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Where is the sober evidence?

By: Staff Writer

23/11/2009 1:00 AM | Comments: 9

THE business of battling addictions is a growth industry. The Alcoholism Foundation of Manitoba is one of 13 community organizations in the province that gets public money to treat addicts to meet the government’s stated aim of reducing substance abuse in the province. It would be a stretch to concede defeat in the war, but the AFM’s results are difficult to applaud.

The foundation can show it has good results keeping addicts clean or dry for 28 days, or whatever is the length of a residential treatment program. After that it is largely up to an addict to help him or herself, through sheer will or through resources in the community, such as Alcoholics Anonymous. Addictions programs shoot for much more in theory and agencies ought to show at least some clients meet short- or long-term abstinence or measurable harm reduction, such as drinking less or resistance to the urge to shoot up.

At present, the AFM’s measure of success is essentially the goal set by a client, which means that measuring success is a moving, arbitrary target. That means there is no possible value-for-dollar analysis to show taxpayers that, indeed, substance abuse is declining or that a dent is being made in the personal toll addictions take. The AFM should have some means of tracking the number of people who are no longer hooked, or who can manage addictions to the point they are back to work, no longer committing criminal offences to support their habit or no longer an abiding threat behind the wheel of a car.

Ironically, the Manitoba Healthy Living department believes it is getting sufficient proof that public funding is being productively spent, but the AFM, which has recently moved to national accreditation (which provides some level of oversight), has recognized the shortcoming of evaluation. It is embarking on definitive measurement of outcomes. Clients will be contacted, for example, at three-, six- and nine-month intervals to self-report substance abuse or other benchmarks of harm reduction. That kind of evaluation has been a long time in coming for an agency more than 50 years old.

The AFM, like most community-based programs for addictions or mental health, sees that the demand for its services and the cries for help outstrip the ability to deliver. In the case of the foundation, an operating budget increase greater than 55 per cent since the NDP assumed power in 1999 still elicits complaints from front-line workers that they are doing more with less, that waiting lists are growing and that working conditions are dangerous. The grievance springs from the acknowledged fact that there is too much work for everyone. It is just as true, however, that simply drying addicts out and putting them back on the streets with the hope they’ll do better falls short of the mark.

There is no currency in cutting budgets of trusted community agencies upon which government relies to reach those in need. Programs that work, however, should get the investment. Yet, there is a lot of ground to travel to ensure that the money being spent makes a difference as the number of government-funded programs expands to serve people with more complex problems. The Selinger government needs to impose stricter reporting standards on all community agencies to show their programs produce results.

Republished from the Winnipeg Free Press print edition November 23, 2009 A14

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9 Commentscomment icon

AFM needs to use differential diagnosis. For many repeat clients/patients AA/NA will not work. There needs to be long term treatment (3 months) with trained therapists i.e. not just recovering individuals with 3-6 months training. If you don't deal with the underlying depression, self hate, past abuse the addicition will attempt to deal with the 'PAIN'.

Docwray

SouthEndSam

I believe that as individuals we are the only ones who can channel our own energies.

Step 2 takes advantage of the ingrained Christian indoctrination most people from Western Cultures undergo.

I don't believe in higher powers of any sort.

I just believe in me.

Therefore there would be nothing A.A or any like program could do for me.

There is an extremely high failure rate for A.A. and similar faith based programs.

Maybe it is time to re-think the issue to empower the individuals and reduce the power of the "helping professions."

Like I said, I'm all in favor of anything that is achieved through voluntary cooperation. I used to support A.A. and N.A until they started taking people the courts forced to attend. That is all forced conversion of morals and I can't support that any more than I would support forced conversion of Christians into atheists.

That's my biggest problem with government funding all these worthy causes....the government takes my money by force..what? the government has to harm me to do someone else some good? Doing good things for people is what the church should be doing, not the state.

None of that is to mention that the history books are quite clear....the best thing to do with dissenters...heretics...and assorted other scapegoats is to leave them alone.

Helping people who don't want your help is called persecution.

Chris Buors, if the AFM is really just a secular church, I agree it shouldn't get government funding.

Government should not be funding programs that are essentially "faith based".

Government should only fund programs that are scientifically based and scientifically tested (to the extent "social science" and psychology programs can be).

That said, those scientifically based programs might include using a "belief in a higher power" as a tool to achieve a result. But only when it is shown that such beliefs actually deliver results (which I believe they do for many addicts).

Alcholics Anonymous, which most addictions programs try to lead their clients into, uses belief in a higher power as a tool. (It doesn't matter whether the higher power of the addicts choose really exists or not.)

I agree with the article that there needs to be more measurement of the success of addictions programs. And follow-ups should be made many months even years later to check on success.

I question whether measurements made by an agency should be the only measure of the agency's success.

Especially with smaller agencies with shorter histories, Manitoba Health and Healthy Living should be doing its own spot checks on results to audit what the agency reports.

But I would not stop there.

The government should ask the mid and long term results of re-training programs for the unemployed, and for English as a second language programs. (How many computer network administrators does the government have to train before it realizes it has flooded a disappearing job market?)

And government should do spot checks as an audit of those results.

Similar to my comment on "Addicts out in cold: workers" it would be responsible of the anonymous staff writer to do some background work before writing such generalizations. From the previous article, it appears that doing follow-up work on close to 20,000 admissions might require several full time workers....I wonder about their corporate infrastructure. I have heard it is scant compared to other community agencies and health authorities. I have done follow-up work in the past - it isn't as easy as one might think especially with this unique population. I was confused as to the premise of this article - is it about program effectiveness or more a slam against the structure of AFM's programs --> way too short and "not effective" in the sense that clients are in the program for such a short time and then left to their own devices??

jon dingleberry

You are absolutely correct and so is Jay. All the studies ever done can be found in Addiction is a Choice by Jeffery Schaler.

Secular churches like the AFM ought to have to raise their funds the same way all the other churches do: obtain donations from the believers.

"Programs that work, however, should get the investment." --Editors--

I have a problem with that. The confession booth "works" and taxpayers...I was going to say taxpayers don't pay for the confession booth, but we subsidize churches with tax free status.

The bottom line? This is all about soul saving when we look at the issue under the microscope.

I forward the timeless wisdom of Thomas Jefferson on what the government ought to do: leave the soul saving to the individual!

"The care of every man's soul belongs to himself. But what if he neglect the care of it? Well what if he neglect the care of his health or his estate, which more nearly relate to the state? Will the magistrate make a law that he not be poor or sick? Laws provide against injury from others; but not from ourselves. God himself will not save men against their wills." --Thomas Jefferson--

Of course today the magistrate has made laws that men be neither poor nor sick (welfare and Universal healthcare) so there will be strong argument to support the care of souls too.

There will always be more demand than government can deliver "helping" the poor, the sick and the injured souls. It's all church business.

Addiction is not a disease, it is a choice! It is time to treat it as such.
There is way too many people that use addiction as an excuse for their behavior.

my son's mother uses afm as a get out of jail free card.any time she gets in trouble she says she has a problem and goes to"treatment"for 28 days.within 2 weeks she has "relapsed"and goes back to her old ways because there is not much follow up.

I believe it has been shown that these addiction programs are no more effective than people who don't use em. If someone has a study to show otherwise, please post it.

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