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Alex_ Powered By Docstoc
					[ Doctor DeLuca’s Addiction Website ]

Alex,

Maia asked me to forward this to you, and asks that
you call her so she can apologize about the editorial
hatchet job that NY Mag did on the article. This is
what she submitted to them. You can compare it with
what they published.

I think we should write a very strong letter to the
Editor about this whole thing. It certainly doesn't
represent a journalistic highpoint!

Fred

--- Maia Szalavitz <maia@ECHONYC.COM wrote:
  Date:     Tue, 4 Jul 2000 08:09:52 -0400
  Reply-to: Academic and Scholarly Discussion of
  Addiction Related Topics
  <ADDICT-L@LISTSERV.KENT.EDU
  From:      Maia Szalavitz <maia@ECHONYC.COM
  Subject:   NY Mag (my original)
  To:       ADDICT-L@LISTSERV.KENT.EDU

 Rehab Reversal:

       The world of alcohol treatment has been stirred up recently by a controversy it
thought it had settled long ago: can alcoholics ever learn to drink moderately? The
treatment industry, based on the precepts of Alcoholics Anonymous claimed that
alcoholics (and other addicts) must always abstain. Following these professionals, the
public agreed. But, as a recent episode of 20/20 pointed out, scientific research on
addiction problems has long suggested that the truth is more complicated.With managed
care and other forces pushing every type of care to produce hard data to justify insurance
coverage, the field is only now being forced to face these facts. Though some--like the
Betty Ford Center-- which wrote letters to ABC complaining that the 20/20 show was
"sensationalistic, simplistic and unbalanced" and that people would die as a result of its
presentation of controlled drinking-- are kicking and screaming, many others are started
to embrace the research.

       Take the Smithers Center's move. In alcohol and drug treatment, it's comparable
to the Catholic Church reversing its position on abortion. The center--which is famed for
treating troubled Met Daryl Strawberry and Pulitzer-prize winner Nan Robertson-- has
actually ditched the abstinence-only approach.
Counselors, who once told patients that prayer and AA meetings were their only hope of
avoiding jails, institutions or addiction-related death, now help them decide for
themselves how to recover. Cut down
rather than quit? No problem, Moderation Management meets on site. Need
medications? We use everything from methadone to Prozac. Want to quit crack but not
marijuana? We have techniques. Prayer? Not necessary.

         "No matter how you put it, it's pretty damn radical." said John Bellamy Taylor,
Director of Evaluation Services for Smithers "It is radical for addiction treatment, but it's
really a return to traditional medicine," said Dr. Alex DeLuca, Chief, Addiction Medicine
for St.Lukes/Roosevelt Hospital which runs Smithers. "In medicine, you start treatment,
and if it doesn't work, you change it. I humbly submit that this is the way alcoholics
should be treated, but it very often isn't."

       In the 1950's, Smithers was one of the first to adopt what is called the Minnesota
Model-- other remaining pioneers are Minnesota's Hazelden and the Betty Ford Center.
From this perspective, total abstinence from all psychoactive drugs for all alcoholics and
addicts is compulsory from day one-- and anything else, even if it results in major life
improvements, is failure. Attending 12-step meetings is considered the only route to
recovery. A typical day in Minnesota Model treatment consists mostly of group therapy
and 12 step meetings-- the aim is for patients to admit their addictions and commit to
abstinence. Acceptance of
"powerlessness" over drugs and surrender to a "Higher Power," (generally God) is
vigorously promoted. Resistance is confronted. Patients who don't comply are said to be
"in denial" and often expelled. Critics have long charged that this approach is little more
than brainwashing and recruitment into a thinly-disguised religion. "We do find that
people who go to 12 step meetings do better," says DeLuca, explaining why AA ruled for
so long. "But it doesn't work for some and I'm not going to tell them, 'Come back after
you have
suffered some more and are ready to do it our way.' I can't operate that way as a
physician."

       At the new Smithers, the inmates run the asylum, in some sense. AA and
abstinence are recommended-- not required. Counselors cajole, not confront. The
kinder, gentler Smithers recognizes that there are ways to improve relationships,
productivity and health even if lifetime abstinence cannot be achieved. This ostensibly
common sense approach is backed by reams of research-- but the field has refused, until
recently, to consider change. The idea of choice for people seen as "powerless" over their
behavior doesn't make sense to traditionalists-- and options other than total abstinence are
viewed as a slippery slope, "enabling" continued denial and compulsive use (despite lack
of evidence to support these contentions).

       Dr. Anne Geller, DeLuca's predecessor, understands why counselors (who often
themselves recovered through AA) might not accept other techniques. However, no other
area of medicine consistently rejects scientific advance. "Would you want surgery done
now the way it was in the 50's?" she asks.
        Kenneth Lewis has been a counselor for Smithers for 16 months. He found the
changes difficult. "It conflicted with my training," he said, "But it gave me a chance to
re-think what I believed. I found that my
belief system was faulty."

        Smithers' has re-made itself gradually, reflecting a growing trend. Said William
White, author of "Slaying the Dragon: The History of Addiction Treatment and
Recovery in America" (Chestnut Health Systems, 1998) "I don't think the Minnesota
Model is dying out, but its traditional assumptions are under enormous challenge. People
are moving away from 'this is our program' to offering a menu, real options." Pressure
from managed care-- which resulted in the closure of half of U.S. rehabs in the last 15
years-- has forced remaining centers to prove that what they do works. Comparative
research hasn't been kind to them.

       When asked for comment on the new Smithers, Christine Anderson, a
spokesperson for Hazelden was shocked. Radical? "Boy, I'd say so," she said. Despite
the research, Hazelden "will stay with our current model. We are sticking strictly with
the AA concept." she said. The Betty Ford Center did not return calls or faxes. As for
Smithers' patients, most seem to prefer choices to old-style coercion. Said DeLuca, "We
have people who are so relieved that it's not the nightmare they thought it would be--
some melt they're so happy it's not what they saw on TV."


[Note: I did see the version that ran before it ran, but I didn't catch
 one mistake and the tone didn't sound as wrong as it did without the
 horrible headline and illustration they used. -- Maia]

				
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