We’ve read over the years about notorious failures of drug and alcohol rehab, made even more public by Hollywood’s perpetually neurotic glitterati. Is it all a scam? Well, in fact, some people do successfully untangle themselves from drug and/or alcohol abuse. So how do they do it?

The repeated failure of drug/alcohol rehabilitation can be attributed to a single factor: It only addresses the symptoms, i.e., the act of abusing alcohol or drugs. In large part, it ignores the individual’s emotional and behavioral attitudes that brought on the addictions initially. In my experience, the only people with sustained recoveries are those who make a serious, initial commitment to transforming their character. The underlying attitude needs to be, “I’ll stop the drugs and the booze. But that’s the least of it.”

With that in place, rehab then requires a lifelong obligation to change. With these two factors in the addict’s favor, one could potentially benefit from certain elements of rehab, such as counseling or AA. I’m not a particular fan of Alcoholics Anonymous, mainly because I don’t get how surrendering yourself to a “higher power” can substitute for taking control of your mind and your actions. Though the 12 Steps don’t suggest it, I can only assume that it’s so frightening for a person to become self-responsible after years of addiction that they need a sense of something to lean on.

My experience has shown that relying on some mystical, undefined entity isn’t required for a person to do what he or she is already doing. It’s a lot more empowering to give oneself more credit than that. That being said, I still applaud the many people associated with AA who strive to overhaul their value and belief systems, rather than settling for a quick fix – with or without something to lean on. Techniques include a personal inventory, i.e., holding everything they believe up to objective scrutiny, then accepting responsibility for their actions.

In short, they replace drinking with thinking. AA might spend too much time on peer-oriented “fellowship,” but the successful 12 Steppers with whom I have worked de-emphasize these particular points and focus on action. Despite the apparent contradictions, I still find AA more valuable than inpatient rehab.

Government regulations, subsidies and policies are slowly destroying quality medical treatment and psychiatric care in this country. It’s no wonder that celebrities, rock stars and actors (the only ones who can afford private sector rehab) do so poorly! These programs assume that addiction is a disease over which one is as helpless as, say, cancer or heart disease. True medical problems benefit from surgery or medication where the recipient remains largely passive.

Unfortunately, that same passivity is also encouraged in clinical rehab. They spend a month or so attending meetings and perhaps a little individual counseling, while being exposed to the higher power aspect and (hopefully) the more rational components of AA. Then they’re set loose in the real world. Addicts are led to believe that they’re “cured” but when they get out, they find that everything that supported their “illness” – drugs, alcohol, friends who shared their addiction and the various triggers and situations that originally led to their departure from reality – is right there once again for the taking. Relapse is virtually inevitable. Lindsay Lohan and Charlie Sheen are examples, though there are many others about whom we never hear. Insanity is defined as doing the same thing over and over and expecting different results. Repeated and expensive inpatient rehab doesn’t “cure,” for the simple reason that addiction isn’t a medical illness. Even if it were, addiction takes place outside of the hospital in specific behavioral contexts.

At best, rehab is a time-out. For worst-case drug addictions, especially where there may be medical problems related to the abuse, a prolonged hospital stay may be required to stop the daily intake of substances. But effective and permanent addiction management doesn’t begin until the day of release. That’s where AA or (if it existed) a more consistently rational equivalent is needed to help restructure the emotional and interpersonal context that feeds the addiction.

Without that final component, they’re right back where they started.

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