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	Introduction

By Janet Firshein

Wendy took her first drink at age 12 and was a full-fledged alcoholic, she says, by 16. By the time she first sought treatment, in her twenties, she had spent ten years, or nearly half her life, addicted to alcohol and heroin. She had dropped out of school, nearly been killed in a drunken, four-story fall, and lived only to drink and drug. And even after she got clean and sober in treatment and spent seven years in recovery, her struggle with drugs and alcohol wasn't over. As many recovering addicts and alcoholics do, she relapsed, and had to undergo a more intensive, residential treatment program to get clean again.

But since that second treatment episode, 14 years ago, Wendy hasn't had a single drink of alcohol or taken any illicit drug. Even though she had to do it twice, she says, "Treatment works. [It] taught me the truth about my disease and the truth about what I need to do to stay sober." Today, Wendy is a senior counselor herself at a drug rehabilitation center in New York, living a drug-free life that she says finally has meaning.

Introduction

A Long-term Approach

Kinds of Treatment

Some Questions to Ask When Choosing an Addiction Treatment Program

How Managed Care Is Affecting Addiction Treatment

A Personal Journey by Nan Robertson

Interviews
       • A. Thomas McLellan, Ph.D.
       • Patricia Owen, Ph.D.
       • Paul Earley, M.D.

Changing Public Perceptions

Despite success stories like Wendy's, however, attitudes toward addiction treatment often remain skeptical. According to a just-released report from the National Academy of Sciences, "one of the most enduring myths about addiction is that treatment for these disorders is ineffective."

"It's a phenomenon that's been frustrating to me, because we have studies that have been done for years and years showing that between thirty and sixty percent of [addicted] people are able to get into recovery after any treatment," says Patricia Owen, Ph.D., director of the Butler Center for Research and Education at the Hazelden Institute in Center City, Minnesota. "Unfortunately, we [only] see the people who don't make it. Recovering people are invisible because they're functioning so well in society. . . . but active addicts and alcoholics are quite visible."

Playground for clients' children at Project SAFE, a treatment program.


	Another reason why this myth continues is that people unfamiliar with the disease of addiction tend to believe that an addicted person can and should remain entirely abstinent for the rest of his or her life after a single treatment episode, says A. Thomas McLellan, a professor at the Center for Studies of Addiction at the University of Pennsylvania School of Medicine in Philadelphia. More often, an addicted person will relapse once or more after treatment, perhaps punctuating periods of sobriety with "slips" back into chemical use; or will reduce instead of entirely eliminating his or her substance use. (McLellan says the treatment community bears some responsibility for its own reputation for "failure," because it has sometimes perpetuated the perception that the only successful patient is one who manages permanent abstinence after treatment.)

A. Thomas McLellan, addictions researcher at the University of Pennsylvania.


	"We don't have a 'cure' for hypertension, diabetes, or asthma either, but you don't hear the world talking about how ineffective treatments [for those disorders] are," McLellan says. A study by the National Institute on Drug Abuse, one of the federal National Institutes of Health, found that 40 to 50 percent of patients receiving drug treatment did remain abstinent three to five years later (the duration of the study), and another 30 percent significantly reduced their drug consumption.

Moreover, McLellan notes, what people really want addiction treatment to accomplish is not just to reduce illicit drug and/or alcohol use, but to improve the addict's social functioning and health and to end such addiction-related problems as crime, family disruption, and high insurance costs. Effective substance abuse treatment, he says, can deliver on that. Studies have found that every dollar spent on substance abuse treatment produces at least seven dollars' worth of savings in terms of health care costs, increased productivity, and reductions in accidents. Minnesota, for example, reported that the state saved $22 million in annual health care costs by providing treatment to chemically dependent clients.

And while some believe that the solution to drug-related crime problems is locking up addicted people, not treating them, McLellan says studies have shown that incarceration merely postpones a return to substance abuse and more crime. He did a study that compared naltrexone, a medication used to treat opiate and alcohol dependence, with stricter punishment, to see which had a bigger effect on addicts' return to crime. One group of addicted prisoners received standard probation, another received twice the amount of probation, and a third group got standard probation plus substance abuse treatment with naltrexone and counseling. Sixty percent of those who had double the usual probation were re-arrested and reincarcerated within a year after completing probation, versus only 23 percent of those receiving naltrexone. "Twice the criminal[-justice] effort was not as effective as simply adding substance abuse treatment to standard probation," McLellan says.

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