Alcohol: The Most Anti-Social Drug

This week's Lancet, the British medical journal, drives a silver spike into the heart of the undead myth that alcohol is the lubricant of sociability and good fellowship.  A systematic comparative ranking of 20 different addictive drugs found that alcohol is the most harmful drug, more harmful than heroin, crack cocaine, and methamphetamines.

The study, by an industry-independent panel of scientific experts, ranked drugs in terms of their harm to the user and their harm to others.

Heroin, crack, and methamphetamine scored higher than alcohol in harm to the user.  But alcohol's score on the scale of harm to others was double that of heroin and crack, the next leading chemicals, so that when the scores of harm to others and harm to self were combined, alcohol led the sordid parade of harmful consequences by nearly twenty points.

A key point in alcohol marketing is social bonding.  Alcohol is said to promote romantic linkups, male bonding, business networking, and general friendly togetherness.  It's sold as the antidote to the isolation, alienation, and competitiveness that make so many people feel lonely even in crowds.   The industry spends billions every year trying to persuade us that if we'd all drink together, we'd all be happy together.

Not so, found the panel of medical experts.  The group evaluated the harm each drug caused to others in terms of physical and psychological injury, crime, environmental damage, family adversities, international damage, economic cost, and damage to community.  The panel also ranked social harms such as the loss of tangibles and loss of relationships.

Alcohol led all other drugs in measure of injury to others, family adversities, economic cost, and harm to the community. In other words, the person under the influence of alcohol caused the most bloodshed, broken families, and other mayhem to economic and social life.

The Lancet study corroborates other, similar studies conducted by other scientists independent of the alcoholic beverage industry, and cited in the Lancet article.  This relatively recent group of studies moves beyond older research which looked at drug consequences more narrowly, in terms of a single factor, such as drug-related deaths.

The finding that alcohol is a more harmful drug in society than heroin and crack cocaine upsets some deep seated stereotypes.  We've been taught to identify the "drug problem" with hard drug users, and we've been led to believe that most of these are black and socially marginal.

This research says that society's drug problem is really first and foremost an alcohol problem, and that you'll find the most dangerous drug addicts among outwardly respectable middle class whites.

That isn't really news to those who have attended most any addiction recovery support group meeting.  How many stories of hospital visits, court dates, divorces, abandoned children, lost jobs, and other chaos do you need to hear before you realize that the slick TV ads for alcoholic beverages are lies?

Even in parts of the recovery subculture, the alcoholics have tended to turn up their noses at the heroin and crack addicts. This elitist bias underlies the segregation of the legacy support groups into separate alcohol and "narcotics" branches.  (Modern groups such as LifeRing include both alcohol and other drug users.)  Now science is turning this conceit upside down.

True, the heroin and crack users have nothing to be proud of.  But the drug that really tears apart the bonds of society doesn't come in a syringe or a pipe, it comes in a bottle.

[First published in hellowellness.in on Nov. 7 2010]

Recover and Be Killed

[Originally published 29 Oct 2010 on hellowellness.in]

Trying to get clean and sober is a pathway to a new life in most places, but in some cities of Mexico it’s a ticket for getting killed.  Gunmen believed to be narco gangsters this week stormed into a drug rehab center in Tijuana, found 13 patients watching a movie, lined them up on the floor, and murdered them with machine gun fire.  

A few days later, masked gangsters invaded a car wash in the central Mexican city of Tepic, not far from the tourist destination Puerto Vallarta.  They sprayed employees and customers with automatic weapon fire.  Most of the murdered car wash workers were recovering addicts.

The border town Ciudad Juarez has seen a streak of massacres in drug rehab centers.  Minutes after the mass murder in the rehab center in Tijuana, a narco voice was heard on the police radio saying that this was “a taste of Juarez.”

Public speculation as to the narco gangster’s motives in targeting people in recovery ranged widely.  A New York Times reporter guessed that the rehab centers were used as a refuge by former gang members trying to get away from the criminal syndicates.  A Mexican official speculated that the Tijuana attack was retaliation for the authorities’ seizure and burning of 134 metric tons of marijuana the previous week.  El Blog del Narco, the semi-clandestine online kiosk for narco-related information and disinformation, is silent on the topic of motive.  

A more likely explanation is commercial.  One has to remember that the drug business is a business, and a business depends on customers.  From the narco standpoint, people who seek recovery from drug use are dissatisfied customers who not only step outside the market but stand as living testimony, human Yelps, for the defects of the product.  In the supercharged atmosphere of the Mexican drug war, that’s reason enough to kill them.  

I write this in Oakland, California, a city whose city council this year approved a far-reaching measure to regulate and tax medical marijuana.  City leaders are also on record in support of Proposition 19 on the California state ballot, a measure that would legalize, regulate, and tax marijuana possession and cultivation, medical or not.  The measure has drawn worldwide attention, including notably in neighboring Mexico.  

Both the Mexican government and the U.S. administration under President Obama have come out against Prop. 19.  Obama’s position appears to be part of his general unfortunate slide toward appeasement of the conservatives.  Mexican President Felipe Calderon’s position is an understandable reluctance to make a 180 degree turn from his efforts at military suppression of the wars between his country’s drug cartels.  If one of the major export crops he is trying to stamp out suddenly becomes legal in its primary market across the border, he will look at first like a fool.  

Legalization of marijuana in circumstances like these has never been done before, and nobody can say with assurance what will happen.  Political leaders prefer the devil they know to the devil they don’t.  But many analysts believe that legalization in California will deal a harsh commercial blow to the Mexican cartels.  California already grows its own marijuana, said to be of much higher potency and quality than the Mexican variety. If the local cultivation is legalized, the Mexican product may become practically unsaleable here.  The Mexican president may find that the passage of Prop. 19 puts him for the first time in the driver’s seat.  

For myself, I have long ago made the choice to abstain from alcohol, marijuana, tobacco, and other addictive drugs, and I persist steadfastly in that decision.  In my experience, the vast majority of people who have personal experience with these drugs have gotten free of them, or wish they could (and they can).  Nevertheless, in the upcoming California election, I will cast my vote in favor of Prop. 19.  The prohibition of marijuana has not worked.  Young people can score marijuana more easily than alcohol.  Prosecutors have used the laws not to break the distribution networks, but to persecute minority youth for petty infractions resulting in major prison terms.  The “war on drugs” has been a scandalous waste and abuse of taxpayer resources that would be better devoted to education, prevention, and treatment.

Pain Relief Without Addiction: Walking the Tightrope

[Originally published on hellowellness.in on 29 Oct. 2010]

Roger T., a middle-aged systems analyst, showed up at a LifeRing recovery support group looking for help with addiction to painkillers.  Years earlier he had been a passenger in an auto collision which left him with chronic pain in his lower back and hips.  His doctors had prescribed the standard opiates, and this had provided him with some relief, but over time he needed larger and larger doses.  He said he had been taking 300 Vicodins® per day.  He knew he had to stop the drugs -- but he couldn’t live with the pain.  

Not only patients but also their physicians have to walk a tightrope between pain and addiction.  A hot case in point is the jury trial involving Dr. Sandeep Kapoor, the 42-year old Hollywood internist and physician to celebrity model Anna Nicole Smith.  Smith died of a drug overdose in 2007.  Dr. Kapoor and two other defendants were not charged in her death -- this was ruled accidental -- but were charged with conspiracy to provide her with excessive quantities of pain medications while knowing she was an addict.  

In other words, Dr. Kapoor was charged with crossing the line from medical helper to drug pusher.  It’s an issue that inflames hundred-year old wounds on the U.S. medical community.  With the passage of the Harrison Act in 1914 and regulations and court decisions shortly thereafter, the federal government severely limited physicians’ professional freedom to prescribe analgesic medications.  They could prescribe opiate painkillers only in tapering doses, and their good faith professional medical judgment was ruled irrelevant.  

In the following decades, the US Treasury Department indicted more than 25,000 physicians for prescribing opiates; some 3,000 went to jail, and more than 20,000 were forced to pay fines.  It was a shameful period, and it has left enduring scars on modern medical practice.  The California statute under which Dr. Kapoor was charged is a direct descendant of this period.  These laws have chilled physicians’ treatment of patients with chronic pain problems.  

The Harrison Act rested on paranoia about anarchists, radicals, criminals, and foreigners -- especially Chinese -- who were (wrongly) seen as the typical opiate users of their day.  Scratch any subscriber to what passes as public opinion in the US today and you’ll find, not far beneath the surface, a similar identification of drug users with social undesirables.  

All of that goes on the scrap heap when a celebrity is involved.  As everyone familiar with the criminal justice system in the U.S. must be aware, celebrities are above the law, particularly the law of addictive substances.  Lindsey Lohan, Mel Gibson, Paris Hilton ... all would be locked up for years if their names were Smith, Jones, and Johnson.  And so here.  With Anna Nicole Smith, a genuine neon blazing celebrity at the center of the trial -- even more dazzling a presence in death perhaps than in life -- the judge found ample justification for her possession, post mortem, of more than 1,500 pills.  In a phrase that will reverberate in courtrooms for years, Judge Perry T. Fine admonished the jury, "The number of pills is not a determinative factor in this case. Please keep that in mind.”  

The jury did.  After 13 days of deliberations it returned yesterday a verdict of “not guilty” for Dr. Kapoor.  It found, in other words, that Ms. Smith was not “addicted” and that Dr. Kapoor’s prescription of opiate painkillers was medically justified in view of her many and severe symptoms of pain and anguish.  

Dr. Kapoor still faces a lengthy process of rehabilitating his reputation and defending possible attacks on his medical license.  But he will not go to prison.  

With this courtroom victory, physicians who specialize in the difficult art of pain management -- a small and endangered species -- will breathe a long overdue sigh of relief.  

Most of these physicians are members of the American Society of Addiction Medicine (ASAM), a highly respected and conservative professional body of providers who more or less successfully navigate the tightrope of giving pain relief without enabling addiction, every working day.  

But  there is also a fringe element of medical opportunists who will prescribe whatever the patient asks for, so long as the check is good.  And there are well-intentioned general practitioners with zero schooling in addiction medicine whom the experienced opiate addict plays like a violin.  

There are no easy answers to pain.  I have had conversations in LifeRing meetings with a number of people like Roger T. who suffer from chronic pain, medically managed with conventional opiate-based pharmaceuticals.  They tell me that they have learned to recognize when they are crossing the boundary from pain relief into seeking euphoria.  Unfortunately that insight came only after multiple boundary crossings with harmful consequences.  I have also talked with chronic pain sufferers who have found relief through hypnosis, meditation, special exercises, nutrition, and other alternative approaches.  Pharmaceutical research is also hinting at new types of analgesics that do not involve the classic addictive brain circuits, as the opiates do.  

Obtaining pain relief without falling into addiction is one of the most difficult challenges for professional and patient alike.  One thing seems certain.  There will be more progress if this problem is left in the hands of providers and patients, without massive interference from uninformed legislators and political appointees, frequently with demagogic motives.  To that extent, the jury’s verdict freeing Dr. Kapoor is an important step forward, and Judge Fine deserves recognition for a well-reasoned set of jury instructions.

Catch me on Audrey's Show

Last August I had the privilege of being a guest on the Audrey Chapman show; see my blog post about it.  Today I had the honor of being invited back for a second appearance.  We recorded it today, and it'll air on Saturday, April 24 at 8 a.m. Eastern Standard Time, on WHUR-FM at 96.3 -- heard up and down the East Coast from Florida to New Jersey -- and via the Internet at http://www.whur.com.
Audrey has a great touch.  I've not had the pleasure to meet her in person, but if I were looking for a counselor to tell my troubles to, Audrey would be high on my list.  She's empathetic, she's widely read and well informed, and she has a knack for getting to the core of an issue in a heartbeat.  Try and catch the program; it'll run about 45 minutes, and it's focused on my new book, Empowering Your Sober Self. 

On the Air with Audrey Chapman

It was my great pleasure this morning to appear via telephone on the Audrey Chapman show, broadcast in the Washington DC area on WHUR-FM at 96.3 and via the Internet at http://www.whur.com. Audrey is a relationship specialist who has written several books on love and its problems. She's active as a writer and speaker and also maintains a busy counseling practice. She talks with radio listeners every Saturday morning from 8 - 10 am (5 -7 a.m. my time), and her show is said to have a huge morning audience up and down the East Coast.

From the first words, you can see why Audrey has such a following. She's calm, she's clear, she's relaxed; she projects empathy without judgment. You immediately feel comfortable talking to her, telling her your problems. She also sees right to the heart of an issue. She couldn't have had much time to read my new book, but she clearly understood the main points. Her questions were relevant and moved the conversation forward.

Audrey thrives on the freshness and urgency of listener calls. And her callers didn't disappoint. In just a few conversations, much of the huge panorama of addiction problems in the society was laid out before us. A grown up woman was concerned with the drinking of the auntie who raised her. A mother was troubled by her teenage son's drinking. A father worried that his own drinking was leading his son into alcoholism. And so on. Addiction is an enormous problem, and there are people everywhere struggling with it.

We don't yet have LifeRing meetings in the D.C. area, but I had the opportunity to tell listeners about www.lifering.org, our website. I was pleased that Audrey asked me to stay on into the second hour of her show. There was still much more that could have been said, and I had to bite my tongue once or twice when callers pushed concepts and solutions that have very limited utility. But I loved the live interaction, and I could see myself engaged in a longer and very interesting conversation with Audrey on some other occasion. She's smart and she has an open mind and a great way with people.

Check out her website at audreychapman.com.

Empowering Your Sober Self: The LifeRing Approach to Addiction Recovery

Jacqueline Foreman (right) interviews me on Your Mental Health Talk Radio about my new book, here:

Empowering Your Sober Self: The LifeRing Approach to Addiction Recovery

The program aired July 7 2009 at 5 pm Pacific Time.

A Reader Writes With More Reading

One of the readers of this blog was kind enough to email me with the following information, which I pass on as received:

mr. nicolaus,

i'm a regular reader (& sometime commenter) of your "new recovery" blog. i'm writing to draw your attention to a few items i think might be of interest to you:

1 - the april/may 2009 issue of "Free Inquiry" magazine ran a great piece by Steven Mohr entitled "Exposing The Myth of Alcoholics Anonymous"; "Free Inquiry" is the first American publication to take AA head-on in a long, long time & the article is thorough & even-handed (unfortunately, you have to pick up a hard copy as the contents aren't available online)

2 - Dr. Harriet Hall (www.sciencebasedmedicine.org, www.skepdoc.info) ran a blog post on the above article & gave an MD's view of the article & the organization (http://www.sciencebasedmedicine.org/?p=490); i thought that might be of interest as well

3 - at my request, Dr. Hall visited & commented on a blog post at www.mentalhelp.net (http://www.mentalhelp.net/poc/view_doc.php?type=weblog&id=700&wlid=5&cn=14); the "editorial comment" to her post was -- putting it mildly -- elusive & openly condescending to any lay critique of AA; again, i was hoping this might be of interest of to you & that you might want to lend your voice to the discussion.

in any case, i thank you for your time & wish you all the best with your book. i'll be visiting the blog & www.unhooked.com regularly.

warmest regards,

peter [Name withheld]

donewithaa.wordpress.com

LifeRing in New Living (NY)

An excerpt adapted from Chapter 2 of my new book (Empowering Your Sober Self) appears in the April issue of New Living, a free 20-p health and wellness newspaper published in Stony Brook NY and distributed in the New York City area and Long Island.

This chapter from my book contains a set of tips and exercises designed to help the person who wants to stop using addictive substances to move across the gap from contemplation to action. They include visualization, laughter, self-forgiveness, reframing, exercise, and other attitude-builders. I wrote a 900-word excerpt for the paper.

The editors took some minor liberties with the chapter. They took the sentence, "Becoming drug or alcohol-free can exhilarate you and enable you to accomplish great things in life," and added the phrase "... and perhaps, more importantly, give you gratitude and humility, two spiritual qualities hard to find in most people."

OK, I may not be the most original writer in the world. But I try not to stoop to moth-eaten cliches like "gratitude and humility." But it's good to have the article in the paper, with a plug for the book, and a plug for the two LifeRing meetings in Long Island; and I guess there's a small price to pay for that. I am humbly grateful.

Alcohol Killed 'The Prophet'

The excellent New Yorker continues its literary war on the alcohol-as-muse delusion. In the Jan. 7 issue is a thumbnail bio of Kahlil Gibran, author of the huge bestseller, The Prophet. After the success of this book, Gibran took to drinking heavily. Eight years after The Prophet, having produced nothing further of note, he died of cirrhosis of the liver, at age 48.

If liquor doesn't get you, nicotine will

Last week's New Yorker had a bio of Malcolm Lowry, a lauded writer whose alcoholism claimed him at age 47; see my blog note, "Alcoholocaust," below. This week's mag covers iconic short story writer Raymond Carver (What We Talk About When We Talk About Love), also an alcoholic, but one who got sober in 1977, and stayed that way. But he kept smoking. He once said that he was only "a cigarette with a body attached to it." Lung cancer claimed him at age 50.

The mag's Lowry story took the author down a notch or two by suggesting that his wife was actually responsible for much of the greatness in Under the Volcano. The mag continues on its debunking tear by demonstrating beyond reasonable doubt that the savage blue pencil of Carver's editor Gordon Lish was responsible for creating the terse, minimalist style that made Carver famous.

Score: New Yorker 2, theory that alcohol helps the creative juices flow, 0.

Oh, and don't miss the cartoon on p. 68. A bar patron drinking coffee to a neighbor with a cocktail: "Been there, drunk that." I'd copy it here but I worry about overstretching the boundaries of the "fair use" doctrine.

Let them drink Grand Marnier!

A proposal out of Tacoma to "treat" chronic street alcoholics by banning the sale of cheap wine caught the fancy of S.F. Chronicle columnist C.W. Nevius last week. The scheme is simple: in a defined "alcohol impact zone," stores are banned from stocking Thunderbird, Boone's Farm, Royal Gate, Takaa, and similar cheap rotgut.

If the homeless alkies want to buy Cabernet Sauvignon or Grey Goose, that's ok.

Public health authorities in Tacoma laud the idea, citing reduced emergency room admissions and other medical costs. That's not surprising. The same thing happened nationwide during Prohibition.

The logic by which Nevius calls this simple class-based Prohibition scheme "treatment" escapes me. It's just one more aspect of the ubiquitous economic bias that Prof. Merrill Singer describes so vividly in his recent book, "Drugging the Poor," reviewed here.

Alcoholocaust

If you have illusions about the role of alcohol in creativity, read "Day of the Dead" by D.T. Max on p. 76 of the Dec. 17th issue of the New Yorker. It's a thumbnail bio of Malcom Lowry, author of "Under the Volcano" (1947), hailed as one of the top twelve English novels of all time; he was considered the heir of James Joyce. He died ten years afterward, after passing out from massive quantities of alcohol and barbiturates. He was 47.

The chronicle of his marriage and collaboration with Margerie Bonner is a tortuous, gruesome story of love, hate, help, hurt, rescue and revenge. Bonner, who edited and rewrote Lowry's texts daily, almost certainly contributed the discipline and warmth that raised "Under the Volcano" above the rambling, two-dimensional symbolism that was Lowry's best unassisted effort. He was consumed with rage at everything and everyone; his violent tirades drove all their friends away.

She tried for years to get him to cut down or stop his drinking, but ended up matching him bottle for bottle, and when he finally found a doctor who got him to take a break (using aversion therapy), she refused to stop, and dragged him down again.

Much of the article deals with the theory that she murdered him, for which many women acquaintances and critics applauded her. It's a thin case. British local authorities, who conducted the inquest, pinpointed asphyxiation by aspiration of vomit as the cause of death. That's not murder. But it hardly matters. Lowry was bent on death by alcohol sooner or later. During one of his few lucid moments, he described his own life as an "alcoholocaust."

If a movie is ever made of this marriage, it should be on a double bill with "Pollock," and made required viewing for young artists considering careers in alcoholism and addiction: don't go there.

Cartoon of the week

From the Nov. 12 New Yorker (which consistently, over time, has published the best addiction cartoons, to my knowledge):

Well said

Sometimes fiction writers (but aren't we all?) say it better than authors of solemn research monographs. In the Fiction section of the current New Yorker, writer Alice Mattison describes a character, Jerry, who, at dinner with his ex-wife and his daughter, shook his head when they suggested a glass of wine:

"... he so enjoyed being exactly as he was that he didn't want even the mild alteration in mood brought on by a glass of Chardonnay."

Well said! "So enjoyed being exactly as he was"!

On this topic, see also Katharine Hepburn, and (much more obliquely) Stereo Sue, or the Quale of Sobriety, both below. Thank you, writer Alice Mattison, for this brilliant little gem, one of several in her story.

Triggers in your ear

Recovering people trying to minimize environmental cues about drinking and drugging should consider staying away from rap music and country music. Rock music, once believed the major gateway to drug abuse, is relatively safe.

Researchers who looked at the bestselling songs in several genres from 2005 found that 37 percent of top country songs featured references to drugs or alcohol, compared to just 14 percent of rock songs. Rap was worst with 77 percent. Source.

A short list of songs about drinking/drugging and NOT drinking/drugging is here, and a long collection of the same is here.

Researchers didn't, but should, look at classical music also. Item No. 1 for my mute-button list is Mahler's Das Lied von der Erde -- an operetta that celebrates being drunk and depressed. Oh, and what about that line in Beethoven's Ninth about being "drunk with fire"? LOL.

Reviews Pan Bill W bio-drama

March 6, 2007, N.Y. Post:

Who would have guessed a drama about the founders of Alcoholics Anonymous would be the laugh riot of the year? But that's the unfortunate result of "Bill W. and Dr. Bob," the well-intentioned but haplessly executed effort written by novelist Stephen Bergman and clinical psychologist Janet Surrey that opened last night.

What should have been a powerful and inspirational story plays instead like a drunken road-show version of "The Producers."

Read full review

Broadway World.Com's reviewer writes:

A program note for Stephen Bergman and Janet Surrey's Bill W. and Dr. Bob advises us that performance of the work does not imply affiliation with nor approval or endorsement from Alcoholics Anonymous World Services, Inc.

Smart move, A.A.

Doing for alcoholism what Reefer Madness did for drug abuse (or at least what its New World Stages neighbor Sealed For Freshness does for Tupperware), Bill W. and Dr. Bob is a frightfully melodramatic bio-drama which uses the same kind of character-probing sensitivity one might find in a driver ed movie to tell the story of two men who, in dealing with their own demons, developed the treatment techniques that would birth Alcoholics Anonymous.

... The authors turn their heroes and everyone around them into cardboard cutouts ... while I can't imagine anyone feeling inspired or enriched by this misdirected corn, I know a few more evenings like this could have me swearing off theatre for a while.

Source.

Anonymity is only for the anonymous

Once again Alcoholics Anonymous has lent its name to the publicity thirst of another bratty celebrity. This time it's Britney Spears, whose publicist let the world know that she was given a pass from her upscale Malibu treatment program to attend an AA meeting. E.g. Source. Millions of 7-year old girls will now make a mental note to become alcoholics and get their names in the paper by going into rehab and to AA. It's great promotion for AA and for the celebs. But it reinforces the two-class system in AA. If you're in the celebrity class, your AA membership glitters like a glass pebble in a brightly lit goldfish bowl. If you're not a "name," you're in the dark. Anonymity is only for the anonymous. What would Bill W. say?

Canada Readers Digest publishes "12 Steps to Nowhere"

The Canada edition of Readers Digest has published an abbreviated version of award-winning journalist J. Timothy Hunt's article "Twelve Steps to Nowhere," which originally appeared in Toronto's Saturday Night magazine (offprint here). The piece is the author's personal story of recovery from severe alcoholism -- a recovery in which the author thoroughly investigated but strongly rejected the 12-step approach. Although some 60 per cent of successful recoveries from alcoholism occur outside of and without AA (Source), few and far between are the published personal narratives of non-AA recoveries. Readers Digest's publication of Hunt's compelling autobiographical essay hopefully signals a more evenhanded attitude toward all recovery pathways (at least north of the border). Read the piece in Readers Digest.

Ban all booze ads, top UK doc says

London: A leading doctor says all advertising of alcohol must be banned in a bid to curb Britain's growing drink problem.

The comments by the head of the Royal College of Physicians come as latest data show alcohol-related deaths in the UK have doubled in the past 15 years.

Professor Ian Gilmore said the measure was necessary to protect children who were influenced by sporting heroes wearing branded clothing. -- More

Upscale treatment centers chafing at 12-step

The Betty Ford treatment center, once the very icon of celebrity rehab, is being upstaged by a slew of newer and tonier facilities, many of them dumping Ford's you-can-have-any-program-you-want-so-long-as-it's-12-step model.

So says a survey of upscale inpatient facilities in the Feb. 19 Newsweek. Ford, which at last report charges $38,000 for a 28-day stay, is now on the low margin of the upmarket segment. There are programs that charge up to $100,000 for the same stretch. They include Malibu sunsets, equine encounters, Native American talk circles, gourmet cuisine, and -- more important -- elements of cognitive behavioral therapy, Motivational Interviewing, pharmacological treatments and other modern therapeutic approaches.

Newsweek's article quotes Chris Prentiss of Passages Malibu, an upscale facility that has dumped AA altogether. Prentiss says that AA's "emphasis on helplessness in the face of addiction makes people feel stupid and ashamed." Other providers talk in more guarded terms, but the trend away from exclusive reliance on the 12-step model is remarkable. What the high-priced celebrity showcases offer today, the K-mart treatment shops will be trying to copy tomorrow. Without the hot tubs, the sunsets, or the horses.

For a listing of non-step or steps-plus treatment facilities, click here.