How Rehab Makes You Believe You’re an Alcoholic

Outdated thinking and assessments create potential problems.

Posted Jul 11, 2018

  • Have you ever looked into rehab for yourself or a family member and been disappointed by the lack of options?
  • Have you ever had a bad experience or ‘failed’ after a rehab placement?
  • Have you felt frustrated by a facility because they labeled you an "alcoholic" and insisted you give up on alcohol before they offered you any actual support?

I’m not surprised…

What if I told you that many rehabs still hand out an assessment tool from the 1930s to their visitors? I picked one up at a recent talk I gave (see the picture below) as a handout at the door. The Johns Hopkins 20-Question Assessment is severely outdated and out of step with reality, and yet it’s still widely used online and in some rehab facilities. Imagine someone trying to use ether on you in surgery or giving you mercury to cure your cold (yes, these are actual old medical practices).

Adi Jaffe
Source: Adi Jaffe

It’s absurd.

We've come a long way in research and treatment approaches for medicine and addiction in the last 90 years, and yet we still rely on archaic and harmful assessment tools like these. Assessment tools that focus on inappropriately broad definitions that are sure to snare many into thinking they’re alcoholics. This is not the way to find out if you have an alcohol problem.

There are many treatment facilities across the United States—about 15,000 according to SAMHSA—with little regulation of therapeutic methods, and many of these providers use outdated assessment and treatment approaches when it comes to addiction.

This reliance on outdated methods is at least part of the reason why many rehab facilities insist that you:

  • Acknowledge you’re an "alcoholic" immediately (this happened to me less than 30 minutes into treatment).
  • Quit alcohol altogether before entering the program (many of the people who come to see me resist the notion that their drug problem will require lifelong abstinence from everything).
  • Avoid alcohol at all costs, or else it is seen as a relapse—i.e., failure (I was kicked out of rehab for relapsing and so were many of my clients).

Before you even set foot in a facility, you are judged, shamed, and stigmatized as an alcoholic, and we wonder why people won’t use the available help?

What STOPS you from seeking treatment?

If you answered abstinence, then you are not alone. When I was a postdoctorate researcher at UCLA, I discovered that only 10 percent of individuals with alcohol or drug problems enroll in treatment. I was shocked.

When I started a study to look at what it was that was keeping 90 percent of people from getting help, I learned that about 50 percent of the respondents indicated they enjoyed drinking/using drugs too much to stop. This was the reason they delayed or avoided treatment. 

Now, it’s important to mention here that these people were part of the study because they were interested in treatment options. So, let’s avoid the labels “lazy” and “unmotivated” or “in denial” that are often associated with addicts. These individuals wanted treatment, they knew they needed help, but they did not want to stop drinking or using altogether (at least not yet). 

To everyone else, this seemed oxymoronic. That's when I realized; maybe we were approaching this all wrong?

“What if people wanted help, but they just didn’t want to stop?” —Adi Jaffe, The Abstinence Myth

What if people wanted help BEFORE they quit (or reduced intake of) alcohol and drugs? Rehab facilities want people to QUIT first and then seek help. But isn’t the biggest hurdle for many the stopping in the first place? Isn’t that where this "help" would come in handy?

Labeling everyone as "alcoholic" sets people up for failure

Assessments like the Johns Hopkins nearly 90-year-old 20-item questionnaire are heavily biased against drinkers, leaving nearly anyone who drinks at risk of being labeled an alcoholic (take it yourself, right now!).

Some sample questions:

  1. Do you drink because you are shy with other people?
  2. Have you ever felt remorse after drinking?
  3. Do you crave a drink at a certain time of the day?
  4. Do you drink to build up your self-confidence?

Sure, there are more relevant questions in this assessment, such as “Have you ever been to a hospital or institution as a result of drinking?” But those are meaningless placeholders when a mere two “Yes” responses win you the coveted “chances are that you are an alcoholic.” Three affirmative responses and you are diagnosed as “definitely an alcoholic” according to this form.

These methods have nothing to do with the modern notion of alcohol use disorder assessments (and I can guarantee that John Hopkins does not stand behind this assessment even as it is still touted by many for the cache it provides this ridiculous and outdated form). This form is essentially created to MAKE people believe they are alcoholics.

Honest Exploration: A nonjudgmental approach to alcoholism

So, what other options do we have available to assess our drinking behavior? There are much better, more scientifically proven assessments to utilize to determine how severe your alcoholism is.

We can start with the AUDIT (Alcohol Use Disorder Identification Test—you can take our automated version with immediate response HERE). Used as one of the assessment tools in my IGNTD recovery course, it offers a shame- and judgment-free assessment that generates an understanding of the severity of one's drinking.

The AUDIT asks 10 questions that place people across four categories of alcohol problems: low risk, moderate risk, high risk, and potential dependence. It is used to assess where you stand regarding your alcohol use compared with the norm and can be a motivator toward healthier behavior. This is quite different than the ridiculous rating of—potentially an alcoholic, likely an alcoholic, or definitely an alcoholic, that the 20-question assessment offers.

Understanding the severity of your drinking is important, but in my IGNTD recovery course, I extend the Honest Exploration method to examine ALL aspects of your life. It involves looking into the life experiences that have brought you to this point so that the underlying reasons for the drinking problem are not forgotten. 

It’s only when all the underlying issues are examined, accepted, and treated that you give yourself the best chance of minimizing or abstaining from alcohol and improving your life.

We must stop the madness

It is simply absurd that 90-year-old, outdated, and shaming assessment tools are being handed out at professional treatment facilities across the country. As far as I’m concerned, this is the equivalent of surgeons not washing hands before cutting open a patient or neurologists feeling for bumps on one’s head to measure intelligence.

We need to introduce nuance and evidence into our assessments of individuals and move away from fear and all-or-nothing, shame-based tools. We need to look at individuals—the unique circumstances that have led them to this point and the unique circumstances that will move them forward in their lives.

“Clearly we needed a path to recovery that was wide open—where everyone could seek and receive help and without abstinence as the prerequisite and only measure of success.” —Adi Jaffe, The Abstinence Myth

Do you want to ditch the traditional treatment options for alcoholism? Want to find an approach that works with where you are at right now, that doesn’t necessarily involve quitting alcohol, that does not require you to check out of your life for weeks at a time, or shame you when you have a setback? Discover how the IGNTD recovery approach is changing the way we treat addiction and changing lives in the process. You can access it through the course or in my upcoming book, The Abstinence Myth.

Copyright 2018 Adi Jaffe

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