The Efficacy of Faith-based and Secular Addiction Treatment
You have broken the Commandment, “Thou shall not bear false
witness.” That was my reaction to the editorial by Ronald Sider, president of
Evangelicals for Social Action, lambasting the efficacy of secular addiction
treatment programs and extolling the efficacy of faith-based programs.
Mr. Sider claimed that most current treatment programs have less than a 10% success rate as compared to a success rate of 80%. This assertion simultaneously slanders reputable treatment programs and undermines the credibility of faith-based programs.
Since 1980, I have been involved in the evaluation of addictions
treatment programs throughout the United States. Under a grant from the Robert
Wood Johnson Foundation, I have also lead a review of over 800 scientific
reports related to treatment outcomes. Neither my own evaluations nor the
scientific literature supports the contention that most programs have so poor an
outcome rate as Mr. Sider suggests.
The impression one gets from the science is that most individuals
benefit from reputable treatment programs that employ qualified professional
staff. The other is that no single measure of “success” is adequate.
Although many individuals are successful in maintaining abstinence for
protracted periods of time, others succeed in at least brief intervals of
abstinence or show substantial reductions in alcohol and drug use.
We need to remember that addictions are chronic conditions. Like
other chronic conditions such as diabetes, asthma, and hypertension, they are
not “cured” but managed. Thus, we should not expect that any one course of
treatment would always result in lifelong remission. In fact, prominent
researchers have documented that readmission rates for addiction treatment tend
to be as low or lower than readmission rates for or conditions such as diabetes,
asthma, and hypertension.
Bottom line—current treatment programs help the majority of
people seeking help. They may not always achieve long-term abstinence, but most
people benefit and many do achieve durable recovery. It may not happen the first
time, but most who persist achieve some level of recovery. Afflicted persons and
their families should not be dissuaded from seeking help because of
unrealistically pessimistic pronouncement such as those made by Mr. Sider.
On the other side of the coin, I have never seen evidence that an
adolescent program had an “80% success rate,” where success is defined by
abstinence. The only persons I have encountered making such claims had either
naively misinterpreted data or where outright charlatans who simply made up the
numbers. One example of the former was a program representative who claimed that
their program achieved 80% abstinence for two years in treating adolescents.
Upon closer examination I learned the following. Of 200 adolescents who entered
the residential program, 50 stayed six months. Of those 50, 10 continued in
aftercare for the next 18 months. Of those 10, 8 had remained abstinent. Indeed
80% of that small group were abstinent, but they represented only 4% of those
entering the program and fewer than 20% of those finishing the residential stay.
Such preoccupation with statistics defining “success” only in
terms of total abstinence also miss the point that many individuals will have
lapses or relapses prior to establishing durable recovery. It diminishes the
efforts of those continuing in the struggle with their addictions.
Making outlandish claims for “success” discredits the entire
addictions treatment field. Addictions treatment as any other area of medicine,
such as oncology, has had its share of charlatans and “faith-healers” (not
to be confused with competent professionals who are persons of faith).
Disreputable and incompetent practitioners detract from the reputations of
reputable programs and professionals. They also have the unfortunate effect of
increasing pessimism for those they ineptly fail to help.
I do agree with Mr. Sider that faith-based programs should be
evaluated for efficacy against the standard of current practices and programs.
However, this should be done BEFORE we invest significant resources in
faith-based programs. We should also be reassured that the faith-based programs
employ competent, properly trained and credentialed professionals. Some of the
recent efforts in Congress have attempted to exempt so-called “faith-based”
programs from licenser and requirements regarding standards of care. This would
be a disservice to the afflicted and a travesty in social policy.
Professionally sound faith-based programs already exist in
virtually every state, and they can access public money. Catholic Charities,
Lutheran Social Services, and the Salvation Army are classic examples of
faith-based organizations capable of providing quality services and who can, and
do, access public funding. Why the impression that funding faith-based programs
is new? Is the current push to fund programs that do not have the type of
professional staff that the current organizations employ? The fear is that the
“new” programs will be more interested in evangelical promotion of their
views of the hereafter than in addressing problems of the here-and-now.
Many programs currently serving the public sector clients are
marginally funded, if not seriously under funded. Only if the push for exploring
faith-based programs involves new federal money, is this a reasonable
undertaking. Siphoning off funds from programs with documented efficacy to
alternatives such as new faith-based programs will just diminish the
availability of services to all.
If the intent is to shift responsibility for the indigent to
charities, the effort has even worse consequences. It is unreasonable for
charities to shoulder the burden for the indigent that the state should assume.
Such a cost shifting to charitable funding would overburden already taxed
resources and undoubtedly be a disservice to society.
In considering alternatives for complex problems such as
addictions, we should remember the sage’s warning. For every complex problem,
there is a simple answer—and it’s wrong.
-- Norm Hoffman --