Last week on this blog I shared the story of one of my patients, and how her situation illustrates that the truth is never simple, especially not when it comes to healthcare and the management of debilitating diseases. This week I want to talk about the same complexity from the treatment side of the problem.
12-step programs are often concerned with addiction as a “spiritual and moral” disease, instead of (or in addition to) a physical condition. Most 12-step programs incorporate moral lessons into their treatment plans. Possibly the most common moral lesson, and one of the most important, is the idea of “letting go”, of turning control over to a Higher Power, which is almost always synonymous with God. The point of this step is to “teach” humility and help patients to “let go of their pride”.
Humility is one of the core values that 12-step programs try to impart to their patients. Yet, looking to the people and organizations who run the 12-step programs, humility doesn’t seem to be among their core values. Each and every 12-step program insists that it is the only possibly path to recovery, that it is the only one capable of giving patients the wisdom they need to overcome their “spiritual” shortcomings. The plain truth of the matter is that no particular model can show recovery numbers that stand out; nearly all have a very low overall recovery rate. Those that can boast more impressive recovery rates can usually only do so to the extent that they include treatment of addiction’s physical causes in with their “spiritual” treatments. This is because teaching moral values, even good moral values, won’t help cure someone of a physical disease. To people who are sick and suffering, the message often won’t even get through.
It’s easy to see why each needs to paint itself as the only one that works; in a market where no one product is distinguished by superior quality, everything depends on marketing to convince potential customers to choose them. It’s a ploy, one that can play on a customer’s need to feel that they are getting exclusive or secretive treatment, that not everyone has access to. In the worst cases, it’s little more than a snake oil pitch.
But again, we have to remember that the truth is never that simple. Many people who run and participate in 12-step programs honestly believe that their’s is the best, perhaps because they went through it successfully, or knew someone who did. There are any number of ways that passionately convinced people can dismiss or argue against numbers that indicate a pretty standard failure rate across programs. It can be difficult to see the faults of a system while you’re in the middle of it.
I don’t support the methods 12-step programs use to treat their patients, or the hypocrisy that the 12-step business model seems to make necessary. AA and NA, since they are nonprofit and therefore aren’t competing for customers, are much less dependent on this sort of “marketing”; they function more as amateur community support groups. There is certainly a place in the field of addiction for such support groups, although they should never be the primary form of treatment.
12-step programs make money by selling a system of morality to their customers — a system which their own business model often makes impossible for them. It’s always difficult to negotiate a relationship between medicine — the relief of human suffering — and money; the American government is seeing the fallout from a poor medicine-money relationship right now. But a business model that encourages lying to customers in order to convince them to choose one service over another is predatory and should not be allowed to continue.