Addictions Treatment: Myth vs Reality

Addictions Treatment: Myth vs Reality

Effective Interventions Often Don't Match Stereotypes

By Jay Lebow

March/April 2004

Substance-abuse treatment used to bring to mind a no-holds-barred, in-your-face engagement, such as the notoriously confrontational rap groups of the '70s and '80s, often led by tough former addicts, or the Johnson intervention, in which family members and close friends came together to overwhelm the abuser's denial with stories of the harm done and to insist on treatment. It was widely accepted that the best therapists for addicts were former addicts. Many thought intense, confessional, 12-step programs, such as Alcoholics Anonymous (AA), were necessary adjuncts to any treatment. Long-term inpatient treatment, which removes addicts from the stresses of everyday life, was considered the treatment of choice, for those who could afford it, and still is even today.

While treatment approaches to substance abuse have continued to evolve, a clear, new picture of what works in addiction treatment hasn't emerged. Clinicians and the public continue to rely on a hodgepodge of old and new approaches, unsure what works when. Fortunately, two recent landmark reviews of the research on adult substance-abuse treatment give us a much more coherent picture of what the literature tells us about effective substance-abuse treatment.

Psychologist Rudolf Moos of the Department of Veterans Affairs and Stanford University, widely considered the dean of researchers in substance-abuse disorders, prepared one summary of the research. A panel of experts in substance-abuse treatment and…

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