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Baldwin Research Project of 1991, Continued

Drug and Alcohol Addiction Treatment Research

Baldwin Research Project of 1991, Continued

4.0. Baldwin Program

The Baldwin Program for alcoholism and drug addiction recovery at The Hagaman Guest House has evolved through several generations to what we know as the model of the 90's. The Baldwin Program emphasizes the process of learning through "doing," and "experiencing," and providing positive role models. The development and acceptance of the Baldwin Program in New York State has been a dynamic process that continues to evolve to meet the needs of the recipients.

4.1. Background

The concept of the Baldwin Program in New York State is probably older than the State itself since the phenomenon of people helping others who have a like problem surely dates back to the dawning of civilization.

Characteristics of the Baldwin Program of Recovery

  • The basis of authority is experiential knowledge. The primary therapeutic relationship is between the person and the group as a whole, rather than between the person and an individual therapist.
  • Everyone gives and receives help.
  • An alcohol and other drug free environment are a crucial part of the Baldwin Program service.
  • The primary responsibility for recovery is viewed as being held by the individual participant rather than the program or program staff.
  • Individual responsibility is reinforced by shared decision making with program participants.

The Baldwin Program operates on the premise that experiential learning is the path to recovery. The Program is structured so that opportunities to experience recovery and to observe and interact with persons who have experienced phases of recovery are available. The therapeutic relationship is between the person and the program, and the program is made up of all participants, volunteers and staff. There is a reciprocal sharing between the individuals and the program so that all give and therefore all receive. The program takes place in a positive sober environment wherein the individual feels comfortable and safe, and the program relies heavily on the larger community to provide additional health and social support services. Involvement in The Fellowship early in recovery provides an opportunity for a life-time support system. The Baldwin Program is extremely cost effective and extremely outcome effective because of its ability to build strong and lasting social support systems.

The preceding description of the Baldwin Program was originally published in part by The California Association of Addiction Recovery Resources and described this organizations understanding of "social model" programs operating in California. By merely changing the words "social model" to "Baldwin Program" The California Association of Addiction Recovery Resources description of social model programs exactly describes the Baldwin Program with one notable exception: the Baldwin Program includes a powerful educational program that actually improves upon the results of the California social model programs.

Another important difference between the Baldwin Program and conventional treatment is the Baldwin Program is not based on "the disease" model. Attendees are taught that alcoholism and drug addition is not a disease. The disease model provides alcoholics and drug addicts an excuse for relapse in that the concept sets up in the addict and alcoholic a self-fulfilling prophesy. An article published earlier this year (1999) written by Gerald K. McOscar, a West Chester, Pa. attorney with a longtime interest in substance abuse, education and treatment articulated the truth about the disease model. He writes:

Upon hearing that his former teammate Darryl Strawberry had been arrested by Tampa police on drug and solicitation charges, pitcher Dwight Gooden had this to say: "All this shows that you never beat an addiction. Once you're an addict, you are an addict for life. There is no such thing as winning. My heart goes out to Darryl. I almost cried when I heard about this."

A graduate of one or two rehabs himself, Gooden adheres to modern medicine's warm and fuzzy disease model of addiction.

Florida Circuit Judge Jack Espinosa, Jr. had a different take on the problem. "They've made mistakes. They've all got the same problem. They've all got excuses," Strawberry's sentencing judge said. Indeed, drunk driving, spousal abuse, prostitution and other drug and alcohol-fueled offenses against society paint a less than flattering portrait of substance abuse. In declaring drug and alcohol addiction to be a disease 40 years ago, the medical profession unwittingly removed two of the bulkheads which kept substance abuse at bay: stigma and consequences. Not only is the theory scientifically suspect, it has most likely exacerbated the problem. Despite billions spent on education and treatment, America is awash with drugs and alcohol.

No amount of medical jargon can alter the incontrovertible fact that addiction begins and ends with a choice. Nature and nurture may play their part, but predisposition is not and will never be predestination. The suffering addicts suffer are largely of their own making.

Gooden is wrong when he says, "There is no such thing as winning." The same idea in treatment circles is expressed by the label "chronic." With its tone of defeatism and self-interest, the concept serves no purpose other than to mask the failure of the disease modality and to give both addicts and providers another excuse to fail.

Relapse happens (especially among those new at the game) but so does long-term recovery. "Chronic" is misleading and ignores the mountain of evidence to the contrary. Twenty percent of all addicts quit on their own. Millions more live sober and productive lives two, five, 10, 20, 40 or more years with the help of religious or peer support groups. Relapse has become a self-fulfilling prophesy, with providers a big part of the problem.

Even the term "treatment" is a stretch. Treatment centers (many publicly funded) dispense a strange brew of indoctrination, religion, and medicine in a faux-hospital setting and admixture of medically supervised detox, three hots and a cot, education, therapy and large doses of 12-step meetings. Discharge is marked by the admonition: "Don't drink and go to meetings."

But the emperor has no clothes. This isn't medical treatment in the traditional sense of the word. Worse, these resources are readily available at little or no cost elsewhere (especially 12-step programs, which are available to all).

The public instinctively knows what men and women of science can't or won't admit: Addiction doesn't become a public health problem until the addict chooses to drink or drug, just as anger doesn't become a crime until someone gets punched in the nose. Studies show that the public is squarely at odds with medical providers on this score.

Dr. Jane Osborn, chairwomen of one doctors group, suggests that we "rebalance" our approach to the problem. "This doesn't mean that the criminal justice system has no role here, but it shouldn't be left to deal with addiction on its own."

Nor should the medical profession. Physicians do not do themselves or society or addicts any favors by denying the moral component of what Dr. Osborn describes as a mere "biological event." An addict's serious and frequently fatal character flaws often require lessons in self-discipline, integrity, restraint and personal responsibility that only pain and punishment can teach.

My heart likewise aches for Mr. Strawberry, but better he be called to account than killed with kindness. "This really isn't about baseball," Judge Epsilons said. "When you stop producing, nobody will care about you. If this is a picture of life after baseball, it's not pretty. This is only an opportunity. I hope you make the best of it," he said. To which I say, Amen.

The previous article was entitled The 'Addiction' Excuse and was repeated in this report with the author's permission. Mr. McOscar is not, nor has he ever been, affiliated with Baldwin Research. Up until my calling him in June to seek permission to use his article, I am certain he did not know Baldwin Research. Yet, in 1994 Baldwin Research abandoned the disease model for the very reasons set forth in Mr. McOscar's article.

Understanding what disease is gives us a better understanding of what disease isn't. When I was first getting sober I was so happy to hear that I had a disease, the disease of alcoholism. I was also a drug addict and many addicts told me that drug addiction was also a disease. That, too, was a great relief. I was a young, upwardly mobile, type "A" personality, moving up the corporate structure. I was strong willed and in charge of my own life, along with the lives of my wife and children. I was good at running things, a great organizer, "planned my work and worked my plan," but I just couldn't stop drinking and drugging. When I came to understand that drinking and drugging was a "disease," it became the perfect explanation for my dilemma. It really wasn't my fault. After all, people who have cancer, heart disease or diabetes are not blamed for having their diseases nor are they, themselves, the cause.

I went to AA where "my disease" was discussed at just about every meeting. At least once in the course of every meeting someone would make reference to his or her "disease." People would give testimony that they had a chronic incurable disease, which they would have for the rest of their lives. They would introduce themselves with their disease saying "I'm so-and-so and I'm an alcoholic." They would say silly things like "alcoholism isn't a 'was-m,' it's an "is-m,'" meaning that even though they were not drinking at the time, they still had the disease of alcoholism. They would tell each other that they must keep a constant vigil because their "disease" is getting stronger by the day-"it's just outside the door doing pushups in the parking lot." After each meeting the fear of the "disease" was fortified in me and like a dragon it laid in ambush to devour me should I let down my guard, even for a moment. The next day the fear would subside some, only to be rekindled into a fiery dragon's breath by the end of the next evening's meeting.

All this fear didn't seem quite right so I looked in the book Alcoholics Anonymous to better understand what this "disease" was all about. I was surprised to find that in the book Alcoholics Anonymous nowhere did it present alcoholism as a disease. In fact the word disease is only used once in the text. And, even in that reference it is not referring to alcoholism as a disease, it is talking about a "spiritual disease." Clearly, in the early years, when Alcoholics Anonymous was most successful, it did not push the disease concept.

The truth is alcoholism and drug addiction is not a disease in the same sense as pneumonia, tuberculosis, cancer or even the common cold. I suppose that in the strictest definition of disease, alcoholism and drug addiction could be called a disease. But, then, so could a hangnail or an ingrown hair. Such frivolous uses of the word detract from the seriousness of conditions like cancer, AIDS and diabetes. People with these life-threatening diseases do not get up in the morning and start planning how they are going to continue to have their cancer, AIDS or diabetes. Alcoholics and addicts begin each day planning their drinking and drugging. They actually plan how, when and where they will continue their "disease."

To get an alcoholic or addict to buy into the disease concept is not a hard sell. Alcoholics and drug addicts want to blame anybody or anything, but themselves for their malady. Telling alcoholics and drug addicts that they have a disease is providing them with an excuse to continue their selected destructive behavior. Who with cancer would not choose a cure for their cancer if there was one and what diabetic would not choose to be freed from their medication or insulin if they could be? Who with AIDS would not give anything to have another chance? Cancer and AIDS victims and diabetics usually don't get a second chance, but alcoholics and addicts have a new chance of recovery every time they wake up. At any moment in time they can decide not to have alcoholism or drug addiction. Millions of alcoholics and drug addicts have recovered and moved on to happy, productive lives. Those who have not recovered have not because they have chosen not to. Alcoholism and drug addictions are not a state of disease, but a life style that is chosen.

In sharp contrast to the highly effective Baldwin Program that rejects the "disease model," conventional treatment with essentially a 0% success rate promotes the disease model. Moreover and at this time, it appears that if conventional programs had to compete in a free enterprise environment against social and/or educational model programs, conventional programs would be unable to compete effectively. The reason that conventional treatment programs are able to exist is the market is not free to open competition. Most state governments have a monopolistic hold over the entire industry. These conventional treatment programs use statute rather than effectiveness to protect their market. Further, had the efficacy of conventional programs been better, there would not have been a place in the treatment industry's market for the Baldwin Program and any other social based or educational based programs.

At this juncture it is also important to understand that: (1) no disrespect is intended toward existing programs and those working in the treatment industry when Baldwin Research reports the low success rate of the treatment industry and licensed programs. The results of these programs are what they are; Baldwin Research's interest is purely objective, and (2) had the success rate of the treatment industry been substantially higher, other researchers and Baldwin Research would not have questioned the methods in the first place.

The Baldwin Research Institute came into being because over a ten-year period there was a sharp decline in recoveries among those attending Alcoholics Anonymous. As a researcher of many years, Gerald Brown became interested as to why a previously successful program, suddenly appeared to be faltering. This prompted Mr. Brown to conduct an informal observational study of 10 meetings of Alcoholics Anonymous during 1989. The results of that study indicated that less than 10% (actually 9.6%) of the people who came to those 10 meetings during 1989 were still attending Alcoholics Anonymous meetings at the end of the one year study period.

Please understand that Baldwin Research does not purport that Mr. Brown's 1989 observations of Alcoholics Anonymous are conclusive of anything. However, it strongly suggests that the success rate of Alcoholics Anonymous in 1989 (9.6%) was not as good as the success rate of Alcoholics Anonymous in 1955 (75%) or Alcoholics Anonymous's 1941 Cleveland success rate of 93%. The precipitous decline in the efficacy of Alcoholics Anonymous was not an isolated event. The decline of Alcoholics Anonymous' effectiveness over a thirty-year period was inversely proportional to the growth of the drug and alcohol treatment industry.

Baldwin Research's initial interest, then, was with Alcoholics Anonymous, and not the treatment industry. However, as Baldwin Research studied Alcoholics Anonymous' declining success rate, it was clear that the decline in the success rate emanated from the burgeoning treatment industry. The treatment industry promoted a secular solution based on the assertion that alcoholism and drug addiction (and perhaps other compulsive and obsessive conditions) are forms of mental illness. As such, the treatment for these conditions, in many states, was legislated to be the responsibility of the mental health community.

Moreover, these legislated methods of treatment were implemented without any clinical evidence supporting the notion that alcoholics and drug addicts could benefit from group therapy, counseling, and other psychological techniques. As time went by and few recovered, the mental health community concluded that alcoholics and drug addicts could never completely recover and relapse became an expected characteristic of the "disease." Rather than improving the treatment methods or trying alternative methods to medical and psychological methods, the treatment industry changed its understanding of the malady to fit the poor results achieved by the treatment they offered.

The treatment community actually uses the low success rate to motivate patients. Credentialed alcohol counselors typically tell their patients that only 1 in 12 (many counselors use the ratio of 1 in 30) will "make it." The theory is that if only one in twelve (or thirty) patients is going to get well, each one wants to be the one that gets well. Thus, each patient will try harder in treatment to be the one that gets well. Whether patients try hard or not seems to have little impact on the outcome of their treatment, and it is of more than passing interest that independent studies confirm that; indeed, the success rate for these programs range from 3% to 8% at 5 years post treatment.

Recognizing the ineffectiveness of their treatment, the treatment industry insisted that patients attend Alcoholics Anonymous meetings upon discharge. This practice began the dilution of Alcoholics Anonymous's 75% success rate to a less than 10% success rate, today. The treatment industry hoped that patients' attendance at Alcoholics Anonymous meetings would positively affect their patients' prognosis and improve the success rate of the treatment industry programs. Tragically, just the reverse happened. As the treatment industry began dumping their discharged still-addicted patients into Alcoholics Anonymous, they displaced Alcoholics Anonymous's spiritual solution with treatment's secular solution. The displacement of Alcoholics Anonymous's spiritual solution that had previously produced a success rate as high as 93% began to plummet to that of the treatment industry.

Today, there are numerous indicators as to the alignment of Alcoholics Anonymous with the treatment industry. For example, the name "Alcoholics Anonymous" is used in the Alcoholism Regulations of New York State Office of Alcoholism and Substance Abuse Services and is part of treatment requirements set forth in that regulation. Another example of Alcoholics Anonymous's participation in the treatment industry is its policy to sign attendance statements as to attendance at meetings of individuals in treatment. There is no effort here to argue whether or not Alcoholics Anonymous should or should not be included in the laws of New York State and other states. Nor is there any effort to argue whether or not Alcoholics Anonymous should or should not sign treatment attendance statements. The point is that the close relationship does exist, and these relationships have contributed to the loss of Alcoholics Anonymous's effectiveness.

Nevertheless, Alcoholics Anonymous, without any treatment, does appear to be a more attractive alternative financially than professional treatment programs. In the early 1990's, Dr. Diana Chapman Walsh of Harvard School of Public Health reported that after two years it was approximately 10% less expensive to refer people to Alcoholics Anonymous directly without any treatment. The significance of this study is that it is another example of studies that brings into question the efficacy of professional treatment programs.

Still, another area where the treatment industry and Baldwin Research has been unable to agree is the efficacy of treatment programs in general. Baldwin Research has provided the treatment industry with information on dozens of studies over the years that indicate that the efficacy of conventional treatment programs is less than 30% at six months post-treatment and less than 14% at five years post-treatment. We provided members of the treatment industry the results of a New York State adolescent study conducted in 1993 where 100% of the 30 subjects from three different schools relapsed within 14 months (See Section III.). All thirty adolescents were treated at conventional treatment programs.

Baldwin Research, however, is not the only organization that has been reporting the poor results achieved by conventional treatment programs. Over the past decade insurance companies have overtly backed away from drug and alcohol treatment citing poor results as the reason. In addition, three years ago Mr. Vincent A. Rawlins, St. Peter's Addiction Recovery Center's Community Liaison gave a presentation at Union College. Two individuals, Mr. David Eder and Mr. James Oppy, who at the time were volunteers at The Hagaman Guest House, attended the presentation. During the question and answer period following the presentation, Mr. Eder asked Mr. Rawlins what the success rate was at St. Peter's Addiction Recovery Center. Without hesitation, Mr. Rawlins said, "1 in 12." Mr. Eder pointed out that Mr. Rawlins was saying that St. Peter's Addiction Recovery Center's success rate was approximately 8%. Mr. Rawlins became quite defensive, but in the end did not disagree that St. Peter's Addiction Recovery Center's success rate was approximately 8%.

While this historical anecdote demonstrates Baldwin Research's concern with professional treatment programs, it is believed that the industry, as a whole, would ignore Mr. Rawlins comments or suggest that his statement was untrue. Moreover and based on dialogue with the treatment industry experts, the treatment industry is of the belief that Baldwin Research somehow manufactured these studies and stories to discredit existing programs in an effort to promote the Baldwin Program. Neither of these beliefs is accurate.

There has been a long-standing misunderstanding on the treatment industry's behalf with respect to the intentions of Baldwin Research Institute, Inc. Since the treatment industry became aware of Baldwin Research's research back in 1991, the treatment industry has been behaving as if Baldwin Research's intention is to become a drug and alcohol treatment program as set forth in the OASAS's Regulations and to provide such services without certification. Moreover, it seems to us that the treatment industry believes that Baldwin Research is intentionally attempting to find a "loophole" in the Mental Hygiene Law and OASAS regulations that would allow Baldwin Research's Hagaman Guest House to operate without a license. Neither of these perceptions is true.

From the beginning, Baldwin Research's intent has been, and continues to be, to develop and provide drug and alcohol recovery programs that offer improved recovery rates. Hence, Baldwin Research's programs have become an alternative to programs offered by the treatment industry. At the onset, Baldwin Research did not believe that the treatment industry would take up a position against methods that were different from theirs simply because the methods were different. Moreover, Baldwin Research thought that if the treatment industry took a position against treatment programs that fell outside of the statutory regulations, it would be incumbent upon the industry to show where such programs were in some way detrimental to the people it served. It would not be the industry's responsibility to discredit, publicly, such programs based on vague interpretations of state regulations and unfounded rumors.

However, the treatment industry, predominately controlled by members of Alcoholics Anonymous and speaking through OASAS did react in a defamatory and malicious manner. The following is a review of some of the public comments made by OASAS, the regulators of the treatment industry in the State of New York.

On April 5, 1993, The Recorder, Amsterdam, New York's primary newspaper, reported the following: "His [meaning Jerry Brown's] program is being reviewed by the state Division of Alcohol and Substance Abuse, which is trying to determine if Brown should apply for a permit to operate the home."

"We're in the process of deciding if they need a license to operate the home," said Richard Chady, a spokesperson for the department [meaning OASAS]. "We have some correspondence from them and we're evaluating it now."

There are many examples of government agencies stating the truth in such a way as to cast a negative light on otherwise positive situations (e.g. Senator McCarthy's hearings on un-American Affairs and the Federal Bureau of Investigation's investigation of Richard Jewel). As a spokesperson for a government agency, Mr. Chady must know that inquiries by the press as to the status of an "in progress" investigation must not be responded to. Specifically, Mr. Chady's response, by design, left open the possibility that we may have needed a license from OASAS to conduct our business. Readers of his statements would apply the logic that if the state is "evaluating" them, they must be operating illegally--"where there's smoke, there's fire" rationale.

It would have been equally accurate for Mr. Chady to respond: "To the same extent that we review all programs dealing with drug and alcohol problems in the state, we have been in contact with the Baldwin Program. At this time there is no indication that they are operating illegally." This statement is true and at the same time does not defame Baldwin Research or it divisions. Alternatively, Mr. Chady could have said to the newspapers: "We have received written assurance from The Hagaman Guest House that they are not providing treatment. They have reported that they are a guest house." This type of report would not have been defaming. Actually, there were many ways Mr. Chady could have worded his statement to the newspaper that would not have been defamatory.

As a further example of the public comments made by OASAS, in a July 1994 article, the Amsterdam Recorder reported, "Brown said that a 1990 study of the method he used showed a 79% success rate in helping people stay free of drugs and alcohol... but Mr. Chady [spokesman for OASAS] said Brown's numbers cannot be verified." This is simply not true; Baldwin Research repeatedly invited OASAS and many other members of the treatment industry to review its data. OASAS, along with the others, chose not to verify Baldwin Research's results. In the same paragraph Mr. Chady attempts to further discredit Baldwin Research's studies by referencing some other vague studies that suggest treatment, as promulgated by OASAS, is equal or better than Baldwin Research's results.

Mr. Chady's "turf" protectionism would seem to be diametrically opposed to Ms. Rodak's (Senior Attorney for OASAS) statements regarding the mission of OASAS. On 13 September 1993 Ms. Rodak wrote: "According to New York State Mental Hygiene Law Section 19.07, it is the statutory responsibility of OASAS to regulate and provide quality control of alcoholism and substance abuse services. OASAS is also charged with the responsibility for seeing that persons who abuse or are dependent on alcohol and/or substances and their families are provided with care and treatment, and that such care, treatment and rehabilitation is of high quality and effectiveness. Then again on 14 March 1994, Ms. Rodak writes: "we are determined to fulfill our statutory responsibility to regulate and provide quality control of alcoholism and substance abuse treatment." (Bold prints added.)

Clearly, Ms. Rodak believes it is the responsibility of OASAS to ensure the very best care, treatment and rehabilitation is available to the people of the State of New York. Baldwin Research agrees with Mr. Rodak on this point. But, indeed, if it is true, then OASAS would be compelled by its mission to study and understand all programs, licensed or not. OASAS' posture to study only licensed programs would not serve OASAS' mission to ensure "care, treatment and rehabilitation is of high quality and effectiveness." And, such posture ignores the possibility that any treatment not currently licensed by OASAS might produce better results. Moreover, it imposes a restriction on the researcher(s) conducting studies for OASAS. It forces the research to produce results that support existing licensed programs without regard for unlicensed programs. Thus, studies by OASAS are not unbiased scientific studies, but rather marketing presentations to maintain the status quo. Consider the following.

4.2. OASAS Evaluation Systems: Preliminary Analysis of Behaviors of Clients Remaining in Treatment at Least Six Months.

Recently (1998) we reviewed a report by OASAS entitled OASAS Evaluation Systems: Preliminary Analysis of Behaviors of Clients Remaining in Treatment at Least Six Months. This report asserted some rather remarkable conclusions that, to be sure, supported OASAS (conventional) treatment programs, but failed to be persuasive as an unbiased, scientific study.

In Section IV of the aforementioned report it states: "Although an experimental design was not employed and a control group was not utilized, the data presented in this report convincingly demonstrate the effectiveness of the four drug and alcohol program types in reducing negative consequences associated with drug/alcohol use."

Without a study, it is reasonable to expect that while in treatment, particularly residential treatment, measurements such as arrests, incarceration, detoxification services, hospitalizations, ER episodes and drug and alcohol use would decline. OASAS's claims of efficacy were reported while the subjects were actually in treatment and did not report on the efficacy post treatment, which is the reason for putting someone in treatment in the first place. Furthermore, to suggest the decline in the categories measured was the result of a specific type of treatment, such as psychological or medical treatments, would not be true. Non-professional social programs comprised approximately 30% of the providers in the CALDATA Study. These social programs presented better overall results than residential programs, outpatient programs and methadone programs, although outpatient and methadone programs were less expensive in the short term. The New York State OASAS study did not compare its results with any other programs.

Further, in Section IV of this report it states: "The analysis demonstrates that clients retained in treatment at least six months produced significant savings to New York State taxpayers." These "savings" may be far more elusive than the report indicates. The author points out "that the cost of treatment was not factored into the savings figures." The author suggests that because the benefits are so great, accounting for the cost of treatment would not appreciably change the results. Although interesting, such a conclusion is not accurate. Conservatively, the average cost (average of all four program types) of six months of treatment can be estimated at $3,600 per individual. Thus, the cost of treatment for the entire client sample would be approximately $67 million or a loss to the taxpayers of $16.8 million. If one extrapolates the purported savings from the 58% sample to all the clients expected to stay in treatment at least six months the total savings would not be $87 million but a loss of more than $30 million. Because of the wide disparity, it is difficult to tell whether the researcher simply did not know what he was doing or OASAS was intentionally attempting to mislead the state legislature and the New York State taxpayers.

Additionally, it is disturbing that the report measures the efficacy of the programs using pre-existing conditions in its favor. For example, the report indicated that Alcoholism Outpatient Clinic programs were 52% effective in "Maintaining Full-Time or Improving Employment-Related Status." If people were employed at the time of entry into the program, there is no evidence that suggests that they would not have been employed six months later without attending the program. What's more, it is likely that 45% or more of the 52% were already employed and would have remained that way without treatment. Thus, the "real" impact of the treatment may have been 4% or 5%. However, even 4%, 5%, or even 7% cannot be attributed to the types of treatment programs studied by OASAS. Arguably, those same individuals putting the same amount of effort into Alcoholics Anonymous, which costs nothing could have achieved the same results. There is also strong evidence the "no treatment" would have produced even better results.

But probably the most disturbing information is the report of "% Discontinued Use of Primary Substance." This category implies that one measure of the efficacy of treatment is the reduction in use of the clients' primary substance while in treatment. While it would be good if clients refrained from using their drug of choice during the time they are in treatment, the goal of treatment programs is usually thought to provide methods and skills for clients to refrain from using their drug of choice when they are not in treatment. Nevertheless, using this category as a point of comparison with the Baldwin Program please consider the following.

Keeping in mind that the Baldwin Program at The Hagaman Guest House is an open program with respect to guests being free to roam about the village at will, The Hagaman Guest House environment is more closely aligned with Ambulatory Drug-Free and Alcoholism Outpatient Clinic than with Residential Drug-Free and Halfway House programs.

TABLE 1

* The length of stay at The Hagaman Guest House varied from two weeks to six months. Guests who stayed less than six months but completed the programs directed, were normalized by using the time immediately following their stay at the guest house as equivalent to time in OASAS programs. The results of the above comparison is as follows:

TABLE 2

The previous discussion is not intended to criticize or demean OASAS's work. The purpose of the discussion is to encourage OASAS and other states to broaden their thinking to include methods that could contribute to ensuring "care, treatment and rehabilitation is of high quality and effectiveness." Assuming OASAS's responsibilities are to ensure "care, treatment and rehabilitation is of high quality and effectiveness," would it not be incumbent upon OASAS to study and move toward programs that produced better results? Moreover, with respect to Baldwin Research's comparative data, OASAS and the rest of the treatment industry should not cavalierly reject the data claiming it cannot be verified. Baldwin Research is willing to share all its study data with OASAS and the entire treatment industry.

As a matter of record, Baldwin Research supports the need for verification of studies. We offer firsthand testimony as part of our verifications. That is, for the purpose of verification, we arrange interviews with people who have gone through our program. In these interviews the interviewees not only speak of their own experience but also freely talk of others who were successful in the program and those who were not. We are certain that no other program in the country provides this level of verification.

Baldwin Research knows, for example, that the treatment industry's programs are unable to provide such data. Periodically, Baldwin Research contacts a test group of New York State treatment programs and asks for, among other items, their success rate. In December 1997, we randomly contacted 25 New York State treatment programs. Only one of the 25 was able to give us their success rate. Although state law requires such information be available, none of the 25 programs considered it a problem not having that information available. Thus and from Baldwin Research's point of view, it would appear that the treatment industry is not very interested in how many people are getting well in their programs. Or, another possibility is that the treatment industry does not want those numbers available where they may have to disclose statistics that would be embarrassing. Again, this is only Baldwin Research's perception and if this perception is wrong, Baldwin Research would gratefully accept information correcting its error.

While treatment programs in New York State do not publish verifiable success rates most successful programs do. Why would programs that are successful not keep accurate records of their success rate and use their success rate as marketing information? The answer is-they would-and, they do. Any organization that is performing well in its market, whether it manufactures widgets or provides cardiac rehabilitation, certainly wants its potential customers or clients to know about its successes. The fact that drug and alcohol treatment programs do not use their respective success rates in their marketing is testimony that these programs know that they have terrible success rates. In fact, the information that "treatment doesn't work" and educational programs do work is not new information, nor is it unique to Baldwin Research. Other educational based programs have achieved similar success rates as Baldwin Research.

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