[subabuse] RE: subabuse digest: August 28, 2001 Date: Thu, 30 Aug 2001 18:31:32 -0700 From: Lonny Shavelson <lonny@photowords.com> Reply-To: "Subabuse" <subabuse@lists.jointogether.org> To: "Subabuse" <subabuse@lists.jointogether.org>

Thanks, folks, for your responses to my book, "Hooked."  I'm not going to go into much at length here (having already written about 120,000 words in the book), but to respond briefly to the comments that what I observed in researching "Hooked" applies more to the public rehab system than the private --  Well, yes, and no.  The major problems illustrated by the stories in the book: We expect (insist) that clients can maintain sobriety while in programs, when what they came to us for was help because they can't maintain sobriety.  This fundamentally strange idea, that they have to be cured to be treated, still strikes me as bizarre.  That concept correlates with another issue of rehab -- our often inappropriate responses to relapse. Next -- for those addicts who demonstrate a serious desire to get clean and stay clean, but then recurrently relapse, there's usually another mental health disorder involved, i.e. scratch the surface of a chronically relapsing addict/alcoholic and you've got a dual diagnosis client.  But what percentage of these repeatedly relapsing clients are treated appropriately as dually diagnosed, i.e. simultaneous treatment of both disorders?  How many of us still think an addict/alcoholic MUST have a prolonged period of sobriety before we will deal with their mental health issues?  Is this so different in the private than in the public world?  Not in my experience. Finally, long-term follow up and care: Public or private, how many are getting more than "you've been through our (30, 60, 90-day) program, now stick and stay with your NA/AA meetings"?  That's the most common continuity of care and follow up that's offered.

Of course, private programs can better afford trained therapists for the dually diagnosed, and they don't have to deal with homelessness, etc.  But on most accounts, I don't see a whole lot of difference between private and public when someone who is direly addicted shows up for rehab. The focus is on the drug use, while "secondary" mental health issues are addressed "later."  The vast majority of counselors are undertrained ex-addicts/alcoholics whose major knowledge base is "it worked for me this way."  And follow up after your $14,000 30-day private program, is most commonly "now it's time to find a good sponsor."  Sure, there are some affluent folks out there who get skilled psychologists/therapists/psychiatrists/or peer-counselors with training, and long-term care.  But they form a miniscule percentage of all severely addicted people who crave rehab.  The rest arrive at a fatally flawed treatment system.  As noted by one respondent on this list, there are many who do as well without rehab as with rehab.  But that doesn't mean that going without rehab is adequate.  It only means that the rehab system frequently doesn't offer much more than no treatment at all.

Of course, I hope I said all that much more clearly in "Hooked." But I'd be happy to hear other opinions.


Lonny Shavelson


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