Exposing the Pseudoscience and False Claims within the Addiction Treatment Industry
Over the years, there have been many different methods that doctors and researchers have employed to treat substance abuse. Some have become industry standards; others are remembered for what not to do. At best, the pseudoscience and false claims about substance abuse and its treatment are legitimate but misguided attempts at solving a complex problem. At worst, they are confidence tricks employed by unscrupulous conmen on vulnerable and desperate victims.
The Nature of Pseudoscience
While there is no established definition for pseudoscience in the field of addiction treatment, it is generally understood that any method promising a “breakthrough” is unlikely to be validated by research. Websites and doctors that offer nothing but breathless testimonials by people who claim to have been “cured” (and at an unlikely rate of progress) should send warning flags; if it sounds too good to be true, it probably is. Real science, real medicine, and real treatment are often slow and methodical, lasting weeks or months, and clarifying that recovering from an addiction problem is a lifelong journey.
Pseudoscience doesn’t bother with the gritty details, instead offering a quick and easy fix, usually with a hefty price tag involved.
Sometimes, the price tag takes a lot out of the client, in more ways than one. Despite a complete sea change in the understanding of how addiction works, there still persists the school of thought that substance abuse is a fault of morals, and that people who drink too much or use drugs are of poor character. Labels like “junkie” are applied liberally, and the individual is treated as someone with a personality defect, not as a patient in need of medical help. In more traditional societies, this approach is taken into consideration, even during treatment. In Russia, for example, where there is a long history of suspicion toward all things American (even science), there is a chasm of difference in how a very old country, with a long history of drinking, views the problem of alcoholism and the people who fall afoul of it.
This presents itself as a self-described “controversial treatment” that comes out of the sparsely populated but massive Siberian region of Russia, and it is making waves internationally. Two psychologists, Dr. German Pilipenko and Professor Marina Chukhrova, use corporal punishment (caning) to literally beat addiction or other undesirable behavior out of clients who pay 3,000 rubles ($99) per session. They claim to the Siberian Times that they have treated over a thousand patients, some of whom come from as far away as the United States.1
Specifically, “beating therapy” is said to work when clients fail to respond to other treatments. Pilipenko and Chukhrova say that their methods work for substance abuse and other mental health conditions, and their patients leave satisfied and happy.
Like “alternative medicine,” this form of pseudoscience attempts to strike a chord by harkening back to days of corporal punishment being practiced in schools and monasteries. And, like most forms of pseudoscience, this one claims to be “updated” or “modernized” with half-truths applied from legitimate understandings of psychology.
Chukhrova, a psychiatrist with 25 years’ worth of experience treating substance abuse patients, paints a picture of addicts suffering “happiness hormones” that they try to self-medicate with drugs or alcohol (or, failing to do so, fall into depression). The pain of being struck with a cane induces the brain to release endorphins, redressing the balance and restoring happiness.
The caning “counteracts a lack of enthusiasm for life,” according to Dr. Pilipenko. With the caning sparking a new zest for living, there is no more room in the patient’s mind for addictions, suicidal thoughts, or mental health disorders.
Treating Addiction through Pain
Natasha, a 22-year-old woman who was addicted to heroin explains that, like other patients who sign up for this treatment, she was given psychological counseling before the “treatment” began. She received 60 lashings across her buttocks, while patients with less severe addictions might receive only 30. As part of medical due diligence, Natasha was given an electrocardiogram to ensure that the pain and shock of the lashings did not cause heart problems.
Natasha described the sensation as “a stinging pain, real agony.” She would scream and cry, while the doctor – either Pilipenko or Chukhrova – would ask what she was feeling.
Physically, the sessions were “really unpleasant,” but Natasha said that it was the only treatment that succeeded in turning her away from heroin. With every strike, the doctor would explain the danger of the drugs, but Natasha insisted that the goal was not to punish or humiliate her into recovery. “The pain,” she told the Siberian Times, “helps me understand the dangers I have caused to myself,” and how her heroin habit was slowly killing her.
She received 60 lashings across her buttocks, while patients with less severe addictions might receive only 30.
Despite the pain and temporary lash marks on her buttocks, Natasha ardently defended the treatment. She said that the optimism she felt after each session was the first sensation of happiness and normality she experienced since starting her heroin use five years prior. Several months after she started treatment, she landed a job and was holding it down “against expectations.” She still has cravings for heroin, but they are on the decline, and she considers herself free from the drug.
While media attention often focuses on the physical aspects of the counseling, Professor Chukhrova insists that the actual foci are the psychological counseling and detoxification. The caning comes at the end of the treatment, following a medical exam to ensure that the client can endure 30 or 60 lashes. She and Dr. Pilipenko use willow branches: flexible and won’t cause bleeding. The buttocks are a “very good reflexogenic zone,” she says, which transforms pain signals into “positive activity for the human organism.”
The Case against Corporal Punishment
At face value, and for desperate clients, beating therapy may seem logical; but while Chukhrova and Pilipenko’s treatment runs on word of mouth alone, there are decades’ worth of research that suggest how harmful corporal punishment can be to a client’s mental health. The American Psychological Association makes “the case against spanking,” citing numerous studies that show physical punishment can lead to increased aggression, antisocial behavior, and mental health problems. Simply put, corporal punishment doesn’t work, in the words of a Yale University psychology professor. “You cannot punish out these behaviors that you do not want,” says Alan Kazdin, PhD, who also served as president of APA. Corporal punishment “is a horrible thing that does not work.”2
Elsewhere, Psychology Today called physical punishment “a serious public health problem,” one that profoundly affects the mental health of the recipients of the punishment and the societies in which they live.3
But all the research on the downsides of corporal punishment cover the effects of the practice on children. It’s in the dearth of coverage on the effects of physical punishment on adults, to change undesirable behavior, that the spanking therapy out of Siberia exists. That is the modus operandi of most forms of pseudoscience: exploiting the gaps in established research and claiming to offer a therapy that more reliable forms of treatment have not yet been able to cover.
Pioneering an Unconventional Method
Even as Dr. Pilipenko’s practice sounds legitimate – clients have to subject themselves to two beating sessions every week, for three months, and then follow up with visits every four weeks over the next year – the Huffington Post categorized its coverage of the story as “Weird News.”4 Further to the point of Russian medicine and science choosing to go its own way – perhaps especially in the barren, remote regions of rural Siberia – the Post also quoted the Moscow Times in mentioning some of the more “unusual addiction therapies” practiced there: hypnotism, black magic, and even a gang using handcuffs to physically restrain addicts from consuming more drugs, a form of extreme detoxification that could be deadly.
Dr. Pilipenko acknowledged the criticism he receives but remained unmoved. “All pioneers” get skepticism from colleagues, he said, pointing out that “conventional methods” of countering drug abuse have limited success; his beating therapy, on the other hand, produces results (or so he says), while admitting that more time is needed to see if this is truly the treatment of the future. But Pilipenko so believes in what he is doing that he told the Siberian Times that he would not hesitate to send his own children to his clinic if they had drug problems.
Somewhat reassuringly, more mainstream Russian doctors have also expressed doubts over the Siberian treatment. In 2005, the chief substance abuse doctor for the country’s Health Ministry commented that Pilipenko would have more success beating a berry than a buttock, and other researchers noted that other ways of promoting endorphin production in the brain, such as acupuncture, massage therapy, exercise, or even sex, do not entail physically striking patients.
But Dr. Pilipenko, arguing that caning can be dated back to the 12th century, says that no method is as effective as beating. The counseling that takes place before and during the caning is intended to help clients realize the reason behind their stress and self-medication. The pain serves to “wake up the consciousness,” guiding the patient into understanding how and why the drug abuse or self-destructive behavior took root.
The theory is the same as that which is practiced during Cognitive Behavioral Therapy, a standard form of treatment across the treatment industry. But what makes beating therapy a form of pseudoscience is how Dr. Pilipenko uses half-truths and vague statements about psychology and physiology to make his methods look somewhat feasible and passably reasonable.
79 percent of people who were put behind bars for a drug offense were arrested again within just five years of their release.
On more established scientific grounds, there is little to show that threatening a drug user with punishment, or even actively carrying out that punishment, is successful in changing behavior for the better. While corporal punishment for adults is unlikely to make its way out of Siberia, zero tolerance and mandatory minimum sentences for drug offenses were the law of the land in the United States beginning in the 1970s. But extensive research has suggested that such harsh methods are ineffective in reforming criminals. A report out of Connecticut’s Department of Corrections found that 79 percent of people who were put behind bars for a drug offense were arrested again within just five years of their release.5 A statement from an individual who went through a drug court program testified that incarceration does not cultivate a motivation to change criminal behavior through growth and does not provide a structure for such growth to occur.6
Similarly, a 2015 study conducted by researchers at the University of Washington found that when youths at school were suspended for using marijuana, they were more likely to continue using marijuana (at rates higher than before their suspension) than to abandon the behavior because of being caught. Researchers were surprised to discover that students who attended schools that had suspension policies for drug use were 1.6 times more likely to use marijuana the following school year than students at schools that did not have such policies. This applied to the entire student body, not just students who were suspended for violations. The co-author of the study said that the results showed that suspensions “are clearly not having a deterrent effect.” Instead, the effect is “just the opposite.”7
For reasons like this, corporal and harsh punishments toward drug use and abuse have fallen out of favor with the American public, a majority of whom favor more compassionate and educational methods of rehabilitating people away from drug-related behavior.8 But in far-flung places where life is very different and where there exists a deep-seated anti-American current, so much so that outdated and potentially harmful “treatments” are given out by people wearing lab coats (in places like Siberia, one of the most sparsely populated areas in the world), the idea of literally beating addiction out of patients has been allowed to take hold.
It’s easy to dismiss beating therapy as a bizarre pseudoscience that will never emerge from the remote and frozen corners of northern Russia, but many questionable, discredited, and even dangerous practices take place across America’s own borders. One of them is rapid detox, a procedure whereby clients are anesthetized and then given intravenous doses of opiate blockers, which stop the action of opiate drugs (such as heroin) as well as other medications (administered intravenously as well) to control for the involuntary reactions that follow the effects of heroin being chemically broken.
Under normal circumstances, medical detoxification is conducted while the client is still conscious, so doctors and other healthcare providers can monitor the progress and ensure that the client’s body is properly (and safely) being weaned off the heroin (or other applicable drug). But medical detoxification can be a distressing experience, putting the client through a number of physically and psychologically upsetting effects (such as vomiting, diarrhea, fever, and periods of depression and intense craving for the drugs); and this process can last as long as a week.
‘Rich, Famous, and Desperate’ Clients
But with rapid detoxification, with the client unconscious while the body is put through the process, physical cleansing of the illicit substances can be achieved in as little as eight hours. However, any administration of general anesthesia comes with risks, and injecting multiple chemicals into a client who is still under the effects of at least one powerful drug can create new and unforeseen problems. This is why most doctors prefer that the patient remain conscious during the detoxification process, no matter how distressing it is.
Nonetheless, some patients are very taken with the prospect of a short, and seemingly easy, detox period, especially in cases of severe and chronic drug use, and some doctors and treatment centers are willing to offer the practice.
USA Today explains that it tends to be only the “rich, famous, and desperate” who seek out rapid detox.
But doctors and other healthcare providers are cautious of any kind of treatment that promises a quick fix, which is the calling card of any pseudoscience – especially when that quick fix can cost upwards of $10,000, is not covered by most forms of insurance, and has received only tepid and circumspect coverage in peer-reviewed medical journals.9
As a further sign of the alarm bells sounding over rapid detox, a doctor who offered this service in New Jersey had seven of his patients die within days of being treated. That was too much for the state of New Jersey, which in 2000 launched proceedings to strip him and a colleague of their medical licenses. The doctor, Lance L. Gooberman, insisted that he was “just trying to come up with a better way to do detox,” which included giving clients so much overdose-reversal medication that the usual 48 hours of observation wouldn’t be necessary; clients could walk out of Gooberman’s office the same day they detoxed.10 Too drastically good to be true, said his critics, which is often a charge leveled against most pseudoscientific practices.
An Unproven Medical Treatment
The New Jersey court charged Gooberman and his colleague of using unproven medical treatments, giving patients general anesthesia without a supervising (and licensed) anesthesiologist present, and discharging patients without ensuring that they had appropriate aftercare. Patients were often sent home, or even to motels, with instructions given to untrained family members or friends who were required to administer injections as part of the arrangement.
Gooberman said that the people who died after his treatment had undetected medical conditions that were exacerbated by the rapid detox or had used other drugs immediately after receiving their treatment from him.11
New Jersey suspended Gooberman’s medical license in 2003, but a judge ruled that he was not responsible for his patients’ deaths. The Orange County Register writes that in 2005, the Journal of the American Medical Association stated that rapid detox offered no significant benefit over more traditional and safer detox programs, and can actively threaten the lives of patients who are exposed to it. The American Society of Addiction Medicine rescinded their initial (tepid) support of the method, saying that there were too many risks inherent to the process of rapid detoxification in order for it to be reliably used.
Selling a Very Attractive Product
But even today, many doctors and practitioners find ways to market rapid detox to unsuspecting or desperate patients. And, as with any pseudoscience, it really is about marketing. The associate director of UCLA’s Integrated Substance Abuse Programs calls rapid detox “a very attractive product.” A family that has watched a loved one spiral into drug abuse wants to believe that there’s a quick fix, something that can be done within a matter of hours and doesn’t entail the hard work of sobriety.12
For this reason, Fox News asks if rapid detox is “hope or hoax,” quoting a Dr. Clifford Bernstein – who was accused by California health investigators of medical negligence after a patient developed health problems following one of his treatments – as saying that other doctors don’t understand rapid detox; if they did, it would make perfect sense to them.13 Some things about rapid detox do make sense: the promise of a fast and easy detox, the idea that it is “persecuted” by mainstream doctors, and that it offers a cure where other treatments have failed. But that is how pseudoscience operates, by taking nuggets of truth and plausibility and then stretching them into a covers-all-bases solution.
The Centers for Disease Control issued a report that rapid detox “has little to no evidence to support its use,” but, in the tradition of pseudoscience, the problem is unlikely to go away.14
Promoting rapid detox entails going against decades’ worth of research-based results that show traditional methods of detox are much safer and no less successful.
Is Alcoholics Anonymous Pseudoscience?
One of the hallmarks of a pseudoscience is that advocates often attempt to discredit the more established practices within the field. For all the passion with which he defends rapid detox, Dr. Bernstein has an equal ire for one of the most sacred – yet controversial – aspects of recovery within the treatment industry: the 12-Step program. It is an “outdated 20th century concept,” he told Wired magazine, saying that the idea of talking people out of their addiction problem is “ridiculous.” The aftercare model espoused by groups like Alcoholics Anonymous and Narcotics Anonymous is counterproductive. “It’s like a cult,” he said, and the idea of sending a patient to talk “with a bunch of other addicts” all the time, “where all the other drug dealers hang out,” is completely antithetical to what he feels is the most effective method of treating substance abuse problems.15
Dr. Bernstein may not have much support for his use of rapid detox, but he is not alone in his criticism of Alcoholics Anonymous and the 12-Step method. While that approach has remained a sacrosanct part of the treatment paradigm for generations, some researchers and doctors today are questioning the philosophy behind the program, saying that the psychology behind its application is skewed, the success rates are quite low, and the movement has become dangerously insular and almost cult-like – in other words, very much like a pseudoscience.
The Rock Bottom Problem
The loaded term is used very intentionally by New York Magazine and Salon, both of which ask if the relationship between the treatment industry and the 12-Step method needs to end. New York Magazine profiles Unbroken Brain, a book by Mia Szalavitz that details how advancements in psychology and neuroscience cast new light, and raise new questions, over the long-held paradigms of addiction being a disease and how groups like Alcoholics Anonymous treat that disease.16
For example, one of the central conceits of the 12 Steps is that an addict has to hit rock bottom (however that concept is defined) in order for the journey of recovery to begin. Rock bottom (whether it means a relationship ending, being evicted from home, a DUI, or any other sign) is a signal that the addiction has dragged the client down to the lowest possible rung on the ladder. There is no more pretense that the problem is under control.
But Szalavitz argues in Unbroken Brain that using the rock bottom argument in treatment is “harsh and humiliating,” a sense of waiting for the client to make the ultimate mistake before any progress can be made. The graver the situation, and the more punitive the treatment, the greater the likelihood that the addict will want to really quit their behavior.
This, says Szalavitz, “is a totally pseudoscientific concept,” a deeply embedded one that has been adopted by drug courts and become part of the lexicon of the treatment industry. Substance abusers are more likely to turn clean when they still have connections to the world around them (their jobs and family) than when they lose those things and have to start from scratch, which has been the theory of Alcoholics Anonymous since it was founded in 1935. Instead, the idea of being made to have nothing in order to achieve recovery “embrace[s] a totally false, harmful view of what addiction is.” Some treatment programs ran with the idea of breaking clients down to their most emotionally vulnerable, with the founder of one infamous rehabilitation center, initially known as the Synanon organization, proudly saying that while AA is based on love, “we are based on hate; hate works better.” The Synanon organization eventually become a commune, renaming itself the Church of Synanon and then disbanding permanently after criminal charges for attempted murder, financial irregularities, and even domestic terrorism. The Synanon organization has been called “one of the most dangerous and violent cults” in American history.17
Most rehabilitation programs don’t go the way of the Synanon organization, but Szalavitz takes issue with how the principles of AA are still so unquestioningly adopted across the board. Even modern facilities have resorted to various forms of physical and psychological torture to demolish addicts’ egos (such as sleep deprivation, isolation, and other abusive methods), forcing them into the “rock bottom” frame of mind. Practitioners might also tell family members of the addict to withhold sympathy and compassion until such time that the addict admits to having a substance abuse problem.
Some private rehabilitation centers, and 12-Step groups, are notoriously secretive when it comes to disclosing the details of their practices, citing client confidentiality. As a result, Szalavitz writes in Unbroken Brain that there is no independent, clinical research on what happens behind those closed doors; so, if there are abuses of the 12-Step philosophy taking place, no one is aware of it. What is known, she says, is that the pseudoscientific idea of rock bottom that lies at the heart of the 12 Steps run contrary to established, credible data on how addiction should be treated: with understanding, sympathy, and fostering connections with healthy social groups, and not by denying vulnerable and weak people these “vital lifelines” in order to get them to accept help.
Salon magazine makes no bones about calling Alcoholics Anonymous a pseudoscience, criticizing the meager success rate of 5-10 percent that peer-reviewed studies have found. The 12 Steps are found at the core of almost every alcoholism rehabilitation program in the United States, says Salon, but the Cochrane Collaboration (“one of the most prestigious scientific research organizations in the world”) reported that there are no experimental studies that have unequivocally shown that Alcoholics Anonymous is effective in treating alcoholism.18
Nonetheless, AA has a cultural monopoly on treatment in America, spread largely by the word of mouth of people whose lives have been successfully changed by the program. “In reality,” says Salon, “these members speak for an exceptionally small percentage of members.” Those who don’t make it are accused of being unwilling to “completely give themselves” to the program, and refusing to be honest with themselves and others. Salon writes that, as with the most popular forms of pseudoscience, the practice holds itself to be infallible; if someone fails, it is that person’s fault alone, and not because of a weakness or deficiency in the practice. That kind of inflexibility is one of the “rehab fictions” that AA’s longevity has made part of the treatment landscape, to the exclusion and loss of the many, many people whose problems do not fit in the 12-Step paradigm.
A meager success rate of 5-10 percent that peer-reviewed studies have found.
Reconsidering the 12 Steps
However, the book is not definitively closed on Alcoholics Anonymous, and the 12-Step method, being based on pseudoscience. Even the scientific community has come to the defense of AA; it is “an ideal recovery resource,” writes Recent Developments in Alcoholism.19 According to Alcohol Research & Health, the AA model is “the most commonly sought source for help,” and should be used in partnership with pharmacological and counseling methods.20 Scientific American says that even though the evidence for AA’s success is “far from overwhelming,” it helps “some heavy drinkers,” and is worth considering.21
The Journal of Addictive Diseases suggests that, with a number of conflicting and even contradictory findings about the success and effectiveness of AA, it may be up to individual interpretation and preference as to whether Alcoholics Anonymous is a legitimate part of the recovery landscape.22
The journal’s point illustrates the complexities of understanding and treating addiction. It is in this web of complexities that many pseudosciences arise and where the validity of pre-existing practices is called into question. The charge of pseudoscience is a serious one to make; in the same way that beating therapy can be easily dismissed, a form of treatment with actual support (like the 12-Step system) can also be tarred by the same brush.23
- “Beating Addiction Out of You — Literally.” (January 2013). The Siberian Times. Accessed November 30, 2016.
- “The Case Against Spanking.” (April 2012). American Psychological Association. Accessed November 30, 2016.
- “Physical Punishment—and Violence.” (August 2015). Psychology Today. Accessed November 30, 2016.
- “Drug Addicts Beaten to Reduce Their Cravings in Siberia.” (January 2013). The Huffington Post. Accessed November 30, 2016.
- “Recidivism.” (February 2014). State of Connecticut Department of Correction. Accessed November 30, 2016.
- ” Confronting the Cycle of Addiction & Recidivism: A Report to Chief Judge Judith S. Kaye.” (June 2000). New York State Commission on Drugs and the Courts. Accessed November 30, 2016.
- “Suspension Leads to More Pot Use Among Teens, Study Finds.” (March 2015). University of Washington. Accessed November 30, 2016.
- “America’s New Drug Policy Landscape.” (April 2014). Pew Research Center. Accessed November 30, 2016.
- “Rapid Detox” A Quick Fix for Opiate Addiction?” (August 2002). USA Today. Accessed November 30, 2016.
- “2 Doctors May Lose Licenses Over Fast-Detox Method.” (December 2000). Los Angeles Times. Accessed November 30, 2016.
- “State’s Malpractice Case Against Addiction Specialist Opens.” (January 2001). The New York Times. Accessed November 30, 2016.
- “Drug Detox Doctor Accused of Negligence.” (August 2013). The Orange County Register. Accessed November 30, 2016.
- “Rapid Drug Detox: Hope or Hoax?” (January 2005). Fox News. Accessed November 30, 2016.
- “Rapid Opioid Detox Linked to Lethal Events.” (September 2013). Medpage Today. Accessed December 1, 2016.
- “Instant Detox.” (January 2005). Wired. Accessed December 1, 2016.
- “The Tragic, Pseudoscientific Practice of Forcing Addicts to ‘Hit Rock Bottom’.” (May 2016). New York Magazine. Accessed December 1, 2016.
- “The Man Who Fought the Synanon Cult and Won.” (November 2014). Longform. Accessed December 1, 2016.
- “The Pseudo-science of Alcoholics Anonymous: There’s a Better Way to Treat Addiction.” (March 2014). Salon. Accessed December 1, 2016.
- “The Impact of Alcoholics Anonymous on Other Substance Abuse Related Twelve Step Programs.” (January 2009). Recent Developments in Alcoholism. Accessed December 1, 2016.
- “Advances in Alcoholism Treatment.” (2011). Alcohol Research and Health. Accessed December 1, 2016.
- “Does Alcoholics Anonymous Work?” (March 2011). Scientific American. Accessed December 1, 2016.
- “Alcoholics Anonymous Effectiveness: Faith Meets Science.” (September 2009). Journal of Addictive Diseases. Accessed December 1, 2016.
- “The Trouble with Pseudoscience—It Can Be a Catastrophe.” (January 2013). Skeptical Inquirer. Accessed December 1, 2016.