Addiction, Recovery, And American Health Policy

America worships personal tales of redemption. If public figures are caught out drunk or on drugs, cheating on their wives, then they quickly head off to Betty Ford or Hazelden. And we forgive them.
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America is a country that worships personal tales of redemption. If public figures are caught out drunk or on drugs, cheating on their wives, then they quickly head off to Betty Ford or Hazelden, apologize to their families and constituents, and promise not to stray or drink again. And we forgive them.

This process derives from America's revival tradition. At the revival meeting, people rise and denounce the evil of their former ways, declare themselves saved, and commit themselves to God.

This was the format of the Temperance lecture that dominated the nineteenth century American landscape. And the Temperance confession is still with us in the form of Alcoholics Anonymous. For those of you who have been missing your 12-step meetings, here are selected steps to practice at home (note the presence of God, and the absence of alcohol):

  • 3. Made a decision to turn our will and our lives over to the care of God.

  • 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  • 7. Humbly asked Him to remove our shortcomings.
  • Although such penitence is repeated nightly around the country, these stories conflict with rational public policy. According to the latest government research (called NESARC), 30 percent of Americans at some point in their lives qualify for an "alcohol use disorder." But, within four years, 70 percent recover without AA's or Betty Ford's help.

    Others take longer. But only 1 percent of Americans fit the model of the AA members whose drinking carries them to the doors of hell and from which only God can rescue them. Among 300,000,000 Americans, that's 3 million people. But 90 million Americans develop a different sort of drinking problem.

    Many entertainment figures had bad drinking periods (Bing Crosby, Robert Redford, Steve Martin, Joe Scarborough) and cut back - the typical problem-drinking profile. We don't hear much about them because they - and millions of others with similar stories - don't go on lecture tours to tell their tales. Craig Ferguson's compelling testimony about his dead-end alcoholism on You Tube, on the other hand, has had a million-and-a-half views. How can you top that?

    Nonetheless, for the first time - due to the NESARC research - government officials are questioning received opinion. Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, declared: alcoholism "can be a chronic, relapsing disease. But it isn't usually." Thus, intensive treatment addresses a miniscule part of America's substance abuse problems. (Disclosure: I have created an abstinence-oriented treatment program.)

    The limits of public testimony for determining American health policy also appear in yet another declaration of a learned council that cancer screening is overutilized. Up to 1,900 women must be screened ten years in their 40s in order to prevent one death from breast cancer. But, along with all that irradiation, 1,000 false warnings will be generated from such testing leading to biopsies and other procedures that create their own dangers.

    If you talk to the one in 1,900 women whose life was saved by screening - there are plenty, and I can't compete against them - you determine that there is no way America can better spend its finite health care allotment. But there are actually many more productive, less harmful, more life-saving ways to spend that money - including even for cancer prevention.

    Someone has to make these choices. America can listen to one of two groups - health economists and oncologists and internists like those making up the government panel recommending scaling back breast cancer screening, or people who swear that screening is the best use of our health care budget because it worked for them.

    While we're at it, we can treat every kid caught with a reefer or who gets drunk as though he or she had a lifetime disease. After all, you can find very moving and convincing stories of people who claim that being forced into AA at age 15 saved their lives. But it's craziness to do so, even though we won't hear the far more frequent stories of people who were scarred by such experiences.

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