As we try to understand addiction and recovery, it has become increasingly clear that most people do not recover by following the most frequently prescribed methods. The private, for profit treatment industry is primarily based on abstinence from drugs of abuse and compliance with insight oriented therapy and 12 step recovery groups. This method is most often prescribed because it is thought to be the best that we have for treating addiction and no other methods have been shown to be more effective. However, relatively few treated individuals maintain complete abstinence and aftercare compliance with “the program” This leads to the perception of a very low positive outcome rate for addiction treatment as a whole.
Outcome research with privately treated addiction patients is notoriously difficult. Most available data comes from the follow up patients that we can easily see over time. One small set of follow up patients we call “compliant”. These are the patients that we see in post treatment after care groups and therapy and who appear to be involved in 12 step community support. The other small set that we can easily see is the “non-compliant group”. These are the patients who present in need of additional treatment following “relapse” and who almost universally report that they were non-complaint with the treatment plan. Unfortunately, both of the groups are relatively small as a percentage of the total population who have received addiction treatment. When each of these groups (“compliant” and “non-compliant”) are combined they represent, at best less than twenty percent (20%) and probably less that fifteen percent (15%) of this population. We have then used this low percentage data to reach a compliance based solution called “it works if you work it”. The implication is that we have a plan that will work if you are compliant and you will not get better of you are not.
The problem is that both of these groups may be outliers in this model. They may not represent the addiction treated population as a whole. In fact, they probably do not.