Bit more on Obamacare and Addiction Treatment

Bit more on Obamacare and Addiction Treatment

I came across this piece about the effect of “Obamacare” on the future of addiction treatment in the USA’s-membership. It points out that insurance companies will demand more evidence based treatment, rather than the faith-based methods of the 12 step world that have been used in most so-called treatment centres so far. I have written about the effects of Obama’s policies before as I was sent a lot of links via the contact form, but have added this piece so that people can find it in the future. here is my original piece

I have known a lot of people who have gone to rehab and who had not done well. Different people respond to different treatments, because they have different underlying problems. Many in the treatment industry are nut jobs from 12 step groups, or other areas of the recovery world, who probably could not get any other kind of job, but are employable as addiction counsellor a because of the old idea that only an alcoholic can help another alcoholic. I have said many times on this site that I do not believe this is the case, as the best help I received was from medical professionals who were not addicts and not laypeople. My treatment was vastly different to what many receive in a rehab and took place about 18 months into my alcohol free journey, after I had allowed my head to clear a bit. The qualifications required to become an addiction counsellor are really low, considering how many problems addicts are likely to face, and is a reflection on societies view about addiction.


I think the influence of insurance companies will have an effect on treatment although, things may not be all off the better. Many insurance companies in the UK offer little support for addiction and work based schemes often opt out of addiction treatment. I have a very good health insurance policy as I travel for work, but even that does not cover me for large amounts of addiction treatment, despite the high cost. I can see that insurance companies will try to view addiction as a chronic condition, which I do not believe is always the case, as some people do manage to regain control. Insurance companies will often not cover a chronic condition of any type.

Some people feel that this is going to be the end of AA, but I do not think that will happen very soon as it has a large infrastructure and many enthusiastic members, who will run meetings. Even if half of AA meetings closed it would still have more influence than other methods. I think people need to see some really good results from other solutions before they will join them instead of the well known AA type group. This will only happen if people are prepared to stand up and say what has worked for them and be willing to help others. I think that people who have got well in recovery communities away from AA, do not have the religious effect driving them to meetings and often want to get on with their lives, rather than hand out with people that will remind them of their past. I think it is healthy to put addiction behind you, and I did this for a while and only really became interested in writing about it when other people asked me how I had beaten addiction, and I wanted to talk about recovery without the AA method which did not really suit me long-term.

People who require treatment are often very poor and do not have access to much other than some freely provided support groups such as AA, so I would hate to see this taken away from them, even though I do not feel the steps side of AA are that effective and the program is really out of date. People with addiction are regarded as low life’s by many in society and so diverting funds away from non self-inflicted illnesses, is not popular with politicians, although it have a big effect on crime and other areas so is actually money well spent.

The money will be wasted if people are simply pushed into old-fashioned 12 step groups, that are not suitable for them. Many are shocked when they turn up at rehab and are met by some clown telling them a higher power and prayer is the solution. Telling people they are powerless and have a disease is equally stupid. The men who founded AA said that people had to be attracted to AA for it to work for them and I believe that it can have a positive effect on those, with a certain type of belief system, but contrary to chapter 5, which has not been updated, many do fail who have followed these steps.

It would be a huge shame if the treatment industry in America, is brought down by the lack of success of an enforced 12 step solution, that was never intended as a medical treatment. Although the founders of AA were certainly not upstanding members of the community at times, I do believe that they genuinely wanted to help alcoholics and addicts, and would probably be horrified that AA and the 12 step world is actually holding back progress in the field. Some treatment centers deserve to close, as they do not provide a good service, and are a rip off. Others are good, but may unfortunately be dragged down by those who insist on sticking with faith-based solutions. In the Uk there is a huge shortage of treatment facilities for those with no money, but the demand is increasing as society turns a blind eye to the effects of changes in our culture. to get good results in treating addiction, you need to provide different levels of treatment on an individual basis as well as different types of group support. I think that people are realising this in the UK, and CBT is seen as the way forward, but unfortunately there is always a long waiting list and a limit on sessions, unless you are prepared to pay for it which is what I did. You will not see good results if you limit treatment to six sessions. Not everyone can afford help and this does needs to be addressed along with other social changes. Groups like AA which are church related, often become large because they are the only groups that attempt to do anything about these problems that anybody can attend. Unfortunately, they are less effective than they could be because they are weighed down by dogma and old-fashioned religious or spiritual ideas, which means that many avoid them, because they feel they have little value. In doing this, they miss out on being part of a recovery community which can be helpful in making the transition from addict to normal functioning person.

On the other hand, if “Obama care” does find fault with the 12 step style of treatment, it may lead to more people inside AA working to modernise the way AA etc works. People such as Massive from attempted to influence change which would have made AA safer when she was a member, but was met by resistance. Other people such as the members of also try to do this and highlight some of the problems and crazy people who can cause problems in these groups. describes many news stories about the unsavoury side of 12 step groups, and they could certainly be made safer and modified to take advantage of modern advances in dealing with addiction. Unfortunately there is always resistance to change by the “Big Book” that treat AA as their own religion and are not prepared to try anything new to help those that come to them for advice. Change will be a sow process in the 12 step if it happens at all, and that is very sad as it has an enviable infrastructure that could really help people.

People who are addicts or in early recovery often make real poor choices when faced with events. This is always going to lead  to a high fall out rate of people trying to get clean, regardless of the method used. Some people who are sent to these groups do not really want to get clean, and others will need a few attempts, before they finally take responsibility for their actions and attempt change. I think that relying on statistics is a dangerous way to go with addiction treatment as there are so many factors which are not controllable by healthcare providers. Some people like to give the impression that it is always a recovery group or method that is at fault for a relapse, but this is not always the case. People know that getting drunk is going to have a bad effect on them, yet they decide to carry on, and often need a few negative experiences before they decide to change, whichever method they choose.


Commenting area

  1. “…many in the treatment industry are nut jobs from 12 step groups…”

    that’s a very funny line, with serious undertones about the real dangers of faith based “treatment” for a chronic, life-destroying and potentially fatal behaviour issue (aka alcoholism).

    i think two important questions arise from it …

    (1) is there any other kind of 12 stepper? all the ones i know are “nut jobs” to one extent or another. this is basically because while AA is very good at separating people from the immediate source of their addiction (“don’t take the first drink, one day/hour/minute at a time” etc) it offers no long-term respite from what is euphemistically called “the sober condition” in meetings. in fact you could argue that it actively cultivates such ongoing neuroses by encouraging members to “get in touch with their feelings” etc. so, ultimately, does aa/12 step not just replace one kind of denial/insanity with another? (of course i include myself in this, as i was certainly totally bonkers when i was a 12 stepper.)

    (2) the professionalisation of faith healing “treatments” for alcoholism and addiction has been a disaster for the thousands of those afflicted by this condition; in particular those who (unlike myself) have sufficient intellectual integrity to resist what is basically a twentieth century form of exorcism. many of whom have been condemned to death as a result. the longer i am away from AA the more people i seem to meet who watched family members suffer and die because they simply could not accept the institutionalisation of what is, at it’s heart, a damaging judeo-christian falsehood in our healthcare system and media. i have great respect for dr. bob, whom i’m sure was a very good man, but can’t help but recall with horror the closing paragraph of his contribution to AA’s big book: “if you think you are an atheist, an agnostic, a skeptic, or have any other form of intellectual pride which keeps you from accepting what is in this book, I feel sorry for you”.

    surely, a generation from now, the promulgation of AA as a “treatment” for alcoholism will seem every bit as ridiculous to those looking back on it as previously accepted practices of smoking or slavery do to us today.

    • I agree with you on everything except that AA is a Judeo-Christian falsehood. I am Christian and that was my number one reason for leaving the program because while many who may not have been brought up in the church or studied Christian theology come to this conclusion about AA, AA is anything but Judeo Christian. According to the Bible there is only one God and to chose another is idolatry. The group of AA, nature, a door knob or bed pan is not an option. For me personally, I could not support a program with these teachings. There are other key saying in the Big Book that alerted me that the rooms of AA were not for me, such as the Broad Road analogy of the Big Book VS the Narrow Road of the Bible, and all these combined led me to investigate the backgrounds of Bill Wilson, Dr. Bob, and the individuals from who they drew their ideals. I discovered much more than I expected. In addition to Bill Wilson being a womanizing lying nutcase, he was into séances, Ouija boards, and the men from whom he drew his ideals would be considered either leaders or members of a cult or at least showed signs of cult-like thinking. When I first started checking into the background of AA I knew I disagreed with a lot of what I was being told, but I did not think it was a cult. By the time I finished my investigation, I concluded that rather members realize it or not that is what it’s founders intended even if they didn’t come out and say it directly, which is pretty common in the case of cults. I also could not believe alcoholism to be a disease. Not only does it not make sense, but the Bible makes it clear that drinking in moderation is fine, however, drunkenness is both foolish and a sin. I know that sin can lead to diseases, such as cirrhosis of the liver and venereal disease, but I do not believe God would allow me to be born with a disease that is going to cause me to sin. In other words, I believe the sin comes first followed sometimes by a consequence of disease, but never the other way around. I’m not the first one to leave the program because of my belief as a Christian, ironically, my next door neighbor left for the same reason and he is a counselor who now helps people with addictions that are not based on anything to do with AA or the 12-Steps. I agree with everything is you said and I mean no disrespect toward you if you are a non-believer of Christ, but I chose to reply because there are so many who conclude what you have about Christianity and AA, which as a Christian I find very disturbing. There are many Christians who attend AA, but the teachings of AA most definitely are not Judeo-Christian.

  2. I certainly think the steps are pretty stupid as well as a reliance on a higher power. People get sucked in because they have often tried to moderate or stop before and have failed. when they stop in AA they tend to give the steps the credit. I do not think this is a true reflection of what actually happens to them. i think getting caught up in the dynamics of a group, doing some service for others and being with people who have acommon aim is what helps people change. Also it is often the act of actually doing something about addiction that helps them rather than what they do.

    I think you have take the things in the big book that are religious in the context of the time they were written and also reflect that the midwest of America was very religious at that time. Things that were written then are not normally considered to be the answers to todays problems.
    I met some in the rooms who were mad and who I did my best to avoid, they were often hard core 12 steppers. Other people were more moderate in their approach. I found the best people to talk to were the ex street drinkers who had really had to battle to get their life back on track. In the less trendy meetings people would often speak out against the steps but this would not be done in the central London meetings which had a lot of posers in them.

    People do get caught up in the AA world but many do improve their lives there if they get a job and start to mix with more normal people. Others tend to have a life, that revolves around meetings which is not that healthy. People develop at different speeds and some people like being in a religious/spiritual type group which keeps them linked to addiction, which is how they have decided to define themselves, when they claim that they are powerless. Others want to become empowered and wish to distance themselves from addiction and the past.

    It will be interesting to see how things change in the future. Poeple are becoming less trusting of religion and this will probably have some impact. However there always new people coming through the door for the old timers to influence, to replace those who have moved on for saner lives and this keeps the idea of a spiritual solution alive.

    I tend to find that I regard most people who have religion as a bit mad, but often these people are quite caring and do good in the community. The same is true in the 12 step world, and it is the noisy extremists that cause the problems!

  3. This is an excellent article providing additional insight and information on a topic that should be of great interest to all considering the rise in Substance Use Disorder over the past 75 years!

    I am hoping that ObamaCare will prompt the availability of more evidence-based treatment for the people that need it. This issue is too serious to continue to keep our collective heads up our butts.

    I have reposted a link to your article. Many more folks will appreciate what you have to say just as I have.

    Thank you for writing it!

  4. Thanks glad you like it! I just read Carl Hart’s book after listening to him on Monica’s show. That is a really thought provoking book for people, especially those in America. I really enjoyed having spent enough time there to understand where he is coming from. He certainly provides some evidence!

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