever could go to meetings every day to discuss their disease and what they are doing to try to get better. In those days, before antibiotics, we would expect the success rate of Typhoid Anonymous to be about 80%. This is due to the fact that, without medical treatment, only 20% succumb to the disease. So, whether they sat at home or went to daily meetings, the members of TA would have an 80% chance of survival.

How would Typhoid Anonymous do in the 20th century?

After the discovery of antibiotics that were effective against typhoid fever, the survival rate went up dramatically. Only 1% to 4% would die from the disease after being treated with antibiotics. So, imagine now that the Typhoid Anonymous organization has grown and developed influence throughout society. Their message might be of the success of the TA program without the need for medical treatment. Abstinence-based typhoid therapy would still hold steady at a success rate of 80%. The 20% who died might be blamed for not working the program thoroughly enough.

The Fellowship vs Modern Science.

So, the fellowship of Typhoid Anonymous might take a position against new medications being used by doctors to treat typhoid. Why should the sick and suffering go to doctors now? Doctors did not have any success in the past treating the disease. Yet, the doctors claim a success rate between 96% and 99% vs the success rate of TA of 80%. It might seem obvious. See a doctor and get medical treatment. Yet, the influence of the media and large organizations can be powerful. There might still be a surprising majority of experts who recommend the old, dated Typhoid Anonymous program.

What about a disease that has no treatment?

Tuberculosis is another infectious disease that was once untreatable. Even when antibiotics were in use already, tuberculosis would not respond to antibiotics like penicillin. It took more time for scientists to discover antibiotics that would work. During the early days, before effective medical treatment, there were institutions known as sanitariums. These places were not unlike today’s drug rehabs. Fresh air and healthy eating were the treatment for the deadly disease. Obviously, it didn’t work very well, but it was the best “treatment” available at the time. Of course, sanitariums went away with the discovery of effective antibiotics for TB.

Sanitariums for addiction.

Traditional residential rehabs are places where people with addiction problems can go to clean up and get away from daily life. They go to group meetings, therapy sessions, and get introduced to AA and the 12 steps. Like the old tuberculosis sanitariums, it doesn’t hurt to remove the sick person from their usual environment. If nothing else, it can protect their love-ones back home from continued harm. In the case of addiction, removing the drugs from the patient for an extended period of time seems to be useful as well. Rehab can also provide some tools in the form of psychotherapy to help the patient to avoid a relapse in the future. Especially for drug addictions that have no current medical treatment, rehab may be the only sensible solution.

What about when medical treatment does exist?

For opioid addiction, there is a very well established medical treatment. It is called medication-assisted treatment (MAT). It involves the use of therapy combined with one of three drugs: methadone, buprenorphine, or naltrexone. The success rate of MAT is between 50% and 75%. This is compared to a success rate of 5%-10% for 12-step programs. Rehab without MAT has a similarly low success rate. If you or a loved one suffered from opioid addiction, wouldn’t you demand that your doctor provide MAT? If a rehab told you that they do not believe in MAT or only use MAT drugs for short-term detox, wouldn’t you run from that institution and find one that supports proper long-term MAT?

Modern Science and Medication-Assisted Treatment for Opioid Addiction.

MAT exists and it has been proven to be the superior way to treat opioid addiction, especially compared to abstinence-based treatment. With respect to opiate and opioid addiction, rehabs start to look like sanitariums, 12-step groups are of little help, and possibly even harmful, especially when the group members recommend against MAT. For people who are addicted to heroin, fentanyl, or pain pills, the first step to quitting the opioids should be seeing a doctor about MAT. You can even talk to an ER doctor. Many are now being trained in how to provide MAT. This is the present standard of care and the best chance for success. Just like Prince Albert would have certainly taken antibiotics if they were available to him, you should choose MAT for opioid addiction.


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