Over the weekend, yet another famous entertainer—Cory Monteith, star of "Glee"—died following a stint in rehab, which Monteith said he entered in April of this year. (Monteith, who is Canadian, did not say where he was treated.) He had spent the night out with friends and returned alone to his Vancouver hotel room to die in the early morning. Autopsy results are not available, but it is highly troubling when an outwardly healthy person (Monteith played a football star on the show) dies at the age of 31, weeks after receiving "treatment" for his substance abuse.
This follows the death of Amy Winehouse after being treated at a private addiction rehab. The cause of death was alcohol poisoning (drinking far too much). Could the cause of death also have been "attending rehab"? After all, Winehouse had managed to stay alive prior to her treatment for substance abuse. As I wrote for PT Blogs: "Did a policy of abstinence uber alles cause Amy Winehouse's death?" It seems very suspicious that a woman enters rehab—which is totally abstinence-oriented in the U.S. (Winehouse was treated in Britain)—then overuses the substance to the point of killing herself at her nearest opportunity. Might this cause us to re-examine our dominant treatment approach?
Such a re-examination won't happen. We know this because Dr. Drew Pinsky, proprietor of "Celebrity Rehab," has simply doubled down on his 12-step, abstinence-only approach following the death of a fifth graduate of his program. Maia Szalavitz calculated in the on-line recovery magazine The Fix that this represented a 13 percent mortality rate within a couple of years in a program that began in 2010. Instead, Pinsky—who is regarded as an addiction expert throughout the media (Dr. Sanjay Gupta regularly interviews Dr. Drew on CNN)—argues how necessary his treatment is for these poor souls.
Dr. Drew's highly successful (in media terms) approach is to make grandiose, but meaningless, generalizations about brain functioning while applying down-the-line 12-step treatment principles. As I wrote for PT Blogs in describing "The Secret of Dr. Drew's Success":
Dr. Drew presents his trademark -- making vague and meaningless claims about Charlie Sheen's motivation and judgment based on brain processes. If you listen carefully, it's not clear what Dr. Drew says causes these brain-based, residual impairments. Are they actual drug effects? Are they pre-existing in the addict? Are they permanent impairments that outlast intoxication or actual use?
I have been noting this association of abstinence treatment with death in workshops and lectures for some time. Meanwhile, America's premier drug policy advocate, Ethan Nadelmann, made the following startling declaration in The Fix:
Where the 12-step thing has the most to own up to is its role in impeding harm reduction interventions to stem the spread of HIV/AIDS. Why was it that Australia and England and the Netherlands were able to stop the spread, and keep the number for injecting drug users under 5-10 percent, and the U.S. was not? It's that notion that abstinence is the only permissible approach, that we are not going to "enable" a junkie by giving him a clean needle. There has to be a kind of owning up to that role in hundreds of thousands of people dying unnecessarily. . . . (emphasis added).
One might think that such a pronouncement by a leading policy figure would make us re-examine our policies and practices. Not in the least! Conservative thinkers like David Brooks and cutting-edge technology journals like Wired join together in praising AA to the sky. A new movie (due out in September), "Thanks for Sharing," starring cultural icons Tim Robbins, Mark Ruffalo and Natasha Richardson, is a paean to AA. America remains at the forefront in the world in its opposition to harm reduction: in 2011, the United States Congress repealed its extremely belated support of needle exchange, leaving America alone in the Western world in eschewing this approach to preventing HIV/AIDS. (See here as AA—via Treatment4Addiction.com—attacks me for pointing out the negative impact worldwide of America's approach to addiction.)
As I make clear in Diseasing of America, our approach to addiction is not a medical one, but a cultural phenomenon—one steeped in our temperance traditions. America's recovery movement is not about helping addicts (witness Nadelmann's declaration that it has resulted in the deaths of hundreds of thousands of addicts). Anne Fletcher, in her brilliant Inside Rehab, makes clear that American rehabs don't practice useful therapeutic techniques. As Nadelmann declared in The Fix: "I am continually stunned by the lack of humanity and the disrespect for science and public health that I see."
Instead, our supposedly scientific, medical treatment approach is really a matter of hectoring addicts and alcoholics for their bad behavior. Maia Szalavitz has analyzed the key treatment technique in American rehabs: shaming people, as she noted Dr. Drew regularly does on "Celebrity Rehab." This, even though the therapeutic benefit of this technique has been refuted time and again:
A review of the research on the use of humiliating, confrontational tactics, which attempt to induce shame, found that none of the studies done in four decades supported this approach. In one study included in the analysis, the more the counselor confronted the client with past mistakes or other shaming information about his problem, the more the client drank.
The United States is about punitive attitudes towards, shaming, and punishing substance use, intoxication, and drug addiction and addicts and alcoholics. So, when people die as a result of our treatments and policies, we simply shrug our shoulders and carry on killing them. Remember Terry McGovern, who died drunk in the street after being in and out of rehabs, after which her father, George McGovern, was presented with an award by Harvard for his addiction contributions. (McGovern also had a son who died prematurely due to his alcoholism.)
What was wrong with Terry McGovern? As George finally realized in a moment of tragc, horrifying insight:
"She knew what makes a good person," McGovern says. "She knew what compassion was about. She knew what it meant to love other people. But she fell short of loving herself."
Nothing in American treatment is about addicts caring for themselves. And we recoil from programs that treat active addicts and alcoholics like human beings who deserve to live their lives. Why should we—the American recovery movement says they are as good as dead if they continue to use, then does everything it can to make sure that this happens.
Follow Stanton on Twitter and in his Life Process Program.
Post script (July 16):
Thank you for writing this
I've been a sober member of AA for over 20 years but more and more I now see how harmful its choke-hold on nearly all available treatment in this country is. People with addiction problems are assumed to be worthless, lying, unloving, and less than human because of how Bill Wilson viewed alcoholics in the Big Book back in 1938. Most women, and many men, come to AA already thinking they have no worth, then they are told to abolish their ego and constantly look for their defects and how every thought they have is probably selfish and self-centered with self-centered fear. After so many years of that a person can start assuming self-hatred is the mark of "recovery".
One thing your article didn't stress enough is the idea of relapse shame. We are told in AA that to have one drink is as much of a relapse, failure, and loss of status as a week-long binge. And we are told that once we have the first drink we cannot stop. Is it surprising that a person who takes that first drink is quite likely to go on to consume a huge quantity of alcohol/drugs? If you are going to lose your "time" and have to "start over" and face shame in "the rooms" you might as well get your humiliation's worth, and they said you couldn't do any different anyway.
PPS (July 18):
Submitted by Shawn P
Are you SERIOUSLY trying to make the supposition that Treatment Centers kill people and that AA is a bad thing? I take it you are not an alcoholic or an addict, have never been to rehab and do not know what the 12 steps entail. Yes, Rehab is a billion dollars business but it has helped MANY people including myself to recover. (I’ve been sober for 12 years) The fact that some people die after leaving treatment is because they choose to use and EVERY alcoholic knows to drink is to die. It’s an advancement of their disease and NOT a failure of the treatment center or AA which has helped millions of people recover from alcohol addiction. Your article is so blatantly irresponsible and will lead to many not seeking help because of it. Shame on you! (emphasis added)
PPS (July 19):
Submitted by Claire on July 18, 2013 - 9:18pm.
Reading this article was so devastating to me, I am in recovery from serious addiction. Hope is a precious thing that I cling to, I am entering rehab for the third time this year in a couple of weeks and I am so desperate, I need it to work. I don't wanna die.
I didn't really have the concentration to read this article very thoroughly, but it really depressed me that it seemed to say that recovery through complete abstinence leads to impulsivity and death... I need to be abstinent, I need to get better.
Someone please tell me recovery is possible
Submitted by Stanton Peele
you've been forced back into rehab three times in a year and to ask me (and others) to tell you that it works? Isn't that like asking an atheist to convince a doubting Christian that Jesus loves them?
You are involved in a process -- stay with it and think it through. Ask your genuine questions in rehab -- aren't they being paid $tens of thousands to help you? And when the answers don't make sense to you -- they're not helpful or don't jibe with your experience -- express your honest thoughts. You can't "cheat" your way through this exam.
My thoughts are that when you come to see that you don't have a disease -- that you control your own destiny -- then you will be cured -- that what you are being taught now is only setting you up for the uncertainty, self-doubt and relapses that you have been experiencing -- but you tell me whether that is true or not.
My next book -- with Ilse Thompson -- "Recover! Stop thinking like an addict" lays out a way for you to change your thinking, but it says that people do it all the time on their own (read the comments to this blog).
You are strong enough to get through this process (including rehab) -- but you have to take control of it.