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Addiction & Treatment

The Baldwin Research Project of 1991 (Cont II)

5.0. Excerpts from Letter to New York State's Office of Alcoholism and Substance Abuse Services

...It must be understood that Baldwin Research Institute, Inc. has no interest in conducting rehabilitation programs; its mission is to research and develop rehabilitation programs, prevention methods, legislation and social programs that will reduce the use and abuse of alcohol and other drugs. Baldwin Research Institute, Inc. initially brought together The Hagaman Guest House and the Baldwin Program, which it developed, for the purpose of conducting research on a social based program of recovery for alcohol and drug problems...

Additionally, it must be understood that The Hagaman Guest House does not ever want to participate in alcohol and drug rehabilitation activities. Its charter is to be, in every sense of the words, a "guest house." The Hagaman Guest House does not want to serve clients, patients, alcoholics, or drug addicts-it only serves guests. This is no small distinction. The labels we put on people often set the expectations and behaviors of those labeled. For example, a "client" expects the professional to fix whatever problem for which the client has enlisted the professional's aid. The same is true for the label "patient." In both of these cases the burden of performance is the responsibility of the professional. In stark contrast a "guest" does not expect transference of his/her responsibilities. The responsibility to solve any problems guests may have remains their own. Nonetheless, "guests" do have expectations that include being treated with respect, dignity, and having an enjoyable experience. These expectations of the guests at The Hagaman Guest House are met and often exceeded.

As for OASAS's perceived liabilities, there are always liabilities when we extend ourselves into new situations. If businesses were to shrink away from new ideas and opportunities because of perceived, or real, liabilities there would be no progress. Regardless, we can only guess that the perceived liabilities that concern OASAS have to do with the physical attributes of the guest house. However, it is not clear whether OASAS is concerned with a physical liability, (i.e. a sleeping room fails to meet the minimum requirements thereby causing the guest to be in some sort of danger or the guest not having the best opportunity to recover) or a political liability (i.e. a sleeping room fails to meet the minimum requirements thereby causing other licensed residential programs to request a reduction in minimum standards at their respective facilities).

Addressing the possible concerns for physical liabilities first, The Hagaman Guest House meets and in most cases exceeds all physical requirements (except for one 31-inch wide hallway) for a residential program. In fact, guests coming to The Hagaman Guest House from licensed residential programs (inpatient programs) are delighted by the spaciousness and quality of life offered at The Hagaman Guest House.

Nonetheless OASAS's concerns in this area raise some important questions. For example, if a property is approved by local and/or state health officials, even in cases where the minimums required by OASAS are not met, does OASAS have the wherewithal to defend its requirements based on evidence that its regulations are "safer" or "better" than other state agencies or local building codes? Further, is OASAS prepared to show that there is something "special" about where alcoholics and drug addicts sleep as opposed to non-alcoholics or non-drug addicts? And, if OASAS claims that there is something "special" does OASAS have the data to support such contentions? Specifically, does OASAS have data that demonstrates people are safer in a fire or natural disaster or that more people recover from drug and alcohol problems if they are allotted 40 square feet of bedroom space than persons having, say, 35 square feet per person? Moreover, is it not possible, even probable, in the face of no evidence to the contrary, that people may be even safer or have even a higher recovery rate in 35 square feet of allotted sleeping area as opposed to OASAS's required 40 square feet?

This is not idle banter. Every inch of additional space requirement that is not needed adds to the cost of delivering the service. To arbitrarily pick an amount of floor space or to select a standard from some other state agency without regard for the specific needs of the operation may not be in the best interest of the population to be served. For example, it is certainly not in the best interests of the New York State taxpayers to have Medicaid pay one cent more than is needed for an alcoholic to receive treatment. Thus, if treatment facilities could reduce bedroom space requirements by 10% without sacrificing safety and without reducing efficacy rates, it would be in the best interest of the New York State taxpayers for OASAS to change its regulations. Furthermore, it is reasonable to suggest that OASAS could relax some, most, or all of its regulations by 10% without sacrificing safety, quality of treatment or outcome. Such a reduction would translate directly to, at least, a 10% reduction in Medicaid costs for treatment of alcoholics and drug addicts in licensed programs.

Still there are other considerations besides cost. Alcohol and drug problems being problems of ego, specifically selfishness, putting such individuals in a program that provides spacious sleeping quarters where the individual can "carve out a place of his/her own" is contraindicated. There is a delicate balance to be achieved. Individuals cannot be so tightly packed so as to be uncomfortable, but they cannot be so loosely packed that they can escape from constant contact with others. Regulations that ignore the optimum conditions conducive for recovery are not benign; such regulations are actually harmful.

Perceived "plush" accommodations are harmful when treating people for drug and alcohol problems. Thus, the "mauve hotel" type accommodations actually lessen the probability of recovery from alcohol and drug problems. Uncomfortable conditions on the opposite extreme, like prolonged outbound experiences, or punitive treatment such as those offered by halfway houses and therapeutic communities are not merely ineffective, but dangerous. With the notable exception of Baldwin Research, there is little or no data available to substantiate OASAS regulations, luxurious treatment accommodations, poor treatment accommodations, or punitive treatment methods.

We indicated to OASAS that we would be unwilling to make any changes in our bedroom facilities to accommodate OASAS's regulations. The reason is that we have studied the requirements with respect to safety and program efficacy. Our studies suggest that a minimum of 50 square feet (plus or minus 5 square feet) is optimal for safety, program efficacy and return on investment, with program efficacy being the first consideration. This conclusion comes following eight years of looking at a variety of bedroom designs. However, it would be shortsighted to only consider "space per person" as a criterion for a good design.

There are many other factors that are far more important than the amount of bedroom space that is allocated for each guest. For safety reasons guests must have easy access to the hallway. Dressers tend to accumulate clothes and personal items that can contribute to nighttime clutter causing falls and injury to toes and feet. Additionally, clutter, which is easily tolerated by some, can actually contribute to discomfort and depression in others. While there are several solutions to the problem, some punitive in nature, our solution, after trying several of the other solutions, has produced a closet and shelf design that eliminates dressers and other free standing furniture. Also shelves are design into each bed system to provide clutter space that is confined to each guest's bed space.

Emotionally, it is important to see out of a window from ones bed. Each bed in every room is located in such a way so guests can see out of a window from their bed. Window coverings are such that light from the window can only be reduced, not eliminated. Further, a sense of privacy is important. Thus, beds are arranged in a way that no one laying in their bed looks into the face of anyone else. Each bed has its own identity. Bedding and comforters are different even within the rooms. Sheets and pillowcases have color and design. Virtually every detail is designed to eliminate institutional décor and to meet the emotional needs of our guests. To that end, every bedroom has its own color scheme. There are no standard rooms, but every room is built to standard. These standards are the culmination of eight years of study and observation. And, although, there is no conclusive evidence that these standards (or any other standards) contribute to higher recovery rates, there is a body of knowledge that supports the theory that uncomfortable conditions can and often do, detract from program success.

The purpose of the preceding discussion is not to convince OASAS that we know how to design and build bedrooms. Rather we want OASAS to understand that our reluctance to have OASAS regulate our guest house operation would: (1) have us conform to standards that may have less supporting data than our own standards, (2) have us accept standards that may hamper the progress of those we are helping, and (3) limit our ability to continue to conduct our research in areas of study that include the physical attributes and layout of our facility. Please keep in mind, first and foremost, we are a research organization. Hence, limiting our ability to test new approaches for helping people with drug and alcohol problems in order to conform to OASAS regulations would be contrary to our mission.

Here then is the conundrum: We are steadfastly unwilling to have OASAS controls on our facilities and our program. Programs licensed by OASAS, we suspect, complain that we are allowed to operate without having to conform to OASAS regulations. Seemingly and from the point of view of licensed programs, it is unfair to allow The Hagaman Guest House to continue to compete for the same treatment dollars without having to conform to the same regulations. And, I am certain the OASAS licensed programs view The Hagaman Guest House as providing the same treatment they provide.

The truth is that The Hagaman Guest House is providing "treatment" in the generally accepted use of the word. According to Webster's Dictionary the word treatment means: "an act, manner or procedure for treating something." According to that same source "treating" means: "to handle or manage in a particular way." The problem comes when OASAS claims that all procedures that are used to treat alcoholism and drug addictions are covered by OASAS's definition of treatment when, in fact, they are not. Setting aside questions as to the constitutionality and the monopolistic nature of OASAS's word prohibitions, the universal prohibition against using the word "treatment," except by OASAS licensed programs, thwarts any efforts by innovators to develop and enter the market with competing, but different technologies.

Yet, it would seem grossly unfair to allow one group to call themselves treatment without any conformance to regulations within a specific government regulated market, while all others competing in that market are forced to conform. Reasonably, it could be argued that the non-conforming organizations would have an "unfair" competitive advantage over those that do conform. Notwithstanding that having a competitive advantage over ones competition, unfair or otherwise, is American industry at its best, to claim that the perceived, or real, unfair competitive advantage is, in and of itself, problematic would be wrong. Finding a competitive advantage over competition is the bedrock on which a free enterprise system is built.

But those who would assert that The Hagaman Guest House has an unfair competitive advantage based on it not being regulated by OASAS need to look deeper into The Hagaman Guest House's participation in the market. Upon close examination two important facts become clear: (1) The Hagaman Guest House rarely competes against licensed programs for the same treatment dollars and (2) The Hagaman Guest House never provides the same "product" (services) as licensed programs.

Regarding the question of competing for the same treatment dollars, The Hagaman Guest House does accept Medicaid or Medicare payments, but according to these social programs the poor have no right to selection of alternative programs. The Hagaman Guest House does accept insurance payments for guests who have out-of-plan coverage and from out-of-state insurance companies who do not require OASAS certification. These payments constitute less than 1% of The Hagaman Guest House's revenues. In contrast, we estimate that at least 50%, and probably as much as 90% or more, of all revenues paid to licensed programs in New York State come from Medicaid, Medicare and insurance companies. Clearly, then, The Hagaman Guest House is not competing with New York State licensed programs for the same treatment dollars.

However, in the future, The Hagaman Guest House may accept payment from HMOs or insurance companies when such payments are offered. The Hagaman Guest House would not consider accepting such payments as a violation of New York State statute or OASAS Regulations. That is to say that, if one party wants to pay for an educational program and another party wants to accept payment for an educational program, a transaction of that kind certainly is not governed by OASAS regulation or prohibited by New York State statute.

Additionally, The Hagaman Guest House does not compete with New York State licensed programs, in that, it does not offer any services rendered by licensed programs. The Hagaman Guest House does not employ any professional counselors, nor does it purport, advertise or in any way imply that it offers such services as counseling, group therapy or any treatment that requires certification by OASAS. The Hagaman Guest House's certified instructors do not counsel or advise guests, nor do they purport, advertise or in any way imply that The Hagaman Guest House offers such services. The Hagaman Guest House does not rehabilitate anyone, nor does it purport, advertise or in any way imply that it offers such services. In fact the Baldwin Program at The Hagaman Guest House teaches guests how to rehabilitate themselves. Thus, The Hagaman Guest House is not competing for the market that wants treatment based on transference of responsibility (e.g. counseling, group therapy, therapeutic roll play, or any other type of therapy).

Nonetheless, The Hagaman Guest House has an important role to play in the alcohol and drug rehabilitation market. There is a segment of the market that does not want the type of treatment offered by OASAS licensed programs, and there is a segment of the market that is not wanted by OASAS licensed programs. Many people have gone to treatment offered by licensed programs over and over again and have come to the conclusion that OASAS licensed programs cannot help them. Some of these people have found their way to the Baldwin Program at The Hagaman Guest House and approximately 70% of them are sober and drug free today. Then there is a population that licensed programs will not take. This population falls into two categories: (1) it is common practice for licensed programs to refuse admission to those who have already been through one or more programs previously, and (2) it is common practice to refuse admission based on inability to pay. While these refusals may be shrouded in contrived conditions to bar admission (no bed space, not a high enough BA, too drunk, and the like), everyone in the industry understands that inability to pay is the number one prohibiting factor barring admission to licensed treatment programs.

In contrast, the number one reason for professionals making referrals to The Hagaman Guest House's Baldwin Program is the professionals' disenchantment with the results of licensed programs. The number two reason that professionals refer to The Hagaman Guest House's Baldwin Program is the patient's lack of insurance. Definitely, these segments of the market are segments that licensed programs neither pursue, nor want. Ninety-plus percent of The Hagaman Guest House's business is based on these two types of referrals. It does not compete for this business. These referrals would not have gone to licensed treatment programs in any case. But more importantly, it begs the question: who would help these people if The Hagaman Guest House didn't? Can the City Mission or the Salvation Army offer these people a 70% chance of recovery?

Even in the face of the previous discussion it is certain that at least some of the licensed programs would contend that The Hagaman Guest House is in fact competing with them, therefore it should be required to abide by the same rules. For the owners and operators of those licensed programs, we offer the following solution: it's a free country. That is to say that there is nothing stopping a licensed program from abandoning its current methods in favor of offering a social, educational program for recovery from alcohol and drug problems. The Hagaman Guest House would welcome the competition because it knows that social and educational programs produce far better recovery rates than treatment offered by licensed programs. With that said, please keep in mind that Baldwin Research Institute, Inc.'s and The Hagaman Guest House's only interest is to help people recover from drug and alcohol problems (and other compulsive, obsessive behaviors). If more organizations began offering the Baldwin Program, or its equivalent, these organizations would actually be helping Baldwin Research Institute, Inc. fulfil its mission because more people would be getting well.

For seven years now Baldwin Research Institute, Inc. has been asserting to OASAS that it has established a method that far exceeds the recovery rates of OASAS licensed programs. From time to time, and from OASAS's point of view, our tactics may have seemed highhanded. Yet, there are important issues with respect to OASAS's and our programs that demand attention.

For example, we have almost 10 years of verifiable research data on the Baldwin Program. Repeatedly, we have offered to share with OASAS this information. For nearly 10 years Baldwin Research Institute, Inc. has reported verifiable success rates from year to year hovering around 70%. Additionally, it has monitored OASAS licensed programs by way of client exit interviews and direct contact with the providers. By way of client exit interviews, success rates have been poor, less than 25% at six months post-treatment. Licensed adolescent programs were less than 3% one-year post-treatment. And, as recent as ten months (early 1999) ago we polled 25 New York State providers asking their cost and their success rate. Only one quoted us a success rate. They said their program had an 80% success rate, but they could not tell us what the success rate was based on; nor could they tell us anything about the method by which the study was done or the date it was completed. Even more surprising was the fact that only three programs would discuss the price of their program over the telephone. It is safe to say that success rate and price information for New York State licensed programs is not available to the consumer of those services. Moreover, even when success rates have been available there is no standardization of the study methodology. Without standard methods of measurement, consumers are worse off than not having information available at all.

Further, in the last 8 years, Baldwin Research Institute, Inc. has compiled data from a variety of independent studies conducted by others during the past 30 years, and has made that information available to OASAS. While Baldwin Research Institute, Inc. agrees that here and there studies show that psychological and medical methods work, the overwhelming evidence is to the contrary. The truth is that psychological and medical treatment for alcohol and drug problems have not been very effective. In fact, there are responsible studies that have concluded that psychological and medical methods do not work at all and may in fact be harmful.

In a study conducted by the Kansas City Veterans Administration Medical Center, the VA reported on three groups. Group One received no treatment at all except for a 15-minute appointment each month with a doctor. Group Two was given Antabuse and Group Three received the full range of treatment including outpatient programs, individual counseling and therapy, family counseling programs, vocational and rehabilitation guidance, Alcoholics Anonymous and the option of taking Antabuse. The group that had no treatment at all did, statistically, significantly better (20% better) than either of the two treated groups. The reason this study is important is that many studies, like the Chapman-Walsh Study, the CALDATA Study and Project MATCH fail to compare their results with the "no treatment" option.

However, the VA study is not the only study that has shown that the "no treatment" option outperforms the treatment option. According to the findings of Miller et al., the treatment with by far the best overall score was "brief intervention," followed by social skills training and motivational enhancements. "Brief intervention" is as simple as having the client agree to reduce his/her drinking or drugging or to refrain from drinking and drugging altogether. And, "motivational enhancements" is a process of the client deciding what is important in his or her life and then adjust his or her drinking and drugging accordingly. Both processes are far less confrontational than the methods generally employed in OASAS licensed programs. The Miller Report described standard treatment (which includes OASAS licensed programs) as "a milieu advocating a spiritual 12-step (AA) philosophy, typically augmented with group psychotherapy, educational lectures and films, and general alcoholism counseling often of a confrontational nature." These standard treatment techniques ranked at the bottom of Miller's list, with far less proof of their effectiveness than other treatments. Thus, the most frequently used methods throughout the US and in New York State are programs for which there is the least evidence of success.

While there are many other studies that confirm the findings of Miller et al., it would belabor the point to refer to each one individually. The point is simply this: the majority of independent studies show that the same number of individuals recover, by whatever measure is employed by the researchers, whether these individuals receive treatment or not. The absolute conclusion of studying alcohol and drug treatments for the past 50 years is that once an individual who is experiencing problems with alcohol becomes aware of the problem, 20% to 30% will stop the problematic behavior for at least a year regardless of the treatment or with no treatment at all.

The aforementioned studies raise a very important question. In order to determine the exact benefit of treatment as is provided by OASAS licensed programs, those who would have gotten sober and drug free with just a "brief intervention" must be subtracted out of the number that reportedly get sober and drug free through treatment. This is not a ploy to make treatment look bad, but rather it is scientifically sound to remove that portion of the population that would have recovered without treatment. Since studies have indicated that 20% to 30% of people suffering from alcohol problems respond favorably with just a brief intervention, then the percent of those who are claimed to be helped by treatment must be reduced by that same percent to isolate the efficacy of the treatment. Dr. Enoch Gordis in a talk at the NYSAASAP, Research to Practice Conference at Saratoga, New York this past October (1998) said that treatment is 20% to 30% effective. In fact, several researchers confirmed that success rate during that conference. Thus, if we adjust that success rate to eliminate the affect of the "brief intervention," we can convincingly conclude that treatment as offered by OASAS licensed programs does little or nothing to help people recover from drug and alcohol problems. Again, please keep in mind that it is not our intent to criticize or malign OASAS's efforts. As people of science we are merely presenting the facts, as we understand them.

It is also not our intent to promote any particular program. Although Baldwin Research is the creator of the Baldwin Program, it is not Baldwin Research's mission to promote that program. To be sure, if there was evidence that other methods obtained better results, Baldwin Research Institute, Inc. would immediately abandon the Baldwin Program to apply its resources on that which achieved the best results. To that end, Baldwin Research Institute, Inc. expended a great deal of its resources understanding what other researchers are doing. For example, Baldwin Research Institute, Inc. spent thousands of person-hours analyzing the CALDATA Study. After careful review of Andrew Mecca's work we could not agree with his conclusion that stated, "This California study corroborates a number of smaller studies in the United States, which prove that appropriate alcohol and other drug abuse treatment works." This horribly misleading statement by Mecca is based on politics; it's bad science.

To people outside the scientific community the term "treatment works" means people who suffer from alcohol and drug problems get well. Mecca's study was not designed to determine whether or not people got well, but rather it was an economic study to determine whether or not alcohol and drug treatment was cost effective for the taxpayers. It worked out that Mecca proclaimed that there were substantial cost savings by placing lawbreakers in treatment programs in lieu of incarceration. Therefore, he proclaimed that "treatment works" based on his perceived monetary savings. He specifically did not claim that "treatment worked" based on the number of subjects that recovered from their addiction.

But even Mecca's economic conclusions were misleading in that he failed to study the "no treatment" option. Moreover, the greatest savings reported by Mecca was not treatment at all but involved giving drug addicts a highly addictive and mind altering drug, methadone. The treatment that was least cost effective was the type offered by OASAS licensed programs. The most cost-effective program was the social based program, similar to the Baldwin Program, for which there is no license available in New York State.

However, to characterize the Baldwin Program as being closely aligned with the social based programs offered in California and other states would be incorrect. The Baldwin Program has evolved over the years into a comprehensive treatment for drug and alcohol problems that is based on techniques that have actually, scientifically, produced measurable and verifiable results. For example, Miller et al. determined that "brief intervention" scored best as a treatment (or lack of treatment) for drug and alcohol problems. Additionally, Miller et al. reported that social skills training and motivational enhancements scored high. All three of these techniques are integral parts of the Baldwin Program. Baldwin Research discovered the need for these techniques and implemented them in the Baldwin Program prior to knowing about Miller's research. However, the Baldwin Program is far more effective than the 20% to 30% that can be achieved by these techniques alone.

The Baldwin Program provides a powerful educational program that was first described in 1939 by Clarence Snyder of Cleveland. His program required an educational program about finding a non-sectarian spiritual basis on which to live ones life. Today, every major medical school is conducting research to gain an understanding as to what role spirituality plays in disease prevention and treatment. In 1990 an educational program to bring about a spiritual experience became the foundation of the Baldwin Program.

Snyder's program was followed by participation, ad infinitum, in a fellowship program, which he had named Alcoholics Anonymous. In 1941 Snyder reported that this approach had yielded a 93% recovery rate. In 1995, 1996 and 1997 using the same techniques that Snyder used, Baldwin Research duplicated Snyder's results reporting a 95% recovery rate, a 94% recovery rate and a 94% recovery rate, respectively. These results are based on abstinence.

Today the Baldwin Program is the most successful program ever developed for helping people with drug and alcohol problems (and other compulsive and obsessive behaviors). All of our evaluations are based on achieving abstinence, since abstinence is the only normal condition for human beings. The American cockeyed notion that drinking alcohol is normal gives testimony as to just how ill informed we are as a society. Most of the world's population does not drink alcohol and does not want to drink alcohol. Therefore, trying to help problem drinkers and drug users to reduce their drinking and drugging into an acceptable behavioral range is tantamount to actually encouraging them to continue harmful behavior.

Even though it is grossly inequitable to compare the Baldwin Program results with other studies that report ambiguous, subjective results of reduced use of drug and alcohol as a basis of success, Baldwin Research Institute, Inc. is, nonetheless, prepared to present the multiyear statistics of the Baldwin Program against the results claimed by other methodologies. The Baldwin Program statistics presented herein were updated 20 November 1998. Bear in mind that simplicity is the essence of sound statistical analysis.

Our statistical analysis is made up of three categories: sober, drunk, and unknown. The sober category is comprised of two groups: those with less than one year of sobriety and drug free living and those with one year or more of sobriety and drug free living. There are no ambiguities; the technique is binary; the subject is either sober and drug free (hereinafter referred to as "sober") or not (hereinafter referred to as "drunk").

With those parameters set, the most current data (November 1998) is as follows. The total sample was 204 subjects. The total number "known" sober at the time of sampling was 80 of which 33 had less than one year sober and 47 had one year or more sober. 18 were "known" to be drunk and 106 were unknown as to their sobriety and drug use.

Examining, first, the most reliable data, that is, the "known" group with one year or more sobriety, the total number in this group was 62 of which 47 (75.8%) were sober and 15 (24.2%) were drunk. The known group with one year of sobriety has consistently demonstrated success rates of 75% (+-) 5%. Like other studies our data is subject to the same inflation of success rate by those who would have gotten sober by a brief intervention. This inflation rate that ranges from 20% to 30% averages approximately 25% from study to study. Adjusting, then, the success rate of the Baldwin Program for those who would have gotten sober without the Baldwin Program, the actually success rate is 50%.

Still, we are suspicious of studies that arbitrarily throw out the "unknown" population. Although we think most researchers are ethical, there are researchers that would throw failures into the unknown category to improve their statistics. One has to understand that supporting the notion that "treatment works" means a lot of money to a lot of people. My cynicism from being in research for 36 years comes from observing that researchers will lie for a whole lot less than money. Here at Baldwin Research, we have gone to great lengths to report on the total population so as not to hide any results.

To that end we have developed a method of analyzing the unknown category. This technique reports on the last known status of the unknown subjects. There was a point in time when we knew the status of every subject. Then, at some point we lost contact with the subject. The analysis of the unknown category uses the status of the unknown subject just before the subject entered the unknown category. For example, in the current reporting period there were 106 unknowns, of which 60 (56.6%) were classified as drunk because their last "known" status was drunk, just prior to entering the unknown group, and 46 (43.4%) were classified as sober because their last "known" status was sober, just prior to entering the unknown group. It is consistent with the expectations of our research that the percent drunk would be somewhat greater than the percent sober because those who return to drinking and drugging are more likely not to want to be found by our surveyors. Our experience with the "last known analysis" of the unknown population is that if the percent drunk exceeds the range of 55% (+-) 5% then the study is probably stuffing drunk subjects into its unknown category to improve results.

The usefulness of this analysis is to add the last known status of the unknowns to the known population to report on 100% of the population with a year or more sobriety. Using this method, the total number of subjects (excluding the 33 subjects that had less than one year sobriety) was 171, of which 93 (54.4%) were sober or last known to be sober and 78 (45.6%) were drunk or last known to be drunk. Adjustment for the brief intervention phenomenon yields an actual 29.4% success rate.

Finally, we employ 100% accountability for the entire population of 204 subjects. Although this analysis is skewed by the constant increase in the unknown population as a function of time, we continue to be dedicated to stating exactly what makes up the entire population. Thus, out of 204 subjects 33 (16.2%) have been sober for an average of 6 months, 47 (23%) have been sober for a year or more, 18 (8.8%) are known to be drunk, and 106 (52%) are unknown as to their status.

The 100% accountability analysis has the affect of counting all 52% of the unknown population as drunk. This, of course, is not true. What is true is we know precisely the status of 98 subjects. 33 have been sober for an average of 6 months; 47 have been sober for a year or more and only 18 are known to be drunk. Remarkably, 88.9% of the known population is sober. But even more remarkable is the isolated success rate of the Baldwin Program plus one year of active participation in The Fellowship. The Fellowship is a community based support program.

The results reported in 1995, 1996, and 1997 analyzed the success rate within each year, respectively. The average success rate for the three years was approximately 94%. Recently we reviewed all 204 subjects who completed the Baldwin Program and participated a year or more in The Fellowship or in one of its predecessors. 26 subjects (approximately 13%) followed the recommended one-year active membership in The Fellowship. This group with an average of 4.5 years sobriety has achieved an overall success rate of 92.3% over a 6-year period. Adjusting this success rate for the brief intervention phenomenon yields an astounding 67.3% success rate as a direct result of the Baldwin Program and active participation in The Fellowship for one year or more. This combination of the Baldwin Program and The Fellowship is now known as the Baldwin Process.

Considering the previous discussion, it does beg the question as to why OASAS, during the past 7 years, has not had an interest in Baldwin Research Institute, Inc.'s techniques? Even today it seems that OASAS's interests are to pluck the annoying Baldwin Research and The Hagaman Guest House thorn from its side rather than investigating a process that, if adopted and licensed, would save thousands of lives and relieve immeasurable suffering. It would seem appropriate, then, for OASAS to do what it has forced us to do. Because of the questions raised during our licensing discussions with OASAS we had to review and rededicate ourselves to our original mission. It may be appropriate for OASAS to re-decide what its mission is. Is OASAS's mission to preserve the status quo, or is it OASAS's mission to guide the state's policies and programs to provide the citizens of the state with the best possible treatment for drug and alcohol problems. It is important to recognize that these two different missions are mutually exclusive.

6.0. Preliminary Conclusions

It is the purpose of Alcoholics Anonymous, government entities, treatment programs, employee assistance programs and other organizations and individuals current governing and involved in drug and alcohol treatment to maintain the status quo. If social based programs were to grow and significantly replace the current paradigm, for example, it would eliminate the need for professional counselors, government agencies like OASAS, and expensive inpatient and outpatient treatment. The tragedy is simply this: Everybody in the industry knows that treatment doesn't work. Yet because of the professions' fears of loss of job, money and status, these professionals are willing, no compelled, to sacrifice the health and well being of their patients rather than change to a paradigm that does work.

The problem is far more serious, however, than simply providing a treatment that is ineffective. While Dr. Enoch Gordis asserts that 20% to 30% recover by conventional treatment methods their assertions must by viewed in the proper context. First Dr. Gordis's entire organization is in place to oversee the treatment industry-without a treatment industry-no NIAAA. His organization is hardly unbiased with respect to the treatment industry and it success rate. Moreover, it was his organization that authored the flawed MATCH Study. With all due respect NIAAA's hypothesis that treatment must be matched to the individuals' individual needs borders on the absurd. Moreover, Gordis's 20% to 30% claimed success rate ignores the plethora of studies that conclusively show that on the average no more than 18% remain sober and drug free for six months and at five years less than 5% are still sober and drug free following treatment.

These statistics raise very serious questions as to the advisability of people with drug and alcohol problems attending conventional treatment programs. In that 20% to 30% of those identified as needing help recover without any treatment, it is not only possible, but probable, that treatment is actually contributing factor in the relapse of many of its patients. This suggests that conventional treatment is not just a fraud, taking money for a procedure that clearly doesn't work, but it may, in point of fact, be a cause for relapse and the death of those it claims it is helping. This then is our bloodletting. So the question before us is this: Shall we continue to kill thousands of people, including our children, with a failed treatment, or do we have the courage to change?