How It Works
Let me start by trying to address some of the issues Cheryl brought up.
She says she’s never seen a number so low for the percentage of people who start trying to quit or enter rehab who actually end up clean and sober.
The benchmarks for that are actually fairly straightforward. Nobody says “cured.” They say “sober after one year ” and “sober after five yeas,” which is also how most reporting on the effectiveness of cancer treatments works.
As for research into the effectiveness of programs meant to combat addiction, it’s one of the truly Alice in Wonderland experiences of modern lie to look into it. You’d think, given what an enormous issue this has become, that there would be a lot of it.
In fact, there’s almost nothing. Virtually all the research cited for the effectiveness of such programs is, when you hunt it down, not proper research at all, but either entirely anecdotal or self-reported by the programs themselves by methods it’s literally impossible to figure out, since the “studies” give you no clue.
There are, as far as I know, exactly two properly conductive research studies ito the effectiveness of rehab programs.
Two.
But first, let me correct something. I remembered the recovery rate at 3%. It was actually 5%. This doesn’t seem like much of an improvement to me, but here we are.
Anyway, of the two scientifically rigorous studies done of the effectiveness of rehab treatment for alcohol or drug addiction, the most famous is that done by George Valliant, who followed 100 patients admitted to an alcoholism treatment clinic in Massachusetts for eight years, and then contrasted their outcomes with the outcomes reported in a number of studies which followed untreated alchoholics over time.
The result? 5% were reliably sober for the eight years, and 5% of the untreated alchohlics in the other studies also managed to stay sober over time.
In other words, very few patients managed to get sober and stay that way after treatment, and their percentage was no higher than that of untreated alcoholics over the same time period.
What’s more, for the few short years Alcoholics Annonymous itself tried to carry out scientifically rigorous studies on its success rate–between 1980 and 1989–it consistantly reported that the percentage of people who entered its programs who remained sober for six months afterwards without a break was…5% to 7%.
And that was using a much shorter time period for declaring the program effective.
What’s more, the AA studies consistantly showed that over 90% of all alcoholics who entered the programs simply dropped out before the end of a sinle year.
Even ignorning the persistant suspicion among academic researchers that some of the rehab programs are simply making their statistics up, what you get when you look into the “evidence” is: studies reported without any indication of their protocals or an opportunity to examine their raw data; and studies reported not as percentages of addicts free of their addiction, but percentages of additional addicts free of their addiction.
That’s because “this program found 50% more addicts sober after a year than that program” sounds a lot more impressive than “they got out of 100 people sober for a year and we got 6.”
I think I know what the problem is in education–what it is we’re trying to hide by pretending that we’re actually addressing the problem–but I’m less sure with addiction treatments. Maybe it is just a matter of feeling helpless and therefore trying desperately to pretend we can fix something that is both destructive and dangerous and that we as yet don’t actually know how to fix.
Because I’m pretty sure that is what it is with cancer treatment. We haven’t really come a long way in treating most cancers. What we have done–and it is not negligible–is come a long way in detecting them.
Our methods of treating cancer are hamhanded and crude–slah, burn and poison, as one of Bill’s doctor’s put it–but the earlier you catch the cancer, the more likely the crude methods we have will do some good.
With some cancers, we’ve gotten to the point where we can detect the disease before it’s actually started. We can target “precancerous cells,” and that’s about as good as the news gets.
A real cure for cancer, on the other hand, would require us to understand why cells become “precancerous” to begin with, and how to stop that from happening.
But although I’m worried about the logjam created by failed programs and willful delusions in education and the treatment of addiction, I’m not worried about any such thing in cancer research. Not only does n obody have a stake in pretending that we’re better at curing cancer than we are, the results of our failure to be better at it are present, documented and undeniable. Dead bodies are dead bodies. As long as people die from cancer, there will be pressure fro the public to make sure scientists go on looking for something that actually works.
Of course, we’re back to square one, in a way. Deciding what “works” requires deciding what it is we want to do.
And I think we’ve gotten to the point, in the US at least, where actually educating anybody has become a secondary consideration, especially in K-12, but inreasingly in colleges and universities, too.
And right now I’m using “educate” to mean “competently literate.” It’s a low enough standard, and it requires only superficial acquaintance with the Great Tradition.
But I’ll get back to that–and the real problem that fears of racism have caused in US schools–tomorrow.
4 Responses to 'How It Works'
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Theodore Dalrymple (“Romancing Opiates”) believes that rehab programs are more a part of the problem than they are of the solution. Certainly in this country, from what I can see of the anti-smoking campaigns, they’re more about maintaining the “rehab industry” than about solving whatever the problem is that causes people to smoke (take other drugs, whatever).
Anyone who has ever quit after smoking heavily for an appreciable time will know that, rumours and mythology notwithstanding, quitting is easy. There are no significant withdrawal symptoms. Dalrymple believes the same to be true of opiate addiction.
The problem is that few “addicts” really want to quit which is the essential prerequisite for successfully doing so. From what I can see, rehab programs are just means by which addicts can be seen to be going through the motions while getting their health back to something approaching the norm before heading off back into the lifestyle they love so much.
The last people who want to solve the drugs problem are those, including the “rehab industry” who are part of it.
Mique
16 May 09 at 5:54 pm
My cynical take is that rehab programs are there so that the government is seen to be “doing something” about a problem.
On the subject of education, Australia finally has a nationwide system of tests for “literacy” and “numeracy”. I believe they are for grades 3,5,7 and 9. The teachers unions fought them tooth and nail.
There was some point to the opposition. By the definition of average, 1/2 the students will be below average. But standardized tests will at least allow us to find out if different teaching methods can change the average.
jd
16 May 09 at 6:03 pm
Color me unconvinced. Death statistics are generally pretty good. Often homicide statistics are the ONLY crime-related numbers for which one can conduct a proper study across time and countries–but it hasn’t advanced us very far in reducing homicide.
Sometimes you have a population devoted to the process rather than the cure–rehab, obviously, the therapy industry in all it’s guises, and so forth. Education seems to qualify here. The LAST thing such people want is a system which might honestly gauge progress or the lack of it. The complete lack of “good numbers” tells you exactly who’s in charge. Mostly they look like chapters in Huff.
Other times what you have is people who wouldn’t mind solving the problem, and perhaps desperately want to solve it–but only on their terms. Suggest to a diplomat that the way forward on an issue does not involve an interantional conference or respect for existing national borders, and you get much the same horrified response as telling a general that he needs to decentralize and receive fewer reports–or those desperate politicians in ATLAS SHRUGGED demanding a solution from John Galt–so long as it involved more governance. I am rather afraid that medicine falls in this category. Some of you may have studied the huge outcries over sterilzation of instruments and over innoculation. If we find a cancer cure and a trained medical professional can inject it with a needle, or give us a pill to swallow, the medical profession will be on it like a shot. If it turns out that diet and lifestyle is critical, the medical profession won’t have much interest. If the cure comes through meditation, we’re all going to die.
Jerry Pournelle observed that in every institution, there were those who advanced the ostensible purpose of the institution, and those who promoted the institution itself. The long-term tactical advantage, he observed, always lay with the promoters of the institution.
So nearly as I can see, he’s right. The only good news is that it’s true of institutions I don’t like, too.
robert_piepenbrink
16 May 09 at 6:27 pm
The Cochrane Report (I took a quick look yesterday since it has been quite a while since I read up on this) didn’t mention even those two reports, I assume, or else the author considered them poor too.
But two reports aren’t enough to confirm whether something works or, if it does, the “cure” rate. They give you something to work on; something for other scientists to try to replicate. The Valliant study sounds from your brief description like it might have problems the the matching of the two groups, especially since it sounds like his untreated alcholic rates came from other studies, so he didn’t select them himself to match the treated population. But I don’t know.
And Mique, if a desire to quit was enough, the treatment centres would be empty. There’s a world of difference between a drug user – even a heavy one – who, once the physical withdrawal is over, is ‘cured’, and the one for whom the physical withdrawal is the easiest part of a lengthy attempt to regain some kind of mental and emotional stability.
As for cancer – even oncologists have their preferences and beliefs about treatment which are not always entirely rational. Experts differ, and doctors get in the habit of using what’s familiar to them, or promoted to them.
I don’t see the connection you are drawing between these and the school. I think that there are profoundly different views among different people as to what it means to be an educated person, and (if two people happen to agree on that) what methods are most effective. It’s harder to figure out what method is best to teach all students reading than it is to figure out how to treat them for leukemia. To paraphrase one of my former professors – research with molecules is easy, because each molecule (of a type) reacts the same way to the same thing. Students don’t; that’s why research in education is harder than research in chemisty. (He had been a chemist).
cperkins
16 May 09 at 6:56 pm