Rehab, Is It Always Helpful?

A Healthy-Looking Amy Winehouse

The death of Amy Winehouse has produced such a landslide of tosh I hesitate to add anything, but so much of what has been written has been wrong, and in some cases positively dangerous I feel I must contribute.  There have been comments based on her biggest hit along of 'she should have gone to rehab' - rather missing the point that she had in fact just left yet another residential rehab days before her death.
There is the obvious question, does rehab work?  The answer is at best mixed:  as this report in Scientific American shows.  Most drug and alcohol treatment is not evidence-based:  it is faith based.  Once one walks through the looking glass into treatment alternative medicine is the convention. Acupuncture is pushed everywhere even though it just does not work.  Though only as an adjunct to the central treatment, the 12 Step Programme.  A serious contender for the most ridiculous statement on the subject came from Tanya Gold in 'the Guardian':  only the most enlightened doctors will recommend Alcoholics Anonymous or Narcotics Anonymous, self-help groups that sometimes get results, although no one knows why.   Well, in a word, no.
Virtually all rehabs fall into one of two groups:  those which call themselves 12 Step based or "Minnesota Method" (which is virtually identical) or those which say they are not but put in the small print "all clients are expected to attend 12 step meetings while resident and after care consists of 12 step meetings".  Ms Gold states that 12 Step programmes "sometimes get results".
They do if you use the alternative medicine tests of having testimonials:  anecdotal evidence.  When things are tested scientifically things are rather different.  A good summary of scientific studies can be found (along with much else of interest) at The Orange Papers.  Within that page the results of Prof George E Valliant are worth particularly close attention as it follows proper scientific practice in having control groups and Prof Valliant is a firm believer in AA.  Yet his study shows AA performing worse than nothing in many ways.  Especially, as we began with Amy Winehouse with the tendency of those who have undergone AA treatment to be more likely to binge afterwards and the higher mortality rate, which Valliant himself admitted was "appalling".
Another look at AA's effectiveness presented amusingly  can be found here:

If you don't want to watch the whole video (though why anyone wouldn't want watch Penn & Teller eludes me) there is a helpful summary at the end:  if you only remember one thing from this programme you just need one figure: 5% - that's the amount of drinkers who quit with AA and it's the number who quit by themselves.  So if you compare a random guy getting drunk in a bar one day with a guy who has been drinking but decides to turn over a new leaf and goes to his first AA meeting that day there's exactly the same chance of either being sober a year later.
That contradicts one of the AA core beliefs, that alcoholism a "progressive, incurable disease" which inevitably ends in prisons, institutions or death but the facts are that many alcohol and drug abusers do stop; indeed most of those who stop do it without outside intervention.
(Penn & Teller Part 2 & Part 3)
There is a widely-held view that alcoholism is a disease.  This did not originate with AA but it is largely because it has been repeated so frequently by AA that it has become so widely accepted.  The philosopher Herbert Fingarette, isolated the treatment paradox: "If the alcoholic’s ailment is a disease that causes an inability to abstain from drinking how can a program insist on voluntary abstention as a condition for treatment?" His book Heavy Drinking, the Myth of Alcoholism as a Disease is essential reading for anyone interested in the subject.
Somehow AA, its siblings, NA, Al-Anon and all the others have managed to establish themselves as the ultimate authority on addiction without their tenets being checked. The image presented is of benevolent self-help groups deliberately down-playing the cultish aspects and purpose of the 12 steps being to induce a religious conversion.  There is a lot more which could be said on this subject, but for now I would recommend browsing the Orange Papers subtitled 'One Man's Analysis of Alcoholics Anonymous and Substance Misuse Recovery Programs, and Real Recovery. An Online Book.'
Instead let's return to poor, talented Amy Winehouse.

A more recent picture.

She was a woman with problems.  In addition to her abuse of alcohol and other drugs she self-harmed, some would say the tattoos were as much self-harm as cutting herself, she had eating disorders, clearly she had great problems with self esteem and how she saw her own body, she was involved in at least one highly destructive relationship.
Some of the things AA teaches include.  "You are powerless over alcohol and drugs, have one glass of wine and you will automatically be back to the worst you've ever been, so there's no point stopping after one glass of wine, you may as well be injecting speedballs, in fact you will because you're powerless."  And "It's not your fault, it's a disease and you're powerless" but later "it's sin which can only be removed by God".  And to get God to forgive you you have to do your Step Four, where you confess all your moral shortcomings and defects of character and resentments, reliving all the shittiest moments of your life.  And everything is your fault.  Something bad happens to you, say you've been raped, you're supposed to look for what you did wrong.
Part of the AA programme is destroying the individual's sense of self worth, because AA   founder Bill Wilson reckoned all alcoholics were the same, full of grandiose inflated opinions of themself.  Bill Wilson may have understood himself, maybe he did need bringing down a peg or two in order to help himself, but I'm not sure the frail girl in the picture above needed it.
I'll end this on a personal note.  A few years ago I was in a detox unit and the scheduled event for 11am was a walk in the park.  On that day I was the only inmate who was physically fit enough to walk any distance and had been in long enough to be trusted not to make a run for it as soon as I got outside, so I ended up having a one to one chat with one of the staff.  She was a psychologist, we were about the same age, had some common experiences and it turned into something more akin to a chat between friends than formal therapy.  So when we were talking freely I asked her about how poor the measurable success rate for treatment was, and was told, honestly but 'off the record': "the problem that everyone involved has to face up to at some time is that nothing:  detox, rehab, treatment, 12 steps, makes any difference at all".