Updated: Aug 29, 2021
In the United States, alcoholism treatment has become big business, and is increasingly owned by large corporate conglomerations. Much of the 50 billion annually generated revenue is based on repeat business. According to the National Association of Alcohol and Drug Abuse Counselors, the average number of treatment episodes in a lifetime is six.
It is easy, but incorrect, to assume that the above represents a grand and thought-out plan for profit generation. As one of the ultimate industry insiders (I have been the director of 4 treatment centers), I know the truth is far more benign, but no less disturbing for it. The situation the recovery industry finds itself in today is the result of being 'born' too soon, and then clinging obsessively to the romantic memories of its childhood in place of its 'grown up' responsibilities.
In 1939 a book called Alcoholics Anonymous was published. Acknowledging alcoholism as an illness, it prescribed a religious solution. AA's popularity spread quickly and within 10 years alcoholism treatment centers based on its tenets began to spring up. AA members were recruited to staff these centers along with physicians, nurses, etc.
The problem is that none of this was based on any actual research, which didn't even begin in earnest for another decade. AA members who staffed these centers often had no real education, not even about the disease of alcoholism, but were true believers in the religiously based AA approach.
There was also accountability for outcomes and no accurate measurement of them. AA makes no measurement of its success either, basing itself instead on mere numbers of participants.
While spirituality is a fine thing, I personally hold very strong spiritual beliefs, it is no substitute for real health care.
Today much has changed. Master level degrees and credentialing are now offered to worthy counselors. Abundant research into the true origins of alcoholism is available and many
research-based treatment methods are available.
Today, too much has not changed. These methods are often used as mere ancillary approaches to AAs religiously based approach instead of being the primary tools of the trade. Most staff members continue to be true believers instead of objective, open-minded helpers who place individual needs of clients over dogma.
This must change, and if it did, greater confidence in treatment would lead to a far greater number of people seeking help. These five suggestions would be of great help in furthering that outcome:
Viable moderation and self-directed sobriety-based approaches such as The ReNova Method should be taught in basic counselor education courses to everyone training to work with alcoholism.
All candidates for licensure/certification should be mandated to have no less than a bachelors degree, specifically in addiction counseling, by 2025 and a Master’s degree by 2030. Pay scales need to be adjusted to account for this increase in education, which will ensure labor demand can be met. Many more of these counselors should also be encouraged to enter private practice as this is often enough as a front line health option to prevent over hospitaliization and life style disruption.
Inpatient alcoholism treatment programs need to partner more closely with outpatient facilities to provide ongoing supportive level outpatient treatment. This will allow for frequent support groups that can be conducted at those centers long term, instead of over-reliance on AA or other groups that have no oversight or accountability for the actual welfare of the people they seek to help.
Individual counseling sessions while in treatment and in outpatient should be conducted much more often.
Medications and amino acid therapies should be more frequent throughout the spectrum of care, from private counseling to inpatient alcohol rehab to restore brain health and reduce craving and relapse.