"This is the largest market you’ve never heard of."

April 7, 2011 12:12 PM

TheFix.com is a new site targeting the more than 40 million Americans who are recovering from drug and/or alcohol addiction. It features Ask-An-Expert videos, news, editorials and thorough reviews of rehab facilities based on Zagat's system. Founded by Maer Roshan, one of the founders of Radar Magazine. (Via)

Stories:
* Narconon's Big Con.
* An Ex Addict Aims for Motherhood
* Finding the Perfect A.A. Meeting
* The Latest Designer Drugs—For Sale at Your Local Bodega
* Memories of a Meth Queen
* Coming Out as an Alcoholic

posted by zarq (36 comments total)

Man, what a sad little website.
posted by phaedon at 12:40 PM on April 7, 2011

Just want to mention that the "An Ex-Addict Aims for Motherhood" article was written by MeFi's Own Maias.
posted by zarq at 12:47 PM on April 7, 2011

i saw an advertisement for Passages the other night on network TV...they made it look like a goddamn Sandals resort. I mean I respect that it should not be shameful for people to get healthy, but this just... blows my mind.
posted by Potomac Avenue at 1:05 PM on April 7, 2011

So, why shouldn't a rehab do everything possible to make it easier for people to recover? It's not like anyone's going to go out and become an addict in order to go to a cushy rehab. Spas are already available without the stigma!

And the research is very very very clear that making people suffer during treatment leads to more relapse and less recovery.

40-50% of people in treatment are *forced* into rehab by threats of prison. This means that rehabs have traditionally not had to do anything to reach out to customers and in fact have prided themselves on their toughness in order to serve their *real* customer, law enforcement. Who goes to jail when rehab fails? Not the counselors. Who loses money? Not the program: they just get another coerced client off the waiting list.

If rehabs were actually user-friendly and accountable for failure, they'd be much more effective.
posted by Maias at 1:18 PM on April 7, 2011 [12 favorites]

I'm enjoying the articles on The Fix, but man do they ever need a better editor.
posted by item at 1:22 PM on April 7, 2011 [1 favorite]

Maias, your piece is absolutely excellent. Bravo!
posted by item at 1:26 PM on April 7, 2011

alcohol is a drug.
posted by kilo hertz at 1:27 PM on April 7, 2011 [1 favorite]

Maias: My issue with the commercial wasn't that it was user friendly, it was that it was 80k a month, bashed 12 step programs, and generally made the experience seem like fun. AFAIK recovery sucks and is not glamorous or relaxing. But then I've never been a serious addict.

The review on Passages on the Fix seems like it backs me up actually!

Despite the facility’s loudly advertised "cure rates” (they claim 80%), many insist that their record is pretty spotty. While some patients agree the facility is good on follow-up calls, the absence of an adequate after-care plan or 12-step program leaves many former patients at a loss when they get out. Surely, there are worse ways to spend a month than in a dazzling mansion in Malibu. But for half the rates charged by this controversial rehab, addicts may be better off signing on at Canyon Ranch for 28 days with a copy of the Prentiss' book—and maybe an A.A. Big Book just to balance things out
posted by Potomac Avenue at 1:28 PM on April 7, 2011

My experience in the southern California recovery community taught me that Passages is an expensive joke, a rip-off with no real recovery.
posted by item at 1:34 PM on April 7, 2011

(thanks item!)

Potomac, Passages is problematic—but not because it doesn't use the 12-steps. Many, many more programs are needed that don't do that to balance out the fact that 90% of treatment *does* use the 12 steps, even though many people do not find that approach helpful (Just because many people *do* find it helpful doesn't mean it's for everyone and certainly doesn't mean it's the best way or the only way: research simply doesn't support this).

I believe the treatment field erred when it violated AA's 12 traditions and began, essentially, selling sponsorship and meetings as treatment. I think treatment should do what AA *doesn't*—systematize knowledge about relapse prevention, treat co-existing illnesses, help people find social support whether through 12 step programs or elsewhere. No need to pay thousands of dollars for what you can get for free. AA is a voluntary program: using force to make people attend actually hurts AA and hurts patients. Attraction, not promotion— and 12 *suggested* steps...
posted by Maias at 1:36 PM on April 7, 2011 [9 favorites]

Man, what a sad little website.

I'm not sure I get what you mean but I'm trying to give your comment a charitable read. What's sad about focusing on recovery? There are plenty of slick looking websites dedicated to booze, but in general places on the internet that focus on recovery tend to be dusty FAQ pages or ads for rehabs that boast statistics that are difficult to back up or find cites for. I like that this site feels unashamed and current. In the words of Charlie Sheen it's not a "cry, touch yourself and frown" sort of place and I think having a varied tone could really help some people that get turned off by the gravitas that surrounds 12-step culture.
posted by Thin Lizzy at 1:48 PM on April 7, 2011 [5 favorites]

So it's like HuffPo for drug addiction?
posted by Theta States at 2:10 PM on April 7, 2011

Seems very pro 12 step to me.
posted by dave78981 at 2:15 PM on April 7, 2011

Just a little point about 12 step. Believe it or not, AA is NOT a 12 step program. The 12 step program is a suggestion, one which many successful AA members ignore.
posted by charlesminus at 2:27 PM on April 7, 2011

Maias: "So, why shouldn't a rehab do everything possible to make it easier for people to recover? It's not like anyone's going to go out and become an addict in order to go to a cushy rehab. Spas are already available without the stigma!"

I tend to agree. But a comment from an article in today's Times about one of the people who is now working at The Fix: Joe Schrank, addresses this.

There is also the Addiction Institute of New York (formerly known as Smithers), which runs a 26-bed halfway house in Roosevelt Hospital on the West Side. On the lower end of the cost spectrum, Staten Island is home to a six-house 68-bed facility for men in recovery called Harrison House. A room costs from $350 to $550 a month; food — and frills — are not included. Like Loft 107, residents of Harrison House must follow house rules and submit to random urine tests. Unlike at the Loft, there are no high-end amenities. This is no accident, according to Michael Spence, the director of development and public relations for Harrison House and a certified substance abuse counselor.

“If it’s a very cushy-cushy place, it hinders a person’s ability to recover because it’s so comfortable,” he said, adding that if residents are “stripped down to nothing, they can build themselves up.”

posted by zarq at 2:38 PM on April 7, 2011

"Just a little point about 12 step. Believe it or not, AA is NOT a 12 step program. The 12 step program is a suggestion, one which many successful AA members ignore."

There are many in AA who would argue that one is not sober until he or she does the steps. Also, it's clear from reading the Big Book that Bill W. considered completion of the 12 steps as the only way to achieve a "spiritual awakening" which he considered the "cure" for alcoholism.
posted by dave78981 at 2:58 PM on April 7, 2011 [1 favorite]

The thing about the Fix is that it has a mix of people working for it— and there are many with whom I seriously disagree. But the idea is to be ecumenical and to examine this stuff and put the evidence out there and let people decide—rather than covering addiction in the traditional, hands-off "Oh they must know what they're doing because they say they're experts and we don't want to jinx anyone's recovery," way.

There is a lot of value in 12-step programs— and there are some things (largely done by the treatment industry and not by the program) that are extremely harmful. One of the most harmful is the idea—which Bill W. never promoted himself—that AA is the one true way and the only alternatives are jailinstitutionsordeath.
posted by Maias at 3:11 PM on April 7, 2011

Btw, that NYT quote is actually *not* from my colleague, zarq, but from someone who works at some awful-sounding place I've never heard of. You can be a certified addiction counselor and not have a high school degree— it's not exactly a high level credential, and the guy who was quoted clearly doesn't know anything about the research which shows that the humiliating, break-em-to-fix-em approach is harmful.

Again and again, the studies show that if you are kind and respectful and do not work to make people suffer more than they are already suffering, it's more effective. Whereas punishment increases drop out and relapse. After all, if punishment worked, addiction wouldn't exist since by definition addiction is compulsive use despite negative consequences (AKA punishment).
posted by Maias at 3:18 PM on April 7, 2011 [1 favorite]

Maias: "Again and again, the studies show that if you are kind and respectful and do not work to make people suffer more than they are already suffering, it's more effective. Whereas punishment increases drop out and relapse. After all, if punishment worked, addiction wouldn't exist since by definition addiction is compulsive use despite negative consequences (AKA punishment)."

If "punishment" can be reframed by a skilled counselor, it is highly effective. I've seen this time and time again in treatment settings. Granted some addicts do not respond to being broken down and built back up but that is where the skilled clinician comes in. If she/he can recognize that and alter course, treatment can still be successful.

I think your perceptions regarding A.A. sold as treatment are dead on but I think even that has changed quite a bit since the mid 90s. My last position in the field had me working side by side with MDs, LCSWs and psychiatrists. Even then, it was starting to turn in the direction of a multidisciplinary approach.

With all due respect, I find your comment regarding certification in addiction offensive. I myself have been certified in Minnesota, Colorado and Illinois and like many college grads, had to bust my ass three-fold to get those certifications. I'm not sure where you get your information but the field is full of highly qualified people who busted their ass just like me. My class started out with 12 people and only graduated with 4 so not just anyone can be certified.
posted by KevinSkomsvold at 3:51 PM on April 7, 2011

Man, what a sad little website.

Maybe you have to live with or around the disease of addiction to understand just how wonderful a website like this is. A Huffpo for addiction? That's awesome!

Alcoholism and drug addiction are dirty little secrets that need disinfected by the sunshine. A site that treats the disease like part of normal life makes me very happy. Hearing people speak so openly about their illnesses and recovery in this format is incredibly refreshing. I get this. Thank you so much for sharing it.
posted by msali at 6:22 PM on April 7, 2011 [2 favorites]

Oh and Maias? You rock!
posted by msali at 6:22 PM on April 7, 2011 [1 favorite]

In fact, there's precious little known about synthetic cannaboids...

Including knowing how to spell cannabinoids.
posted by Splunge at 6:28 PM on April 7, 2011

Also, it's clear from reading the Big Book that Bill W. considered completion of the 12 steps as the only way to achieve a "spiritual awakening" which he considered the "cure" for alcoholism.

Well, I'm here to tell you that there are those in AA who would like to see the big book relegated to the dust pile of history. Bill W. didn't do the 12 steps. He made them up and made a million bucks selling his book. AA is not a book, it's a fellowship of drunks talking to drunks. It works.
posted by charlesminus at 7:10 PM on April 7, 2011

that there are those in AA who would like to see the big book relegated to the dust pile of history

I'd be interested in meeting said members. In all of my experiences, the big book has been seen as nothing short of a holy book, even though members will insist it's not. Typical AA hypocrisy.
posted by item at 7:42 PM on April 7, 2011

item: "Typical AA hypocrisy."

Oh good lord. So you've made it this far in life and you've discovered there may be some inconsistencies between what some A.A. members say and what the big book says? Yay you! Holy book for some? Yes. For all? Not even close. And if you're interested in meeting some "said" members, look above and below your comment.
posted by KevinSkomsvold at 8:36 PM on April 7, 2011 [1 favorite]

Maias: "Again and again, the studies show that if you are kind and respectful and do not work to make people suffer more than they are already suffering, it's more effective. Whereas punishment increases drop out and relapse. After all, if punishment worked, addiction wouldn't exist since by definition addiction is compulsive use despite negative consequences (AKA punishment)."

If "punishment" can be reframed by a skilled counselor, it is highly effective. I've seen this time and time again in treatment settings. Granted some addicts do not respond to being broken down and built back up but that is where the skilled clinician comes in. If she/he can recognize that and alter course, treatment can still be successful.

Um, just the fact that you believe this suggests that certification is not effective. There is *no*, I repeat, *no* evidence that confrontational and humiliating approaches that break people work better than kind and respectful ones. For review, see here. From author William Miller, PhD, who has repeatedly reviewed the data on addictions:


Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations.

There are now numerous evidence-based alternatives to confrontational counseling, and clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style.

It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate.
posted by Maias at 8:46 PM on April 7, 2011 [3 favorites]

Oh good lord. So you've made it this far in life and you've discovered there may be some inconsistencies between what some A.A. members say and what the big book says? Yay you! Holy book for some? Yes. For all? Not even close.

Coincidentally, just this afternoon I was chatting (seperately) to two people who had embraced the fellowship during their rehab (less than 12 months ago), both of whom had given up on NA because of the dominance of the dogmatic, theocratic approach.

They'd initially found it helpful because they'd met people they could identify with, and they were blown away by the welcome that newcomers get. Over time though, they grew tired of being told that they couldn't expect to maintain their sobriety unless they devoted all of their time and energies to working a religious programme. They very much had the sense of being seduced in with claims that it was a spiritual programme, but over time, they were exposed to significant ongoing pressure to get down on their knees and pray to the Christian God. Old timers were able to exert significant peer pressure to conform in this direction, and people who didn't comply were ostracized, or continuously threatened with the relapse if they didn't pursue this religious programme.

And of course, this is no accident. AA's roots in Moral Rearmament mean that this is precisely how the programme was designed to work.

Try another meeting, I hear you say? Well, the area where I live and work has the fastest growing NA membership in the Western world. There's no shortage of meetings here, but the picture they were painting was that this is the dominant ideology in local NA meetings. One thing I would say, in defence of the fellowships, is that they're relatively recent in this area, so they don't have the same kind of maturity that you'd find in AA perhaps, or in areas where NA has a much longer history.

Both of my interviewees have been out of the fellowships for more than nine months. Both are doing extremely well. Both viewed the fellowship as an obstacle to, rather than a facilitator of, their long term recovery -- despite finding it extremely helpful in the very early stages, when they were doing their 90 meetings in 90 days.
posted by PeterMcDermott at 9:48 PM on April 7, 2011 [2 favorites]

Maias: "Um, just the fact that you believe this suggests that certification is not effective.

Hmm. interesting. How you gleaned that from what I said is a mystery to me. I take that as yet another slam on my former profession but maybe you can enlighten me?

There is *no*, I repeat, *no* evidence that confrontational and humiliating approaches that break people work better than kind and respectful ones.

*raises hand* Well it did work for me. Purely biased on my part but there you go. I underwent an "Anger Restraint" therapy technique that was experimental at the time and is no longer used. To describe it here could be a whole new post itself. It did change my life and was a part of my treatment. Make of that what you will.

Again, this depends on how you define "confrontational." His article references Synanon which I am very familiar with (also Cenikor in Colorado). There were a number of boot camp styled treatment centers in the late 70s and early to mid 80s which used tactics that would never EVER be used or taught in my training or clinical work. My "confrontational" style was limited to presenting the facts (based on what my patient told me) and exploring the impact and ramifications of those facts. Like it or not, addicts and/or alcoholics do need a mirror held up to them by someone who can help pick up the pieces. By their very nature, addicts will use any number of mental judo moves to avoid having to acknowledge the impact of their behavior. Some do not respond as well as others yet we do not give up on them. We use alternative approaches. That's not A.A. jargon or psycho-babble; just the reality of getting well. If you would prefer to lump that in with being confrontational, well then so be it.

There are now numerous evidence-based alternatives to confrontational counseling, and clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style.

This is not new and has been practiced by most clinicians I've worked with as well as myself.

It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate.

Again, this is not new. You will see a few old-school hard-core A.A. folks who, unfortunately, make into the field but they do not last long. Those types used to be revered but are pretty much frowned upon now in most any treatment centers.

Out of fairness to you, I will look further in William Miller's research. I must admit - it is baffling to me how, being a Phd., he was unable to find one success story.
posted by KevinSkomsvold at 10:47 PM on April 7, 2011

Damn I hate when I don't close my italics!
posted by KevinSkomsvold at 10:49 PM on April 7, 2011

PeterMcDermott: "Both of my interviewees have been out of the fellowships for more than nine months. Both are doing extremely well. Both viewed the fellowship as an obstacle to, rather than a facilitator of, their long term recovery -- despite finding it extremely helpful in the very early stages, when they were doing their 90 meetings in 90 days."

Precisely my experience. I have a real love-hate relationship with A.A. As much as I owe my life to it, it grew stale for me a couple of years in. I haven't been to a meeting in nearly three years (maybe longer) and I do not miss them. Being an atheist doesn't help matters much but hey!
posted by KevinSkomsvold at 11:02 PM on April 7, 2011

Hmm. interesting. How you gleaned that from what I said is a mystery to me. I take that as yet another slam on my former profession but maybe you can enlighten me?

Just FWIW, KevinSkomsvold -- it's pretty rare to meet anyone who has experience of drug treatment who has good things to say about your former profession. Even when you meet people who'll admit to having had a positive experience -- they invariably had to kiss a lot of toads before they finally met their shining prince.

And isn't this born out by the research? I seem to recall a study that suggests it doesn't matter what type of model of training a drug/alcohol worker has had, or even whether they've had any training at all. That the key factor in producing positive outcomes is the empathetic qualities of the worker.

Which brings me to a third conversation I had yesterday, in which a friend and I were talking about what we believe should be the dominant qualification for practicing in this field. Both of us were in complete agreement that the main characteristic that we'd be seeking is a good heart. You can teach the other stuff. Historically, most of it has been picked up on the job, fairly quickly.

A good heart though, isn't something you can teach people. Either they've got it or they haven't. Lots of people try to fake it, and it's only by observing someone's actions over time that lets you be certain about it.

People who use drug treatment services though, seem to have an uncanny ability to discern whether somebody has it or not almost immediately. I think it's one of those survival skills you develop after years of hustling. And where treatment isn't coerced, if that good heart isn't in evidence in the staff who deliver it, consumers will vote with their feet.
posted by PeterMcDermott at 12:58 AM on April 8, 2011

There is *no*, I repeat, *no* evidence that confrontational and humiliating approaches that break people work better than kind and respectful ones.

*raises hand* Well it did work for me. Purely biased on my part but there you go. I underwent an "Anger Restraint" therapy technique that was experimental at the time and is no longer used. To describe it here could be a whole new post itself. It did change my life and was a part of my treatment. Make of that what you will.

Anecdote is not data— you may believe this worked well for you but you have no idea if a kinder approach would have worked better at that moment because you didn't experience one. You don't know if you got better *in spite of* that treatment. That's why we need randomized controlled trials to know what works and what doesn't. And again, a good training program to educate counselors would teach this form of critical thinking so that they could evaluate claims made about treatment, rather than simply going by "it worked for me."
posted by Maias at 12:40 PM on April 8, 2011

i am so glad that light is being shed on what a scam that narconon is. it masquerades as a rehab but is really all about indoctrination into the church of Scientology. none of their detox methods are proven to work, and bottom line depending on what drug you are coming off of, you may need serious medical intervention to detox you, especially in the case of heavy drinkers and people that are addicted to benzodiazapines. these drugs can cause seizures and even death. steam baths and niacin are not going to help people in these predicaments. i find it even more insidious that they have taken a name that is so similar to narcotics anonymous, a very helpful organization for recovering addicts in an attempt to confuse and get more in for their cult like money draining program. it saddens me that the CoS is preying on people when they have hit rock bottom and do not take into account legit medical concerns thinking that a bunch of niacin is all they need. they will certainly have blood on their hands at some point if it hasn't already happened....
posted by nancydrew at 1:21 PM on April 8, 2011

Maias: "There is *no*, I repeat, *no* evidence that confrontational and humiliating approaches that break people work better than kind and respectful ones.

Anecdote is not data— you may believe this worked well for you but you have no idea if a kinder approach would have worked better at that moment because you didn't experience one. You don't know if you got better *in spite of* that treatment. That's why we need randomized controlled trials to know what works and what doesn't. And again, a good training program to educate counselors would teach this form of critical thinking so that they could evaluate claims made about treatment, rather than simply going by "it worked for me.""

I see what you did there and while I understand, I think you may have read me wrong. Of course one success story does not validate overall success. I get that and wasn't implying such. I was responding to the statement "There is *no*, I repeat, *no* evidence....." because, well, there is evidence that it did work, for better or for worse. Not only for me but for a few others I can name off the top of my head. Maybe the kid-glove approach wold have worked. I guess we'll never know!

"And again, a good training program to educate counselors would teach this form of critical thinking so that they could evaluate claims made about treatment, rather than simply going by "it worked for me."

Again, your knowledge and/or insight into training programs is sorely lacking or stuck in 1981 or both. Back in the old days, all that was required was some knowledge of A.A. principles, 1 year of sobriety and a willingness to work with others. You may be referring to that type of counselor who, if he/she appeared in my school, would be unceremoniously bounced out the door. Back then yes, the field was rife with people who had no business being within 100 feet of a patient. The field has changed a lot since then and become more specialized. The type of counselor you describe, while I'm sure may still exist in some centers, is an endangered species. I'll go ahead and leave you alone with your disdain for addiction training programs however. No use fighting a losing battle on that front. I'd ask you to re-evaluate your perceptions however.
posted by KevinSkomsvold at 3:53 PM on April 8, 2011

My knowledge is not at all lacking, Kevin: training requirements vary significantly from state to state, for one. Second, since I report on this constantly, I'm constantly in touch with people who work in the field and/or have been in treatment recently. In fact, just yesterday, I spoke with someone whose agency is about to be doing such training in New York state.

And again, I can't believe you are going to defend harsh treatment by moving from one anecdote to several. The plural of anecdote is not data!!!
posted by Maias at 5:04 PM on April 8, 2011

from a mailing list I'm on:

A new paper proposes an interesting new way of thinking about drugs.
I've long felt that the term "drug abuse" is a social judgment about
behaviour masquerading as an actual behaviour. I think it will sound
just as silly to future generations as 19th Century descriptions of
masturbation as "self abuse".
On the other hand, I find talk about sacraments, entheogens,
psychonauts and shamans irritatingly defensive, like saying "I'm not a
wanker, I'm an orgasmonaut. I'm not doing this for fun like those
dirty self-abusers, but for deep spiritual reasons." They're opposing
moral judgments from a different society.
So what would be an accurate term for recreational and
performance-enhancing drug use itself, rather than for how someone
else feels about it? "Non-medical drug use" maybe, but it would be
good to have a term saying what it is, rather than what it isn't.
These guys come up with the best I've heard so far:

---

Müller, C. P. and G. Schumann (2011). "Drugs as instruments – a new
framework for non-addictive psychoactive drug use." Behavioral and
Brain Sciences.
http://journals.cambridge.org/images/fileUpload/documents/Muller_BBS-D-10-00267_preprint.pdf

Abstract: Most people who are regular consumers of psychoactive drugs
are not drug addicts, nor will they ever become addicts. In
neurobiological theories, non-addictive drug consumption is only
acknowledged as a ‘necessary’ prerequisite for addiction, but not as a
stable and wide spread behavior in its own right. The present paper
proposes a new neurobiological framework theory for non-addictive
psychoactive drug consumption, introducing the concept of ‘drug
instrumentalization’. Psychoactive drugs are consumed for their
effects on mental states. Humans are able to learn that mental states
can be changed on purpose by drugs, in order to facilitate other,
non-drug related behaviors. Specific ‘instrumentalization goals’ are
discussed and neurobiological mechanisms of how major classes of
psychoactive drugs change mental states and serve non-drug related
behaviors are outlined. We argue that drug instrumentalization
behavior may provide a functional adaptation to modern environments
based on a historical selection for learning mechanisms which allow
the dynamic modification of comsummatory behavior. It is assumed that
in order to effectively instrumentalize psychoactive drugs, the
establishment of and retrieval from a drug memory is required. Here we
propose a new classification of different drug memory subtypes, and
discuss how they interact during drug instrumentalization learning and
retrieval. Understanding the every day utility and the learning
mechanisms of non-addictive psychotropic drug use may help to prevent
abuse and the transition to drug addiction in the future.

---

It's a huge review paper which goes far beyond just the phrase. A lot
of the fine detail wasn't of interest to me, but I think the central
idea is a very powerful one. I learned of it through the Beckley
Foundation, who I think miss the point in saying the paper

"...greatly supports the message that the Beckley Foundation has been
trying to promote for years that there is a distinction between Drug
Use and Drug Abuse, many people use drugs throughout their lives
without causing harm to themselves or to others."

http://www.beckleyfoundation.org/2011/02/08/drugs-as-instruments-%E2%80%93-a-new-framework-for-non-addictive-psychoactive-drug-use/

I think arguing over what is and isn't abuse just reinforces bad
terminology. So let's hear some other suggestions ...
posted by telstar at 5:23 PM on April 24, 2011