AA Abuse - Forcing People into 12-Step Programs for the Slightest of Reasons.

Written by Stanton Peele

As Marie's story shows, court-mandated DWI referrals generate income for treatment entrepreneurs from insurance companies and state treasuries. The director of one treatment center says: "approximately 80 percent of my clients come via courts and deferred prosecution agreements. Many are simply taking advantage of the opportunity to avoid insurance premiums, blemished driving record, etc. and have no intention of changing their behavior."

Although DWIs constitute the largest number of referrals from the criminal-justice system, defendants are required to enter substance-abuse treatment for other crimes as well. In 1988, a quarter of Connecticut's probationers were under court order to enter alcohol or drug treatment. Penal systems are opting to treat the large number of drug offenders they face, both as an alternative to sentencing and as a condition of parole. The potential flow of treatment clients is huge: New York prison authorities estimate that three-quarters of all inmates in the state have abused drugs.

Adolescents are another rich source of treatment clients. (See "What's Up to Doc?," Reason, February 1991.) High schools and universities regularly direct students into A.A., sometimes based on isolated incidents of drunkenness. In fact, people in their teens and 20s represent the fastest-growing segment of the A.A. membership. The incarceration of adolescents in private mental institutions—primarily for substance abuse—grew by 450 percent during the 1980s. Teenagers almost always enter treatment involuntarily, whether under court order or under pressure (on them or their parents) from schools and other public agencies. In treatment they undergo "tough love" programs, which strip children of their pretreatment identities through techniques that often border on physical abuse.

In The Great Drug War, Arnold Trebach documents the shocking case of 19-year-old Fred Collins, who was pressured into residential treatment in 1982 at Straight Inc. near St. Petersburg, Florida by his parents and the organization's staff. Collins's and other inmates' parents collaborated with Straight in forcibly confining him for 135 days. Isolated from the out side world, he was subjected to 24-hour surveillance, sleep and food deprivation (he lost 25 pounds), and constant intimidation and harassment.

Collins eventually escaped through a window and, after months of hiding from his own parents, sought legal redress. In court, Straight did not contest Collins's account but instead claimed the treatment was justified because he was chemically dependent. Collins, an above-average student, presented psychiatric testimony that he had merely smoked marijuana and drunk beer occasionally. A jury found for Collins and awarded him $220,000, mostly in punitive damages. Nonetheless, Straight has never admitted its treatment program was flawed, and Nancy Reagan has continued to be a staunch advocate for the organization. Meanwhile ABC's "Primetime Live" and "20/20" have documented similar abuses in other private treatment programs.

Another major group of clients are those referred by employee-assistance programs (EAPs). While some employees seek counseling for a variety of problems, the main focus of EAPs has been substance abuse. Typically the initiative for treatment comes from the EAP rather than the employee, who must undergo treatment to keep his or her job. There are now more than 10,000 EAPs in the United States, most created in the last decade, and the number continues to grow. The majority of companies with at least 750 employees had EAPs by the mid-1980s.

EAPs often use "interventions," a technique that is popular throughout the treatment industry. An intervention involves surprising the targeted individual with a phalanx of family members, friends, and co-workers who, under the supervision of treatment personnel, browbeat the person into accepting that he or she is chemically dependent and requires treatment. Interventions are often spearheaded by counselors who are themselves recovering alcoholics. And usually the agency that assists with the intervention ends up treating the accused substance abuser.

"Interventions are the greatest advance in alcoholism treatment since Alcoholics Anonymous was founded," says the director of a California treatment center that depends on such clients. In a 1990 article in Special Report on Health entitled "Drunk Until Proven Sober," journalist John Davidson offered a different assessment: "The philosophical premise behind the technique appears to be that anyone—especially a recovering alcoholic—has the right to invade another's privacy, as long as he's trying to help."

Although employees who are subjected to such interventions are not coerced, they are usually threatened with dismissal, and their experiences often parallel those of criminal defendants who are forced to undergo treatment. Companies confronting employees suspected of drug or alcohol abuse make the same mistakes as courts do in handling drunk drivers. Most important, they fail to distinguish among different groups of employees suspected of substance abuse.

As the stories of Dwight Gooden and Helen Terry indicate, employees may be identified by an EAP even though their job performance is satisfactory. Random urinalysis may find drug traces, a record search may turn up an old drunk-driving arrest, or an enemy may submit a false report. Furthermore, not every employee who screws up at work is screwing up because of drugs or alcohol. Even when an employee's performance is suffering because of drug or alcohol use, this does not mean he or she is an addict or alcoholic. Finally, those employees who do have serious problems may not benefit from the 12-step approach.

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For all its strong-arm tactics, mainstream drug and alcohol treatment does not seem to work very well. The few studies that have used random assignment and appropriate control groups suggest that A.A. works no better, and perhaps worse, than no treatment at all. The value of A.A., like that of any spiritual fellowship, is in the perceptions of those who choose to participate in it.

This year a study in The New England Journal of Medicine reported, for the first time, that employee substance abusers sent to private hospital programs had fewer subsequent drinking problems than employees who selected their own treatment (which generally meant either a hospital or A.A.). A third group sent to A.A. fared the worst of all.

Even in the hospital group, only 36 percent abstained throughout the two years following treatment (the figure was 16 percent for the A.A. group). Finally, although hospital treatment produced more abstinence, no differences in productivity, absenteeism, and other work-related measures were found among the groups. In other words, the employer who was footing the bill for treatment realized no greater benefit from the more expensive option.