Addiction’s Received Wisdom is Challenged

Last day watching the sunrise

Lance Dodes, M.D., whose latest book is The Heart of Addiction, seems to have rethought the field from the ground up and arrived at some conclusions that can only be described as heretical. For instance, when a person seeks a rehab facility, scenery should be the last priority. He elucidates:

If living for a month with a view of the mountains or the beach treated addiction, there would be no addiction in lovely areas of the country.

A previous book, The Sober Truth, was subtitled “Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.” One problem is that nobody ever seems to do follow-up studies of the clients or patients who have graduated from these programs. In the instances where outcomes are known, they are not particularly encouraging. Dr. Dodes mentions several likely reasons.

Residential rehabilitation facilities are pretty much self-defining. Of course the corner office will be occupied by someone with an impressive diploma, but much of the staff may have minimal training.

Group therapy is fine in its place, when led by an insightful, experienced professional. However, an establishment may overemphasize the group therapy concept, to the detriment of genuine progress. A free-form talk session may be enjoyable, but without enlightened guidance it is no more effective than a Friday Afternoon Club gripe session.

Despite these and other inadequacies, the residents of luxury rehabs are charged, the author says, “from $30,000 to $90,000/month.” Just to put that into perspective, an American elementary school teacher earns less than $4,000 a month,

For the founders and administrators, it’s a catch-22 situation. Wealthy parents don’t want to hand over their child to a place that doesn’t have a stable full of horses. A rock star’s manager is reluctant to sign the boss into a place that doesn’t have tennis courts. (Fortunately, there are alternatives for people who don’t want or can’t afford costly inpatient rehab for food addiction. Chief among these is Dr. Pretlow’s W8Loss2Go smartphone application.)

To anyone shopping for a rehab center, Dr. Dodes offers some caveats. Definitely check the credentials of the therapists. Don’t be seduced by a pretty environment or the promise of a cruise-level menu. If the place offers only one methodology, or a program with a fixed time period, give it a pass:

Any rehab worth your time and money must offer a variety of modalities without insisting you fit into their favorite one…Ask if they are based on a single treatment model for everyone, and if so, stay away.
Length of treatment for addiction should be individualized, as it is for every single other medical or psychological hospitalization.

The unorthodox physician also takes issue with a term that is always bandied about, but appears to be ill-defined. What exactly does it mean to be “in recovery,” and is it helpful to relate to addicts who have cleaned up as if they are still in the sick depths of withdrawal? Sure, an addict can fall back into the behavior that once masqueraded as a solution to life’s pain—but we all do that. Addiction is a symptom that can be treated, not the core definition of a human. Dr. Dodes writes:

It makes no more sense to label oneself as “recovering” forever from an addiction, than it does for a person who used to be depressed to forever be “recovering” from depression, or a person who has been cancer-free for 15 years to still define herself as a cancer patient.

Your responses and feedback are welcome!

Source: “How to Avoid Bad Rehab Treatment,”, 09/09/14
Source: “What Does It Mean to Be “In Recovery”?,”, 07/30/14
Image by Sanjoy Ghosh

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