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".

Swimming with Sharks

1:  Spare Some Change

1pm 2/7/11

There’s always someone after your money.

Very specifically there’s always someone outside Sainsbury’s in Westbourne Grove collecting for charity or selling the Big Issue though the problem is by no means confined to that one spot.  Maybe it’s an official collecting area or perhaps just a profitable pitch but there’s always someone there.  I try not to look at them.

“Collecting for disabled children,” rasped a Belfast accent from somewhere near my right knee.  It was surprising as the slumped posture and elderly clothes of the speaker had suggested that she was more likely to be collecting for a can of Special Brew.  Whatever the cause her aggressive tone and refusal to look at me would have stopped me donating, and the events of the previous day had not put me in a generous mood.

Far too much of it had been spent on the telephone.  I can remember when, in general, the telephone was a nice thing; before interminable menus, recorded announcements and call centres in Bangalore turned it from a way people talked to each other into an instrument of torture.  The phone would ring and I would think cheerily to myself, ‘ooh I wonder who this will be, another party invitation, mayhap, or could it be Ms Ciccione pleading with me to road test her new rubberware’ as I skipped to answer my wall-mounted trimphone. Nowadays the phone ringing elicits high-pitched whimper as I place a cushion over my head.

9am 1/7/11

The first call had gone quite well.  A few weeks earlier my utility company had sent me a letter telling me that my existing tariff was about to expire and that I need not do anything, they would simply transfer me to their Super Easy Bonus Save Tariff  (trans. Very Expensive Mug’s Rate).  All it had taken me was to go to a comparison site, find out the cheapest rate available, the ‘Bet You Won’t Spot This Small Print #22’ from the same company, a couple of soul-crushing conversations with the comparison site, (No. 1, ten minutes of asking me to repeat the same details over and over again then them saying it was too early to do anything and to call back on exact day the existing deal expired, No. 2 they called me back a few days later to ask me to repeat everything I’d said in call No. 1 another half dozen times until I hung up) and  then I was able to call the supplier, give the secret code for the lower rate and, Viola! I had reduced next year’s Gas and Electricity bills by £77.  Don’t let them screw you.

2:  Robbing Banks

 

The next bit of business wasn’t quite so simple.  I had tried to transfer money between two bank accounts.  Everything clickable on either website had been clicked in every imaginable permutation and nothing was happening.  It was time to brave the phone.  After hearing for the 98,738^th time that my call was being recorded for security and training purposes (yes I had gathered that) and why not save yourself time by going to our website, www.gnawyourownfingersoffinfrustration.com, where you can quickly and easily do lots of things (but NOT what I’ve wasted the last hour trying to do, which is why I’ve resorted to the phone) it was  time for the ever popular ‘key in lots and lots of numbers game’.

After keying in your account number, sort code, 2^nd. 5^th and 4^th digits of your password you’re allowed to negotiate a few more menus, key in your telephone number, date of birth, mother in law’s date of birth (Argh, I’m not married, snake; back to square 1) ages of Brad and Angelina’s kids and then you’re finally put in a queue to speak to a human being.  When one eventually answers they ask your for name address, date of birth, account number (by which time the website which you had open earlier to remind you of this has helpfully logged you out for your safety and security).*

After the sweating and shaking had subsided enough for me to speak coherently I learned that the reason I had been unable to transfer money from Bank A to Bank B was that my account with Bank B was an ISA, a long term savings instrument, and Bank B had hit on the money making wheeze of giving you a different account for each tax year.  All I needed to do was open another ISA for this new tax year and they would consent to take my money.

Fortunately I have learnt to treat banks with just as much trust as I would give a tiger with toothache which hadn’t eaten for a month.  “So what happens to all the old accounts you build up,” I asked?  It turned out Bank B offered a decent rate on the current year’s ISA but all the old accounts dropped to 1% after a year.  Now I may not be a qualified accountant but even to the barely financially literate me this spells ‘Rip Off’.  No thanks, Mr Bank.

So, the phone call to end all phone calls.  Go to the paragraph above marked with an asterisk, repeat (except this time add keying in the ages of all Mia Farrow’s offspring except the ones by you-know-who).  And repeat again.  Extra, super-duper long wait before a helpful person answers who says, “No Bank A don’t pull that trick, and we’ll pay the same rate on last year’s deposits as on this year’s ISA”.

“Could I open one,” I whimpered, between sobs.

“I’ll just transfer you to our ‘Opening an ISA’ department.”

A mere five minutes or so later someone answers, I only have to key in a few dozen more digits.  “I’ll do it,” I mewled.

“There is a bit of reading I have to do.”  Page after page of incomprehensible gibberish comes back at me.  Much of it seems to be the same paragraph, over and over again with a single word changed.  It’s like listening to Ed Milliband. 

“Yes,” I moan during pauses.  There are lots of pauses where I’m expected to assent. Finally, unbelievably, it ends, and I’m still conscious.  “Now about transferring the money from my Web Saver Account, like you said we could?”

“Ah.  That will mean transferring you to the ‘Closing Down Internet Accounts Department:  I’ll just put you on hold for a moment.”

The minutes dragged by.  Pressure sores were forming on my ear, and I began to wonder if I’ll end up in A&E having an ingrowing telephone receiver surgically removed.  Silence mounted, I had long ago exhausted all possible interest in the game of ‘keep all the bank tabs open by clicking them before they log you out’.  After a few plaintive calls of “is there anybody there?” I could take no more and hung up.

When the pain began to subside I did a rough calculation. I had stopped Bank B ripping me off.  Good; it’s a matter of principle, don’t let them rob you by inertia.  But this hour of agony has gained me less than forty quid in interest over the next year.

3: Night Life

3am 2/7/11

The doorbell buzzed.  And again.  And again.  Long, long rings.  Angry-sounding rings, or, more likely, desperate ones.  I lay in bed.  There is no point shouting at a person ringing your door in the middle of the night to go away:  that’s opening a channel of communication, “please, please let me in, I’ll explain, just let me in, I’ve got a good reason, please,” and it would go on much longer.

The writer William Donaldson once said (approximately, I’m quoting from memory) “I’m the kind of person who will always answer the phone at one am because it will be a drug dealer or prostitute rather than a bank manager.”  (For more on Donaldson’s louche life his Wikipedia entry is here or read the fascinating biography You Cannot Live As I Have Lived and Not EndUp Like This: The thoroughly disgraceful life and times of Willie Donaldson. ByTerence Blacker.)

I used to live something like Donaldson.  Which is probably why the door still occasionally rings at absurd hours, it’s an echo of more reckless days. Things have changed now.  I’ve got more possessions that I care about, more to lose, and rather less in the way of libido that I used to have. I don’t want to seem like some fuddy-duddy old materialist but I’ve paid for my laptop and Kindle and DVDs and I’d rather I had then than anyone else, that’s all.  Plus I’ve acquired a liver which couldn’t endure a third bout of Hepatitis, the rest of my body couldn’t take a second course of Hep C treatment and perhaps I have gained some common sense.

I remember one occasion when one of the night people I knew brought round a friend, much to my annoyance.  When the one I did know was out of the room her friend said to me, “you have to be careful with these people:  they mistake kindness for weakness.”

The biggest thing is; it’s no fun when you’re constantly watching your back.  No matter how many drugs you take the need to be constantly watching out destroys the buzz.  So no more 3am visitors, though if it were a choice between that and spending my days saying my prayers and “Working the Steps” pass the syringe.

 

4:  Spare Some Change 2

1.30pm 2/7/11

I had bought my lunch and was almost home.  A tiny voice appeared by my right knee, “anything for two pounds.”  There was an absurdly-pretty little girl, maybe three years old, standing in a doorway with a couple of picture books and small toys laid out on a toy chair beside her.  A huge, involuntary “Aahh” formed in my mind:  she was so irresistibly cute.  But I really didn’t need a picture book or a stuffed toy, and it dawned on me that she might be cute now, but this was precisely the sort of behaviour with which the crazed-eyed business-speak-babbling sociopaths on the Apprentice started and therefore definitely not to be encouraged. 

A few steps down the road a man spoke to me.  He had a thick beard, looked a little older than me, though that was probably the beard and the lifestyle:  being homeless adds a good ten years to your appearance:  no smell of booze at all, unusually.  He started to give me his spiel about how he’d been to ‘the Centre’ nearby (whatever that was) but they had run out of sandwiches and he was hungry.

I’d run out of resistance.  Keeping hold of money is just too much hard work.  “I don’t need the story:  Have a couple of quid.”

“No, honestly, they had run out of sandwiches…”

L'esprit de l'escalier:  at the time I couldn’t think of anything to say and just walked away, but afterwards I realised what I had wanted to say was “have a good fix”.  You can’t keep holding on tight all the time.