Addiction, Pain, & Public Health website
www.doctordeluca.com
Drink Your Medicine
The Smithers rehab center stuns the AA faithful
by cutting out a few steps.
In the contentious world of drug and alcohol treatment, dissent is never tolerated, and all apostates are ruthlessly cast out. After a recent 20/20 episode described the debate over the new "controlled drinking" trend among some recovering alcoholics, the Betty Ford Center was quick to respond with letters to ABC charging that the show was "sensationalistic, simplistic, and unbalanced," and that people would die as a result.
But now, in a move
tantamount to the Catholic Church's reversing its position on abortion, the
legendarily hard-line Smithers Addiction Treatment and Research Center on
Manhattan's West Side, best known for treating troubled Met Daryl Strawberry
and Pulitzer Prize winner Nan Robertson, has decided to break with the two
other treatment pioneers -- the Hazelden Foundation and the Betty Ford Center
-- and abandon the lifetime-abstinence approach.
In the fifties, Smithers
was one of the first to adopt the Minnesota Model, in which total abstinence is
compulsory from day one -- anything else, even if accompanied by major life
improvements, is failure. Attending twelve-step meetings is considered the only
route to recovery. Acceptance of "powerlessness" over drugs and
surrender to a "Higher Power" (generally God) are vigorously
promoted. Resistance is confronted. Patients who don't comply are said to be
"in denial" and are often expelled.
In the old days, counselors
told patients that prayer and AA meetings were their only hope for avoiding
jail, institutionalization, or addiction-related death. But under the new
dispensation, they let patients decide for themselves how to recover. Cut down
rather than quit? No problem: Moderation Management meets on-site. Need
medications? We've got 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," says John Bellamy Taylor, director of
evaluation services for Smithers. "It is radical for addiction treatment,
but it's really a return to traditional medicine," argues Dr. Alex DeLuca,
chief of addiction medicine for St. Luke's-Roosevelt Hospital, which runs
Smithers. "In medicine, if treatment doesn't work, you change it. I humbly
submit that this is the way alcoholics should be treated."
Why has Smithers broken
ranks? Pressure from managed care, for one -- which has resulted in the closure
of half of U.S. rehabs over the past fifteen years and is forcing the survivors
to prove that what they do actually works. Comparative research hasn't
been kind to them, either. "We do find that people who go to twelve-step
meetings do better," says DeLuca. "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."
DeLuca's predecessor, Dr. Anne Geller, puts it more bluntly: "Would you
want surgery done now the way it was in the fifties?"
The change has been so
dramatic at the new Smithers that it's as if the inmates have taken over the
asylum. AA and abstinence are recommended, not required. Counselors cajole
rather than confront. The kinder, gentler Smithers aims to improve
relationships, productivity, and health even if lifetime abstinence cannot be
achieved.
None of this makes sense to
traditionalists. Anything but total abstinence is viewed by them as a slippery
slope, "enabling" continued denial and compulsive use. Asked to
comment on the new Smithers, Christine Anderson, a spokesperson for Hazelden,
expresses shock. Radical? "Boy, I'd say so," she says. Despite the
research, Hazelden "will stay with our current model. We are sticking
strictly with the AA concept." The Betty Ford Center did not return calls.
Kenneth Lewis, a Smithers
counselor for eighteen months, admits he found the change difficult. "It
conflicted with my training," he says. (Many counselors recovered through
AA themselves.) "But it gave me a chance to rethink what I believed. I
found that my belief system was faulty."
"The Minnesota Model's traditional assumptions are under enormous challenge," says William White, author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America. "People are moving away from 'This is our program' to offering a menu, real options." As for Smithers's patients, most seem to prefer those choices to old-style coercion. "Some people melt," says DeLuca. "They're so relieved that it's not the nightmare they thought it would be."
[END]
Dr. DeLuca's Addiction, Pain, & Public Health website - Originally posted: 1/23/2003.
