I like to think when it comes to methods of recovery, I keep an open mind. But it’s time I got honest with myself and admit that I am not as Switzerland as I would like to be. I wouldn’t say that I’m an adamant “stepper” (as anti-12-step folks like to call those of us who work steps to stay clean and sober), but since that is how I quit drinking, smoking and sexually acting out, I can’t deny being somewhat biased in that direction. However, I am well aware that just because it worked for me doesn’t mean it’s for everyone. The most important thing is that people struggling with addiction find what works for them because at the end of the day, that is all that matters, right?
The Right Things for the Wrong Reasons
Which is why I am not completely at odds with the 2,500-word advertisement for Dr. Mark Willenbring’s (former director of treatment research at the NIAA) Minnesota rehab, Alltyr, which posted in The New York Times last month. The piece, penned by none other than anti-AA crusader, Gabrielle Glaser, paints Willenbring as the one man who is saving the world of dying heroin addicts while still managing to look smashing in John Varvatos. But it does seem like Alltyr offers many of the state-of-the-art treatment modalities, like Motivational Interviewing (MI) and CBT, employed by other successful rehabs. And the fact the treatment center is a relatively affordable outpatient facility located in St. Paul, Minnesota (hometown of the traditional inpatient rehab), does make it a less common business model and something the people of the Twin Cities should appreciate.
Unfortunately, information about the wonderful services offered by Alltyr is somewhat overshadowed by the glaringly slanted tone of the piece, which is resentful with an overt agenda to disparage AA. It’s not clear what bashing treatment methods that have worked for so many people accomplishes in an article about recovery. It would be a much stronger choice to acknowledge how beneficial 12-step has been for so many over the last 80 years but it hasn’t worked for everyone. The piece does present facts and figures about how our country’s drug problem has spiraled out of control in the last decade. There is a call to action that we start looking at as many treatment options as we can—which is just the plain and simple truth.
I’m an Addict, Does it Matter Why?
I was confused by how much time Glaser spent at the top of the piece driving home the idea that the majority of addiction is based in genetics. I’m not sure if the 60 percent number she throws out is accurate but honestly, who cares? If you can’t stop drinking or sticking a needle in your arm, does knowing you are genetically predisposed to addiction help? I have always been aware of my alcoholic genes and it didn’t make one bit of difference when it came to getting sober. But I guess if you believe that shame is the driving force of addiction, then I can see how that information could factor in. However, addiction being a disease that the addict can’t control (and should not be ashamed of) is not a new concept and is strongly supported by the 12-step community. So the idea that a 29-year old opiate addict, who has been trying to get clean for 12 years, heard this for the first time in Dr. Willenbring’s office proves only that he should invest in a hearing aid.
I don’t know where Gabrielle Glaser has been for the last 10 years, but her claim that rehabs “largely adhere to the 12-step principles” is pretty outdated. While technically the majority of treatment programs may still have a 12-step component, there are certainly many programs that do not force the 12-step philosophy on their clients and many that don’t include it at all. She also claims that AA/NA tells addicts they have a moral defect. I have never been told at a 12-step meeting I have a “moral defect”—quite the opposite. I have been told that I my alcoholism is not a moral issue at all, but a spiritual one. And I have found that to be true.
Another strange claim in Glaser’s piece is that treatment centers typically offer group therapy led by counselors “whose main qualification is their own completion of the program.” Whether she means they are alcoholics and addicts who have gone through the 12-steps or those particular programs, is unclear. Either way, I wish this were the case! Would you want to take a parenting class from someone who never had children? The truth is, most rehabs require their staff to have some kind of credentials, like being a CADC/CDAC, LADC/LDAC, CASAC, CSAC, CSW/LCSW and the list goes on. Whether they happen to also be in recovery is a plus, but unfortunately not a requirement.
The Good
Putting Glaser’s spin aside, what can be mined from this piece is that Mark Willenbring, though not an addict himself, has taken his background in academics, passion for psychotherapy and experience in the field of addiction and rolled it in to one pretty cool rehab. Though Alltyr doesn’t appear to be offering anything different that what is available at most Malibu Model and other high end rehabs, it is offering it on an outpatient basis and at a fraction of the price. But when your clientele is in the Twin Cities area, I suppose you don’t have much wiggle room when it comes to what you can charge.
What I also like about Willenbring’s technique is the idea of ongoing treatment. This is what I also love about 12-step; a way for addicts to continue to address their issues that stem from their disease long after they have physically detoxed. This kind of ongoing self-awareness and accountability are a huge part of why 12-step groups are so successful.
Willenbring claims to “treat addiction as a chronic medical condition,” by following the protocol of initial assessment, diagnoses (which can include alcoholism, addiction and any other psychological disorders he observes to be in play) and then prescribes the appropriate medication. But here is where Willenbring’s methodology becomes a bit unorthodox in the eyes of traditional abstinence-based recovery. He will prescribe clients medications ranging from standard antidepressants (non-narcotic) to ADHD and chronic pain (typically narcotic-based). This is all well and good, and may be necessary, but it doesn’t appear that Willenbring recognizes the delicacy of prescribing drugs to addicts. For example, can a former meth addict really take Adderall as prescribed?
The Bad
While the article doesn’t come right out and say that Willenbring compartmentalizes things like shooting heroin and taking Oxycontin for chronic pain, it feels like this is inferred by his laissez faire stance on things like smoking pot or even drinking while in treatment for opiate addiction (I am not sure what his position is when a patient is being treated for alcoholism). While this is a great way to get people who don’t want to get clean and sober to come to treatment, as an alcoholic and addict, I am not sure how effective it is at helping people recover—in other words, actually get clean and sober.
That’s the big chink in the armor of Alltyr as a rehab business model—the goal doesn’t appear to be recovery from addiction. The goal seems to be getting patients to a place with their drug use where they are not endangering their lives on a daily basis. In fact, according to Willenbring, abstinence-based recovery may detox the body but it doesn’t relieve the addict from their cravings. It also lowers their tolerance for drugs, so when they get out of treatment “they use the same amount as they did before and die of an overdose.” Using drugs like Suboxone prevents opiate addicts from going through withdrawal or craving opiates because they are still on opiates. So Willenbring’s approach seems to be saying is, once a drug addict, always a drug addict and the only hope of survival is to stay high on some level. Yikes.
More Community, Not More Opiates.
Thankfully, I know this isn’t true. As a member of a huge recovery community on Los Angeles, filled with every kind of drunk and drug addict you can imagine, I know first hand that not only is making a full recovery from opiate addiction possible—it’s common. Much of that can be attributed to the working models of treatment employed by the amazing rehabs here. I understand this probably isn’t the norm in places like St. Paul, Minnesota, but what that tells me is we need more community, not more opiates.
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