The Free Press, Mankato, MN

March 16, 2013

Author offers sobering view ‘Inside Rehab’

Anne Fletcher: ‘Most people overcome their problem by going to AA or doing it on their own’

By Robb Murray
Free Press Staff Writer

— Anne Fletcher is blunt when it comes to the alcohol and drug addiction recovery industry.

“The industry really is a mess,” the local author said. “This is the Wild West.”

And she should know. Fletcher’s latest book, “Inside Rehab,” is an indictment on the industry. The book goes in depth in its examination of 15 treatment centers across the country, including high-priced so-called “celebrity rehab” facilities as well as such venerable places such as Minnesota’s Hazelden.

What did she find?

A lot.

Fletcher’s research shows there are roughly 22 million people in the U.S. with a serious drug or alcohol problem, and only one in 10 seeks help. Research also shows, however, that most people who overcome their addictions never set foot in a treatment program.

“Most people overcome their problem by going to AA,” she said, “or doing it on their own.”

Which isn’t to say she endorses Alcoholics Anonymous. Quite the contrary. Part of her book delves deeply into the fact that, in many cases, people are never told there are other options beyond AA, such as Smart Recovery.

Fletcher assesses that no matter how much you pay, the effectiveness of your treatment generally doesn’t vary that much. There are exceptions, of course. But Fletcher found evidence that people who pay top dollar for in-patient treatment — in some cases up to $30,000 per month — wind up no better off than people who pay far less for out-patient care.

“Many people will do well in a model where they’re in out-patient care by day and in a good sober house at night,” she said.

Fletcher said that, after conducting her research, she came to three important conclusions.

Cookie cutters

First, she found that a tendency exists for rehab programs to use a cookie-cutter approach to treatment. Within these programs, many offer little one-on-one time with psychologists and rely generally on group therapy sessions.

One woman interviewed in the book — who was attending an expensive in-patient program — said that when she was given homework, it was the same homework many other people had to do instead of a personalized program.

Fletcher said 7 to 8 out of 10 of programs involved AA in some way. In some cases, she said, AA was ordered for treatment by the courts, even though AA is a faith-based program.

“AA is great when it works,” Fletcher said. “People who go to AA, and get involved with it, get a sponsor, show up, set up chairs, make coffee — they do have better outcomes. The problem is, 6 to 8 out of 10 people encouraged to attend AA while in treatment will stop attending AA within a year. They’ll drop out and are not told about alternative methods and resources such as Smart Recovery, a science-based approach, or Women For Sobriety.”

Fletcher said she asked a counselor from a notable treatment program if they ever mentioned Smart Recovery, and the counselor said he’d never heard of it — and that he’d never refer an addict to a program he’d never heard of.

“There’s no malevolence here,” Fletcher said of the industry’s embrace of AA. “There’s so many good-intentioned people. These people recovered with AA and they think it’s the best way to get sober.”

Mind the gap

The second conclusion Fletcher arrived at is that there is a huge gap between science and practice.

She said one of the keys for a person recovering from opiate addiction such as heroin is the use of medications that can help curb cravings, such as methadone and suboxone. But only two out of 10 rehab programs were using medication as part of a treatment plan.

“Research shows most people need to be on methadone or suboxone,” she said. “When people are not given these drugs, they relapse and there is a much higher death rate.”

Also, very few were using science-based marriage and family counseling, which Fletcher says research shows has been proven to be effective.


Third conclusion: There is no unified system to regulate rehab programs. Chief among Fletcher’s findings and concerns is that counselors provide most of the treatment.

“A college degree is not required to provide counseling,” she said, “and it’s one of the most complicated conditions to deal with. It’s a complex, biological, physiological, psychological disorder that requires, for many people, lifelong management. For many people, 30 days is not enough.”

Fletcher says the alcohol and drug addiction treatment industry is wrought with problems because, as she said, “it sprang up in a vacuum.”

When it was needed, there was no one offering.

“When AA came about, there was no addiction rehab. People were thrown into sanitariums. A lot of hospitals back in the day had policies about keeping them out,” she said. “So recovered people started treating addicts. The idea grew out of desperation.”

Fletcher’s advice is simple: If you’re considering going into rehab, stop. Consult a person in your community who has no vested interest in your treatment, and get their advice.