The notorious and documented failures of drug and alcohol rehab (made even more public by Hollywood’s perpetually neurotic glitterati) can be attributed to a single, primary factor: The addict only addresses the symptoms—the act of abusing alcohol or drugs. However, the underlying cause is the individual’s whole way of approaching life—emotionally, behaviorally, morally.

I’m not a big fan of Alcoholics Anonymous. The main reason for this is its supernatural component. I cannot understand how surrendering to a “Higher Power” is any substitute for taking control of your own mind, your life and your actions. Yet, in just as many respects, AA does encourage and enable the addict to do precisely this. I suppose it’s so frightening for a person to adopt this self-responsible philosophy— after years or even decades of being without it—that there’s a sense of, “I must have a ‘god’ to lean on and go along with me.”

My experience has demonstrated to me that you don’t need to create a mystical, imaginary friend in order to do what you’re already doing anyway. You ought to give yourself more credit than that. That being said, I still applaud the ability of many people associated with AA to not merely look for a quick, external fix, but to do an entire overhaul of their value and belief systems, with or without their imaginary friend. For example, they do personal inventories. They look at everything they have ever done or believed in their lives and hold it up to objective scrutiny. They own full responsibility for all of their actions. They replace drinking with thinking. Yes, perhaps they spend too much time on “god” and peer-oriented “fellowship,” but the ones who seem to benefit the most from AA are the ones who de-emphasize these particular points while focusing on the thinking and action. Despite the flaws and contradictions within AA, I still find it more valuable for people than inpatient rehab.

Leaving aside that government regulations, subsidies and policies are slowly destroying medical treatment in this country (and already have destroyed mental health and psychiatric care—particularly inpatient care), the very premise underlying medical rehab for addicts is basically flawed. It’s no wonder that the celebrities, rock stars and actors—the only ones who can afford private sector rehab—do so poorly in these programs. These programs are based on the medical model. The medical model states that addiction is a disease over which you are every bit as helpless and passive as you are over, say, cancer or heart disease. With true medical problems, the only self-responsible thing to do is find the best medical attention you can and submit to the surgery, medication or whatever other form of treatment may be required. Medical treatment is passive, and it has to be; after all, you cannot do surgery on yourself.

Unfortunately, this same passivity is encouraged and adopted by addicts in the hospital. They spend 30 or 60 days where they attend meetings and perhaps do a little individual counseling or self-reflection.

Depending upon the program, they will get exposed to the Higher Power aspect and (fortunately) the more rational components of AA. Then they’re set loose in the real world again. The premise that they are led to accept is that they went to the hospital to be “cured.” With true medical problems, you are not released from the hospital until you are well, or at least nearly well. Yet the addict finds a completely different picture when released from rehab. He finds that everything that supported the “illness” prior to entering the hospital is right back in place again— the presence of the drugs or alcohol; the friends and cohorts who enjoy the addictive experiences, and the various and sundry trigger events and situations that led the addict to want to escape from reality in the first place.

The virtually inevitable result? Relapse. Look at Lindsay Lohan or Charlie Sheen. They're simply the most famous and recent examples du jour. There are many others, and there will continue to be. Insanity is doing the same thing over and over, while expecting different results each time. Expensive, inpatient rehab isn’t a “cure.” It cannot be, because addiction is not a medical illness. Even if it were, the “illness” takes place in a certain emotional, behavioral and interpersonal context—outside of the hospital. At best, a rehab center is nothing more than a “time out.” For worst-case drug addictions, especially where a person may be suffering from medical problems related to the substance abuse, I can see the value of a prolonged hospital stay, in order to stabilize medically and get a desperately needed break from the daily intake of substances. But learning how to effectively—and permanently—manage the addiction cannot even begin until day one of the release. That’s where AA, or (if it existed) some more consistently rational equivalent, is needed to help the individual completely restructure the behavioral, emotional and interpersonal context that feeds the addiction and encourages it to flourish.