treatment center or 12-step group?

People with substance abuse issues, if they live long enough, often find themselves in rehab. Typically, alcoholics and/or addicts are there because someone with some influence over them thought it was a good idea. That someone is usually a significant other, a boss, or a judge. (If they are kids, maybe their parents.) I haven’t seen any numbers, but it seems a safe bet that at least half of the treatment center grads use in the first 72 hours after release. Over the months between release and the one year mark, I’d be willing to bet that at least 80 percent have returned to active addiction. The number may well be higher. The reason is relatively simple. Folks in treatment centers usually don’t want to be there and/or aren’t chewed up enough to be humble. What good then, is going to treatment?

If treatment is a viable option, I can think of a couple of reasons to go. First the alcoholic/addict would be off the street. A few weeks away from potential triggers like spouses, bosses, kids, and druggie buddies never hurt anybody trying to sober up. Second, and most important, the addict/alcoholic would be introduced to AA or a similar 12-step group. Even though most of us don’t make the transition from treatment center to 12-step group well, at least we know where to go when things get bad. And they will get bad. Third, if the addict/alcoholic is unusually intelligent or otherwise attuned to reality, rehab may actually raise the bottom for him or her. Most folks just aren’t going to get sober when they still have jobs, spouses, freedom, health, etc. For a very select few, treatment can make such a low-bottom unnecessary.

What if treatment isn’t an option? Run, don’t walk, to AA, NA, CA, or whatever you think is best for you. The choice is fraught with danger. Many 12-step societies are famous for being little more than places to hook up. I’ve never heard AA mentioned in that sense. There’s usually lots of quality, long-term sobriety to be found there. It’s certainly a good place to start. If the addict/alcoholic is humble, he can certainly get sober with the help of a 12-step group, even if he still has something to lose. Those that do so, though, are the exception and not the rule.


6 Responses to “treatment center or 12-step group?”

  1. 1 Ned February 21, 2008 at 2:41 pm

    Hey Rob, do you think there’s any way that this could be set up differently that would lead to better results?

    I mean, in any other industry where they had an 80% failure rate, somebody would get fired and procedures would get changed. The treatment business seems to be much like education: always begging for money and short on accountablity.

    In my experience, there were some good and bad things about treatment. Certain lessons I learned there remain with me, eight years later. That was the positive. I also learned how to be a better addict. That was the down-side.

    It just doesn’t seem like we’re (and I mean the universal “we”) willing to try things differently. It seems to me that what Bill W. and Dr. Bob did was they were willing to try something different because the way things were going wasn’t working. They established AA and everybody stopped looking at ways to improve on the solution offered.

    Just my thoughts…

  2. 2 Rob N. February 21, 2008 at 5:03 pm


    I think treatment is largely a sham. There are some excellent treatment centers but the vast majority are run by corporate types for the express purpose of milking people’s insurance.

    Can’t say what’s going on on the “bleeding edge” of recovery. I’m sure they’re trying different things. Every now and then I read about a magic-bullet pill that prevents addicts from realizing the desired effect from drugs or booze. There’s the psychiatric model. The churches try. Almost certainly the success rates for all of them, including the good treatment centers and AA, are abysmal.

    I don’t know about you, but I tried all sorts of different things to moderate and/or abstain. Something might work for a little while, but I’d be miserable. There are alternatives to the 12-step approach out there, but they don’t work, or didn’t for me.

    I resisted “the program” vigorously after my initial exposure. Now, though, it’s obvious, at least to me, that all the better mouse traps aren’t really better. I think that’s because Bill, Silkworth, and some of the other founders had such keen insight into the nature of addiction and what it would take to cure it, that there’s no improving on their solution short of completely eradicating the addiction, perhaps through chemicals or gene therapy or brain surgery.

    The program as laid out in the Big Book is fool proof. It’s a bitter pill though, and most prefer to absolutely exhaust any and all other options before they’re humble enough to accept it as offered. There’s a huge amount of luck (grace) involved in being able to grasp the program’s essence. It’s hard to say why. I know I’d read the first 164 several times before it happened for me. Maybe I was finally in enough pain to be receptive.

    Ultimately something has to click. And even then, if you quit working it it quits working, or at least that’s how it happened for me. Twice. I’m slow learner.


  3. 3 angryballerina February 22, 2008 at 11:55 am

    From personal experience, I spent a retarded amount of time in treatment centers (if thats what you want to call them) and they did little good for me. I remember once, when I was about 17, maybe 16, it was my last day, and one of the staff, his name was Frank (I loved him, he was a wonderful man) found out I was leaving and said something to the extend of “I’ll see you back in here in 6 months” to which I replied “Fuck you!”

    I was back within a month.

    I have a hard time w the steps, but what addict doesn’t? No one likes to be told what to do, especially when it comes to getting high, and you’re right, something eventually has to click, or you end up dead.

  4. 4 Rob N. February 22, 2008 at 2:05 pm

    angryballerina – you’re right, it’s life and death. We either bounce or splatter. It’s like playing Russian Roulette, except we don’t know whether there are hundreds, maybe thousands of empty cylinders, of if we’re playing with an automatic. Unfortunately there’s no good way to expedite the “clicking” other than increasing the pain. I think that’s why some AAs are so quick to tell arrogant crybabies to go drink. They don’t have a chance to get sober until more of the pride is beat out of them. If it kills them, well, “some must die so that others might live”. It’s harsh. It’s reality.

    BTW, I like the new avatar.


  5. 5 Ned February 24, 2008 at 12:16 am

    I’m sorry Rob. I don’t mean to beat a dead horse.

    I like the luck/grace reference.

    You are a good friend.

  6. 6 Rob N. February 24, 2008 at 7:36 am

    Ned – Comments never close here and I’m always glad to get them.

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