Yes, Dr. Johnson. Treatment Does Work!

Thursday, August 12th, 2010

On Sunday, 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 that presenting a more balanced op-ed piece wouldn’t sell as many books.

Deni Carise, Ph.D.
Chief Clinical Officer,
Phoenix House

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  • Yes,Dr. Johnson treatment does work! I was suffering from addiction for 20 years or more until I entered Phoenix House. They taught me to identify who I became, and why. How to identify what I needed to do to become a productive member of society. I am sober now 12 years and I want to thank the counselor, who are now my colleagues for the undivided attention and persistance in helping me change my life.

  • it worked for me…7 years clean and counting

  • Come on if it wasn’t for programs like Phoenix House I could not say where would I be today or if they had ask me to paid for it coming out of prison in 1986 I would have laugh at them now you do the math I was release from prison in 1986 it is now 2010 come on it works if you work it…

  • Well stated, Dr. Carise. Dr. Johnson’s article is both startling and offensive to me. It’s unfortunate that someone would use their platform as a medical professional in such a reckless way. I bear witness every day to lives that have changed as a result of their treatment experience at Phoenix House. Furthermore, our doors are open to anyone who is seeking to break free from their addictions, regardless of the money they do or don’t have. While we focus on overcoming substance abuse addiction at Phoenix House, the drug use is typically symptomatic of deeper seeded problems that many of our clients admit they don’t have coping skills to confront. There certainly is a place for medicine in treatment and/or recovery. However, many people have personality tendencies and emotional wounds that are too deep for a written prescription to touch. Hopefully, Dr. Johnson’s article doesn’t cause people who urgently need help to further endanger their lives by not utilizing the tremendous support and resources that treatment programs offer.

  • I agree that Dr. Johnson’s editorial points broad finger at rehab and its so-called failings when treating alcohol dependency. I found it interesting that Dr. Johnson took the time to discuss what is wrong with rehab before letting us know that he would be working on a pharmacological treatment, what he calls “effective medicine.” Curioser and curioser! Rehab may not be a perfect science, but were it not for rehab, too many people would fall down the abyss that is alcohol and drug dependency. Many patients need rehab for support they would never get elsewhere. There are way too many temptations that would keep alcoholics and drug users on their destructive paths and rehab helps them try figure out the best way not to give in to them. Rehab is getting a bad rap thanks to celebrities and their bad behavior. They use rehab as a way of making themselves look good in the eyes of the public instead of taking advantage of what’s being offered to them. Dr. Johnson’s comments are irresponsible, unnecessary and could deter someone who truly needs the help from entering a program.

  • Treatment does work, I have been clean for 4 years and I used the drug “pcp” for 10 years before I came into treatment, we all have choices in life. Dr. Johnson does not have any idea on what goes on an addicts mind.

  • I have to disagree–
    My son has been clean and healthy for 8+ years due to Phoenix House.
    He has a wonderful job and is doing well.
    I beleive it saved his life. He was a self admit and I will be forever thankful.
    *Way to go Belle Terre!

  • The question you have to ask is:

    Which pharmaceutical company is paying Johnson, or which one is he a major stock holder in.

  • Yes treatment does work if you want help. If you want to keep what you learned in treatment then you need to continue to work. Most choose a 12 step program such as AA. Bottom line it only works if you work it!!

  • Evidence?? Come talk to me.
    When a young man who was 15 years old when he got treatment for addiction, comes to visit me when he is twenty, it is the sparkle in his eye that I present as evidence. Treatment works.
    How can you place an emperical scale on that spark of life that was so nearly wiped out?? That spark starts with the seed planted in treatment.
    How can you measure how and when that seed takes hold and hope for a future starts to grow. For some recovery takes hold quickly, for others it takes longer.
    No one has ever come to me to include me in any study. Yet, for seventeen years after treatment I have served my fellow man and society for the greater good. I know of many many cases of ruined lives made to shine. They probably didn’t make it into anyone’s study either.
    One recovering person grows to influence countless others to the benifit of all. How can this be measured.
    How do they dare set a dollar figure on children who can now look up to a father or mother who will always be there.

  • Melanie,
    It’s great to hear from PH grads and wonderful that you are doing so well! Keep in touch with us!

  • Update: Check out the great post on this issue by my friend and colleague Dr. Keith Humphreys.

  • Of course treatment works. I went from Yorktown Heights at age 16 in 1984, directly to the “rooms” of AA after graduating from Phoenix House in early ’87. It has now been almost 26 years of sobriety. Great article, Doctor Carise.

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