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- Treatment Works! Is it time for a new slogan?
Treatment Works! Is it time for a new slogan?
- By William White
- Published 03/8/2007
- Key ideas and recovery tools
- Unrated
William White
William L. White, M.A., is a Senior Research Consultant at Chestnut Health Systems and the author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America.
View all articles by William White
Treatment Works is the central promotional slogan of the addiction treatment industry. This essay argues that the slogan misrepresents the probable outcomes of addiction treatment and misplaces the responsibility for such outcomes.
The slogan Treatment Works should be abandoned and replaced by a cluster of messages that shift the emphasis from the intervention (treatment) to the desired outcome (recovery), extol the importance of personal choice and responsibility, celebrate multiple pathways of recovery, affirm the supportive roles of family and community in the recovery process, and incorporate catalytic metaphors drawn from diverse medical, religious, spiritual, political and cultural traditions.
Slogans are phrases or mottoes that convey ideas and sentiments in a highly condensed and memorable form.
Because of their power to shape how people perceive, think, feel, and act, they serve as mechanisms of control in totalitarian systems (as vividly portrayed in George Orwell’s Animal Farm) and are an ever-present expression of the marketplace of ideas, products and services within democratic societies.
Catchy slogans and jingles have a rich history within the alcohol and other drug (AOD) problems arena.
They have been used to:
• promote psychoactive drug use (“It’s Miller time”; “I’d walk a mile for a…; “Tune in, turn on, drop out.”)
• discourage psychoactive drug use (“Just Say No”; “This is your brain; ….”),
• convey the source and nature of AOD problems (“Alcoholism is a disease”; “Capitalism plus dope equals genocide”)
• portray the character of AOD consumers and those experiencing AOD problems (“The alcoholic is a sick person”; “Users are losers”)
• promote particular AOD-related social policies (“Zero tolerance”; “Treatment works”), and
• shape recovery-based thinking and daily living (“One day at a time”; “Sobriety priority”).
The business, professional, and mutual aid institutions whose missions are related to AOD use/problems have all coined slogans to promote their ideological, financial and therapeutic interests.
Such slogans are complex. They can operate at personal, family, professional, institutional and cultural levels; work at some levels while failing at others; and generate unintended and potentially harmful consequences.
Rethinking “Treatment Works”
The slogan Treatment Works is the central promotional slogan of the addiction treatment industry. It can be seen and heard almost anywhere addiction treatment is being discussed. (A Google search matching the slogan and the word addiction generates more than 12,000 Internet references.)
Treatment Works meets many criteria of a good slogan. It is compact, original, catchy, and memorable. It offers a positive promise of benefit to its multiple target audiences.
It celebrates the hundreds of thousands of people with AOD problems who have used professional treatment to transform their lives.
The slogan is a cogent affirmation of hope to individuals and families experiencing AOD-related problems. It acknowledges the commitment and competence of those who work on the front lines of addiction treatment.
Historically, the slogan affirms the superiority of addiction treatment institutions over “drunk tanks,” (of city jails); “foul wards” (of city hospitals); and “back wards” (of aging state psychiatric hospitals).
Scientifically, Treatment Works stands as a summation of addiction treatment outcome research. The slogan’s introduction was strategically well-timed to counter two potential threats to the status of the addiction treatment field: highly publicized cases of celebrity relapse following multiple episodes of treatment, and growing challenges to the core constructs of modern addiction treatment (Fingarette, 1989; Peele, 1989; Peele and Brodsky, 1992; Davies, 1992; Schaler, 2000).
In summary, the slogan’s purposeful ambiguity (what is encompassed in the term “treatment” and the meaning of the term “works”) has allowed it to serve multiple functions: scientific proclamation, professional self-congratulation, marketing jingle and social policy mantra.
With such advantages, it is little wonder that the slogan has achieved wide dissemination.
The problem is that slogans and sloganeering are complex entities and processes plagued with pitfalls and unintended consequences.
This article, written by a decades-long promoter and defender of addiction treatment, argues that the slogan Treatment Works is ill-conceived and should be abandoned.
The slogan Treatment Works erroneously conveys the existence of a singular, static entity called “treatment” that is consistent in character and quality over time as it is delivered in the United States.
The reality is quite different. Addiction treatment in the United States is a smorgasbord of diverse settings, philosophies, and techniques (White, 1998) that also vary significantly in their effectiveness (Wilbourne & Miller, 2003).
There are widely utilized methods of addiction treatment that lack scientific support for their effectiveness (Miller & Hester, 1986), and methods of treatment with substantial scientific support that continue to be publicly and professional stigmatized, e.g., methadone maintenance treatment (Kreek & Vocci, 2002; White and Coon, 2003).
Outcomes of addiction treatment vary by client and program characteristics (Landry, 1997; Miller, Walters, & Bennett, 2001; Wilbourne & Miller, 2003) and by the intensity of post-treatment monitoring, support and early re-intervention (Dennis, Scott, & Funk, 2003).
Outcomes of a particular treatment vary when delivered by different addiction counselors (McLellan, Woody, Luborsky, & Goehl, 1988).
The quality of a particular treatment approach can also vary over time due to the “inadequate and unstable” organizational infrastructures of addiction treatment agencies (McLellan, Carise, & Kleber, 2003).
Such instability is indicated by the rate of program closures and reorganizations (Johnson & Roman, 2002) and the low status1, low morale, and high annual turnover2 of the addiction treatment 1
One indication of the status of the role of addiction counselor is a recent report that declared addiction counselors along with dishwashers, pest controllers, and funeral home attendants among “The ten most underpaid jobs in workforce (Director’s Report, 2003; Roman, Blum, Johnson, & Neal, 2002; NYS OASIS, 2002).
The sweeping generalization Treatment Works, by ignoring such variability and instability, fails to enhance the public’s ability to make informed choices about addiction treatment services.
Treatment Works perpetuates a single pathway model of AOD problem resolution. The slogan Treatment Works ignores the variety of ways people with AOD problems resolve these problems.
The majority of persons with AOD problems do not seek professional treatment (Narrow, Reiger, Rae, Manderscheid & Locke, 1993), but do resolve these problems without such intervention (Sobell, Sobell, Toneatto, and Leo, 1993; Humphreys, Moos, & Finney, 1995; Sobell, Cunningham, & Sobell, 1996; Cunningham, 2000).
The resolution of AOD problems without professional treatment has been documented in the research literature for more than forty years.
The extensiveness of this literature is indicated by the number of terms used to describe such styles of problem resolution: maturing out (Winick, 1962), autoremission (Vaillant, 1983; Klingeman, 1992), self-initiated change (Biernacki, 1986); unassisted change (McMurran, 1994), spontaneous remission (Tuchfield, 1981; Anthony and Helzer, 1991), de-addiction (Frykholm, 1985), self-change (Sobell, Sobell, and Toneatto, 1991), natural recovery (Havassey, Hall and Wasserman, 1991; Granfield and Cloud, 1999), self-managed change (Copeland, 1998) and quantum change (Miller and C’de Baca, 2001).
The slogan Treatment Works ignores the role of self, family, friends, mutual aid groups and other community-based and peer-based support services in the recovery process.
The slogan Treatment Works fails to distinguish those individuals for whom addiction treatment is most appropriate from those who are likely to resolve AOD problems without professional intervention or who would be potentially harmed by treatment.
Adults and adolescents for whom professional intervention is most warranted are characterized by earlier age of onset of AOD use, polydrug use, longer and more intense AOD use careers, greater AODrelated consequences, high rates of co-occurring psychiatric illness, less occupational opportunity and stability, fewer family and social supports and multiple failed efforts to moderate or stop AOD use (Weisner, 1993; Granfield and Cloud, 1996; Dawson, 1996; Ross, Lin, & Cunningham, 1999; Bischof, Rumpf, Hapke, Meyer, & John, 2001; Brown, 1993; Keller, Lavori, Beardslee, Wunder, Drs, & Hasin, 1992).
The slogan Treatment Works fails to distinguish for referring professionals and the public who could benefit most from addiction treatment from those for whom such treatment is unnecessary or contraindicated due to potential harm.
Treatment Works justifies an acute care model of intervention (analogous to treating a broken arm) that is unsuitable for most people with severe AOD problems. The slogan conveys to the public that the person with severe AOD problems is “broken” but can be “fixed” via a single episode of “rehab” (brief professional intervention).
This acute model, which is coming under increasingly critical scrutiny (McLellan, O’Brien, Lewis & Kleber, 2000), is particularly ill-suited for persons with high personal vulnerability (e.g., family history of AOD problems, early age of AOD use), high problem severity and complexity (e.g., psychiatric co-morbidity), America” because compensation was low in comparison to the “loathsome” nature of the work.
Peoria Journal Star, Peoria, IL, January 4, 2004. 2
State surveys such as one in Iowa reveal a 23% annual turnover with some programs experiencing annual turnover near 90%. Mosher, C.R. (2000). Why do they leave?
Retention and Turnover in Iowa Substance Abuse Agencies: A Preliminary report. Unpublished report.
While such turnover may involve shifts of staff from program to program, state certification boards have reported a non-renewal of certification rates for addiction counselors as high as 34%. Martin, E. (2002).
Addiction Counselor Traits and Turnover. Portland, OR”
Addiction Counselor Certification Board of Oregon. and low recovery capital (internal and external recovery initiation and maintenance resources) (White, Boyle & Loveland, 2002).
There are legions of families whose loved ones have died addiction-related deaths, are languishing in prisons, or are living addiction-deformed lives—all after one or more episodes of addiction treatment.
What must these families feel when they hear the slogan Treatment Works? Treatment Works misrepresents the highly variable and complex outcomes of addiction treatment.
The slogan, by failing to distinguish the variability of treatment outcomes across clinical subpopulations, modalities and particular programs, misrepresents the overall research on treatment effectiveness.
The slogan achieves its intended effect by capitalizing on differences in public and professional definitions of the term “works.” In the public mind, the term tends to be used dichotomously—something works or it doesn’t.
The meaning of addiction treatment “working” to the public is quite simple and straightforward: an addicted person is treated and the addiction is gone forever, the evidence of which is complete and enduring abstinence following discharge from treatment.
Many addiction treatment professionals share this dichotomous view and think treatment “works” because they know of cases of complete recovery following treatment. For them, the view that treatment can work for some individuals is simply shortened to the more positive Treatment Works.
To the researcher, treatment works if the intervention has positive and measurable effects—effects that could range from complete abstinence to any reduction in AOD use and related problems to a reduction in social costs following treatment.
The slogan Treatment Works crosses these worlds of public perception, clinical practice and clinical research but conveys very different meanings within each arena.
The American public will not forever countenance the indiscriminate application of this term (“works”) to addiction treatment. The notion that severe AOD problems can be effectively resolved through a single, brief episode of professional treatment is not culturally sustainable.
Here is a sampling of research findings of the past fifteen years that challenge this mechanistic and inflated portrayal of treatment outcomes.
Continued in PDF document
Treatment Works! Is it time for a new slogan?
The slogan Treatment Works should be abandoned and replaced by a cluster of messages that shift the emphasis from the intervention (treatment) to the desired outcome (recovery), extol the importance of personal choice and responsibility, celebrate multiple pathways of recovery, affirm the supportive roles of family and community in the recovery process, and incorporate catalytic metaphors drawn from diverse medical, religious, spiritual, political and cultural traditions.
Slogans are phrases or mottoes that convey ideas and sentiments in a highly condensed and memorable form. Because of their power to shape how people perceive, think, feel, and act, they serve as mechanisms of control in totalitarian systems (as vividly portrayed in George Orwell’s Animal Farm) and are an ever-present expression of the marketplace of ideas, products and services within democratic societies.
Catchy slogans and jingles have a rich history within the alcohol and other drug (AOD) problems arena.
They have been used to:
• promote psychoactive drug use (“It’s Miller time”; “I’d walk a mile for a…; “Tune in, turn on, drop out.”)
• discourage psychoactive drug use (“Just Say No”; “This is your brain; ….”),
• convey the source and nature of AOD problems (“Alcoholism is a disease”; “Capitalism plus dope equals genocide”)
• portray the character of AOD consumers and those experiencing AOD problems (“The alcoholic is a sick person”; “Users are losers”)
• promote particular AOD-related social policies (“Zero tolerance”; “Treatment works”), and
• shape recovery-based thinking and daily living (“One day at a time”; “Sobriety priority”).
The business, professional, and mutual aid institutions whose missions are related to AOD use/problems have all coined slogans to promote their ideological, financial and therapeutic interests.
Such slogans are complex. They can operate at personal, family, professional, institutional and cultural levels; work at some levels while failing at others; and generate unintended and potentially harmful consequences.
Rethinking “Treatment Works”
The slogan Treatment Works is the central promotional slogan of the addiction treatment industry. It can be seen and heard almost anywhere addiction treatment is being discussed. (A Google search matching the slogan and the word addiction generates more than 12,000 Internet references.)
Treatment Works meets many criteria of a good slogan. It is compact, original, catchy, and memorable. It offers a positive promise of benefit to its multiple target audiences.
It celebrates the hundreds of thousands of people with AOD problems who have used professional treatment to transform their lives.
The slogan is a cogent affirmation of hope to individuals and families experiencing AOD-related problems. It acknowledges the commitment and competence of those who work on the front lines of addiction treatment.
Historically, the slogan affirms the superiority of addiction treatment institutions over “drunk tanks,” (of city jails); “foul wards” (of city hospitals); and “back wards” (of aging state psychiatric hospitals).
Scientifically, Treatment Works stands as a summation of addiction treatment outcome research. The slogan’s introduction was strategically well-timed to counter two potential threats to the status of the addiction treatment field: highly publicized cases of celebrity relapse following multiple episodes of treatment, and growing challenges to the core constructs of modern addiction treatment (Fingarette, 1989; Peele, 1989; Peele and Brodsky, 1992; Davies, 1992; Schaler, 2000).
In summary, the slogan’s purposeful ambiguity (what is encompassed in the term “treatment” and the meaning of the term “works”) has allowed it to serve multiple functions: scientific proclamation, professional self-congratulation, marketing jingle and social policy mantra.
With such advantages, it is little wonder that the slogan has achieved wide dissemination.
The problem is that slogans and sloganeering are complex entities and processes plagued with pitfalls and unintended consequences.
This article, written by a decades-long promoter and defender of addiction treatment, argues that the slogan Treatment Works is ill-conceived and should be abandoned.
The slogan Treatment Works erroneously conveys the existence of a singular, static entity called “treatment” that is consistent in character and quality over time as it is delivered in the United States.
The reality is quite different. Addiction treatment in the United States is a smorgasbord of diverse settings, philosophies, and techniques (White, 1998) that also vary significantly in their effectiveness (Wilbourne & Miller, 2003).
There are widely utilized methods of addiction treatment that lack scientific support for their effectiveness (Miller & Hester, 1986), and methods of treatment with substantial scientific support that continue to be publicly and professional stigmatized, e.g., methadone maintenance treatment (Kreek & Vocci, 2002; White and Coon, 2003).
Outcomes of addiction treatment vary by client and program characteristics (Landry, 1997; Miller, Walters, & Bennett, 2001; Wilbourne & Miller, 2003) and by the intensity of post-treatment monitoring, support and early re-intervention (Dennis, Scott, & Funk, 2003).
Outcomes of a particular treatment vary when delivered by different addiction counselors (McLellan, Woody, Luborsky, & Goehl, 1988).
The quality of a particular treatment approach can also vary over time due to the “inadequate and unstable” organizational infrastructures of addiction treatment agencies (McLellan, Carise, & Kleber, 2003).
Such instability is indicated by the rate of program closures and reorganizations (Johnson & Roman, 2002) and the low status1, low morale, and high annual turnover2 of the addiction treatment 1
One indication of the status of the role of addiction counselor is a recent report that declared addiction counselors along with dishwashers, pest controllers, and funeral home attendants among “The ten most underpaid jobs in workforce (Director’s Report, 2003; Roman, Blum, Johnson, & Neal, 2002; NYS OASIS, 2002).
The sweeping generalization Treatment Works, by ignoring such variability and instability, fails to enhance the public’s ability to make informed choices about addiction treatment services.
Treatment Works perpetuates a single pathway model of AOD problem resolution. The slogan Treatment Works ignores the variety of ways people with AOD problems resolve these problems.
The majority of persons with AOD problems do not seek professional treatment (Narrow, Reiger, Rae, Manderscheid & Locke, 1993), but do resolve these problems without such intervention (Sobell, Sobell, Toneatto, and Leo, 1993; Humphreys, Moos, & Finney, 1995; Sobell, Cunningham, & Sobell, 1996; Cunningham, 2000).
The resolution of AOD problems without professional treatment has been documented in the research literature for more than forty years.
The extensiveness of this literature is indicated by the number of terms used to describe such styles of problem resolution: maturing out (Winick, 1962), autoremission (Vaillant, 1983; Klingeman, 1992), self-initiated change (Biernacki, 1986); unassisted change (McMurran, 1994), spontaneous remission (Tuchfield, 1981; Anthony and Helzer, 1991), de-addiction (Frykholm, 1985), self-change (Sobell, Sobell, and Toneatto, 1991), natural recovery (Havassey, Hall and Wasserman, 1991; Granfield and Cloud, 1999), self-managed change (Copeland, 1998) and quantum change (Miller and C’de Baca, 2001).
The slogan Treatment Works ignores the role of self, family, friends, mutual aid groups and other community-based and peer-based support services in the recovery process.
The slogan Treatment Works fails to distinguish those individuals for whom addiction treatment is most appropriate from those who are likely to resolve AOD problems without professional intervention or who would be potentially harmed by treatment.
Adults and adolescents for whom professional intervention is most warranted are characterized by earlier age of onset of AOD use, polydrug use, longer and more intense AOD use careers, greater AODrelated consequences, high rates of co-occurring psychiatric illness, less occupational opportunity and stability, fewer family and social supports and multiple failed efforts to moderate or stop AOD use (Weisner, 1993; Granfield and Cloud, 1996; Dawson, 1996; Ross, Lin, & Cunningham, 1999; Bischof, Rumpf, Hapke, Meyer, & John, 2001; Brown, 1993; Keller, Lavori, Beardslee, Wunder, Drs, & Hasin, 1992).
The slogan Treatment Works fails to distinguish for referring professionals and the public who could benefit most from addiction treatment from those for whom such treatment is unnecessary or contraindicated due to potential harm.
Treatment Works justifies an acute care model of intervention (analogous to treating a broken arm) that is unsuitable for most people with severe AOD problems. The slogan conveys to the public that the person with severe AOD problems is “broken” but can be “fixed” via a single episode of “rehab” (brief professional intervention).
This acute model, which is coming under increasingly critical scrutiny (McLellan, O’Brien, Lewis & Kleber, 2000), is particularly ill-suited for persons with high personal vulnerability (e.g., family history of AOD problems, early age of AOD use), high problem severity and complexity (e.g., psychiatric co-morbidity), America” because compensation was low in comparison to the “loathsome” nature of the work.
Peoria Journal Star, Peoria, IL, January 4, 2004. 2
State surveys such as one in Iowa reveal a 23% annual turnover with some programs experiencing annual turnover near 90%. Mosher, C.R. (2000). Why do they leave?
Retention and Turnover in Iowa Substance Abuse Agencies: A Preliminary report. Unpublished report.
While such turnover may involve shifts of staff from program to program, state certification boards have reported a non-renewal of certification rates for addiction counselors as high as 34%. Martin, E. (2002).
Addiction Counselor Traits and Turnover. Portland, OR”
Addiction Counselor Certification Board of Oregon. and low recovery capital (internal and external recovery initiation and maintenance resources) (White, Boyle & Loveland, 2002).
There are legions of families whose loved ones have died addiction-related deaths, are languishing in prisons, or are living addiction-deformed lives—all after one or more episodes of addiction treatment.
What must these families feel when they hear the slogan Treatment Works? Treatment Works misrepresents the highly variable and complex outcomes of addiction treatment.
The slogan, by failing to distinguish the variability of treatment outcomes across clinical subpopulations, modalities and particular programs, misrepresents the overall research on treatment effectiveness.
The slogan achieves its intended effect by capitalizing on differences in public and professional definitions of the term “works.” In the public mind, the term tends to be used dichotomously—something works or it doesn’t.
The meaning of addiction treatment “working” to the public is quite simple and straightforward: an addicted person is treated and the addiction is gone forever, the evidence of which is complete and enduring abstinence following discharge from treatment.
Many addiction treatment professionals share this dichotomous view and think treatment “works” because they know of cases of complete recovery following treatment. For them, the view that treatment can work for some individuals is simply shortened to the more positive Treatment Works.
To the researcher, treatment works if the intervention has positive and measurable effects—effects that could range from complete abstinence to any reduction in AOD use and related problems to a reduction in social costs following treatment.
The slogan Treatment Works crosses these worlds of public perception, clinical practice and clinical research but conveys very different meanings within each arena.
The American public will not forever countenance the indiscriminate application of this term (“works”) to addiction treatment. The notion that severe AOD problems can be effectively resolved through a single, brief episode of professional treatment is not culturally sustainable.
Here is a sampling of research findings of the past fifteen years that challenge this mechanistic and inflated portrayal of treatment outcomes.
Continued in PDF document
Treatment Works! Is it time for a new slogan?
