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Addiction & Treatment

Treatment Methodology Comparisons

William R. Miller Study

Methodology Description Effectiveness*
Saint Jude Home Recovery Text Didactic educational approach comparable to Brief Intervention and behavioral Self Control Training. Yields success rate of 30-40% for abstinence depending on severity of drinking problem and motivation of individuals. Moderation yields 21-68% success rate at 12 months.
Social-educational methodology (Saint Jude Retreat House) Choice based didactic educational/social approach teaching responsibility in a program for achieving happiness in sobriety. 62.5% success rate including all program graduates (12 years) based on sobriety including program drop-outs as failures.
Minnesota Model (28 Day) 12-step/disease concept/psychotherapy/ group therapy/psychotropic medications/relapse prevention/ individual counseling sessions Although there are few published studies including a control group comparison the commonly quoted success rate is 3-20% between 1-5 years.
Therapeutic Community (Long-term**) Confrontational long-term usually including 12-Step and disease concept education also similar to Minnesota Model Low retention rates for program completion, low long-term success between 3-20% between 1-5 years. Confrontational approaches have never produced a positive outcome study.
Brief Intervention Non-confrontational meeting with specialist suggesting discontinued use of or moderation of alcohol in conjunction with motivational advice. Continually yields success rate of 30-40% depending on severity of drinking problem and motivation of individuals
Antidipsotropic Medications Medications that cause physical reaction upon consumption of alcohol. (ex. Antibuse) No significant difference from conventional treatment methods.
Behavioral Self-Control Training Educational approach including goal setting, managing consumption, self-monitoring, etc. 21-68% (depending on group studied) moderating after 12-months.
Self-Help Groups (Alcoholics Anonymous, Narcotics Anonymous) Promote powerlessness, social setting, group therapy, disease concept. Limited and mixed studies with very few including a control group. Sobriety after 5 years 2.5% including program drop-outs as failures.
Relapse Prevention Educational methodology including education on coping strategies and stress management. No different from Brief Intervention results.
Marital and Family Therapy Programs for families of alcoholics. (ex. Al-anon) No-conclusive effectiveness studies.
Coping and Social Skills Training Self-explanatory More successful with severely dependent clients than brief intervention.
Aversion Therapy Pairing unpleasant stimuli with consumption of, smell of or thought of alcohol, such as induced vomiting, electro-shock, etc. Short term success of 40% abstinence at six-months faring no better then conventional treatment.
Community Reinforcement Approach Broad spectrum behavioral treatment approach. Although the population of individuals did not properly represent the general population and included a sample size that was unsound, the consistent outcomes varied between 55-90% sober after two-years.
Psychotropic Medications Anti-anxiety/anti-depressant medications. No conclusive effectiveness studies.

*Based on abstinence unless otherwise noted

** Many studies have shown that the length of treatment has no impact on the long-term sobriety of the individual. In other words a little is just as effective as a lot.

To better understand what all of this information means, we have provided some additional explanation.

There are an estimated 12,000 treatment centers in the United States and 97 percent of these treatment centers use a modality that contradicts the approaches responsible research would advocate. Most follow the same "one size fits all" approach that has been a detriment to those who actually want to achieve sobriety and change their lives. [Baldwin Research Institute, Inc. 2003 "Treatment Surveyed").] Obviously the treatment community bases its treatment philosophies on a complete lack of understanding. The promotion of the disease concept and the medicalization of the problem have led to failure demonstrating that the "treatment" offered is not treating the problem. The information promulgated by conventional treatment professionals is not based on research but based on a paradigmatic opinion. While professionals genuinely do want to help their clients, the methods they exercise are, for the most part, completely misguided. The disease concept, conventional treatment and twelve step programs do not have research to back up their effectiveness, in fact, the conclusions of sound research organizations demonstrate the damaging effects of the current paradigm, not the benefits the populous would hope for. As a result, successful outcomes are few and far between. On any given day 700,000 people are subjected to ineffective treatment programs.

The US government spends tens of billions of dollars in support of treatment programs and certifying agencies apparently ignoring valid and repeated independent studies refuting the efficacy of such programs. In fact, many of these same studies have found conventional treatment methods to be detrimental to the very people they are funded to help. It's apparent that those who oversee treatment in the United States, who have the capacity the think critically, are at a loss for what to do. The current paradigm views the out-of-the-box thinker a danger to individuals in need of help. Furthermore, there is the financial aspect of it all. The programs that do exist, fail. Nonetheless, providers of these programs collect billions of dollars in profit every year for these failed methodologies, partly, at least, at the expensive of individual lives.

There are some striking facts that everyone should all be aware of when seeking help. Many assumptions about treatment and the approaches employed are far from the truth. For example, it is assumed that as the expense of the program increases the possibility of success increases as well. This suggests that state funded programs that are often free are less effective than programs costing from $20,000 to $70,000 dollars or more. Inasmuch as 97% of programs use some aspect of the psychotherapy methodology (which includes the Minnesota Model and many confrontation approaches), outcomes are not effected by the amount of money spent on the treatment. Moreover, this methodology has the least amount of positive outcome studies. Treatment, then, that includes group therapy, psychiatry, one-on-one counseling and an unlimited list of variations, has no evidence to support its claim that treatment works. In fact, the evidence that does exist, strongly suggests that conventional treatment actually causes people to relapse. Another commonly used methodology for long-term treatment, the confrontational approach, has also been found to be harmful.

The truth is that there are effective methodologies that exist internationally but are rarely practiced in the United States. It appears that the 12 Step - psychological approach has a firm grip, in the American culture. And, while this methodology dominates, there is little to no evidence proving its effectiveness. "Only two controlled trials were found in which AA was studied as a distinct alternative, both with offender populations required to attend AA or other conditions, and both finding reported no beneficial effect." (William R. Miller, 1995)

The most common forms of treatment in the United States, which have been dubbed "conventional," are the methodologies where the least amount of empirical and controlled studies exist to back up their effectiveness. In other words: "The negative correlation between scientific evidence and application in standard practice remains striking, and could hardly be larger if one intentionally constructed treatment programs from those programs with the least evidence of success." (William R. Miller, 1995)