December 23, 2008

We spend $20 billion a year on drug and alcohol treatment programs -- without demanding much of any evidence that they work.

"[V]ery few rehabilitation programs have the evidence to show that they are effective.... And the field has no standard guidelines. Each program has its own philosophy; so, for that matter, do individual counselors. No one knows which approach is best for which patient, because these programs rarely if ever track clients closely after they graduate. Even Alcoholics Anonymous, the best known of all the substance-abuse programs, does not publish data on its participants’ success rate."

***

By the way, I saw that movie "Rachel Getting Married," which begins with the main character graduating from a drug treatment program. (Here's the trailer.) I hated it. I felt like I was watching the actors doing improv scenes in preparation for a movie to be made later. Maybe you like that kind of thing. Did you like "Festen" ("Celebration")? I didn't. (Yikes, I'd forgotten all about Dogme 95. Scary flashback!)

But RGM wasn't just the actor-fest of a movie about a big dysfunctional family celebration. It also had music. Little bands playing in the next room while the actors emoted over here. Singers coming up to microphones and sometimes permitted to sing a whole song, perhaps to entertain us or perhaps to make us feel like the main character who's rather alienated from the whole affair. Overheard in the lobby after the movie: "It was like being at a bad wedding. If I want to go to bad weddings, I'll go to bad weddings."

There are way too many wedding movies and weddings in movies. I think it's because there's an assumption that women love weddings and if there's a wedding in the movie, women will want to see it. Not this woman.

Also, I complained before about how they always put actresses in bathtubs in movies. And sure enough, they get Rachel Rachel's sister into the bathtub. Want to see Anne Hathaway taking a bath? Yes? Sucker!

IN THE COMMENTS: Chip Ahoy says:
Is this post about spending $20 billion with uncertain results or is it about weddings in movies or actresses in bathtubs? Sometimes I get confused. Because, if it's about weddings, well, weddings make me hurl. I dread going to them. Except for one thing I found delightful. There's a blog I've become fond of, to me interesting, chiefly food-related but not entirely, written by Lucy, an expat living in Southern France. She describes a French wedding that held my interest all the way through.

She writes about weddings at other times too, but I especially like this one....
Charming!

fivewheels says:
"there's an assumption that women love weddings and if there's a wedding in the movie, women will want to see it."

Sadly, it's not an assumption, Ann, it's a fact. American women are so Pavlovianly wedding-obsessed that any movie with "wedding" or "bride" in the title will make a mint, even if they're horrible.

Wedding Crashers? Huge hit. Wedding Singer? Hit. My Best Friend's Wedding? Hit. My Big Fat Greek Wedding? Biggest indie movie ever. Crappy movies that made over $100 million? -- American Wedding, The Wedding Planner. The entire indie revolution was started by? Four Weddings and a Funeral.

The alternative explanation, of course, is that all of these enormously successful movies are wonderful examples of cinema. Right.
I've managed to avoid all those movies, except "Four Weddings and a Funeral" -- which I saw because I had reason to think it would be good and it was.

59 comments:

Zachary Paul Sire said...

It was truly awful. That ridiculous dishwasher scene...and the horrible wedding reception that went on for like an hour, with horrible music. Good acting from the sister, Rachel, though.

Ann Althouse said...

It lost me early on when the 2 sisters were in bed going on about a dream about Elvis Stoiko. And that was scripted, not improv, which is what it seemed like.

New York said...

Sounds like a ridiculous movie for Tunde Adebimpe to be appearing in.

Joe said...

Several studies have found that most people who quite drugs and stop drinking do so on their own and that the recidivism rate from most programs is very high with Alcoholics Anonymous being among the very worse.

Ron said...

Bathtub scenes are exploitation on the cheap! Nothing really is required, but it can pass for "sexy." Win-win for actress and filmmakers...

Salamandyr said...

A little fan service helps the chick flick go down easier.

MadisonMan said...

We spend $800 billion on a Wall Street rescue without demanding evidence that it works either.

peter hoh said...

In response to the opening quote: we spend $200 billion a year on drug enforcement, prosecution, and incarceration, without any evidence that the war on drugs is working.

Okay, I have no idea what the War on Drugs is really costing us, but I'm pretty sure that it has been no more effective than the drug treatment programs in the NYT profile.

Hoosier Daddy said...

We spend $800 billion on a Wall Street rescue without demanding evidence that it works either.

Why stop there? You'll find few government handout programs that do work much less require evidence of success.

Unless of course the creation of a permanent dependent underclass is the goal.

Joe said...

Thread hijack time: Isn't it odd that GM said it would run out of money at the end of December without a loan. A loan is being talked about, but no money is forthcoming so how is GM still afloat? Apparently, we're about to spend $17 billion more for no damn reason.

garage mahal said...

Nobody could have predicted that no strings attached taxpayer money used to bail out failed banks would be used for bonuses instead of credit lines.

Roger Sweeny said...

I don't want to sound like a broken record but education is an industry where there is very little good research about "what works."

You could change one word in the opening quote and be completely accurate:

"No one knows which approach is best for each [student], because these programs rarely if ever track clients after they graduate."

Simon said...

Anne Hathaway? Well, I can imagine things I'd like to see less, but on the whole -- too thin, too young, and too generic.

Hoosier Daddy said...

Nobody could have predicted that no strings attached taxpayer money used to bail out failed banks would be used for bonuses instead of credit lines.

Are you now beginning to realize why conservatives loathe government spending programs?

AJ Lynch said...

AA is basically free right. It does not take any govt money? That is my undertanding.

Therefore it surely represents the most effective use of taxpayer dollars and has a very high success rate per taxpayer dollar spent. Heh.

I defy any other govt social program to match the AA results.

Pogo said...

"Yet very few rehabilitation programs have the evidence to show that they are effective."

"we spend $200 billion a year on drug enforcement, prosecution, and incarceration, without any evidence that the war on drugs is working."

Each generation rediscovers entropy, resulting in a brief flirtation with nihilism.

And then, rebirth: relentless religiosity, postivism, boosterism, and can-do-ism prevail.

Meanwhile the realists see no changes at all, save for modest improvements in health, comfort and safety, at least amongst Westerners. The propensity for human wrongdoing remains, however, forever unaltered and unalterable.

William said...

There's a Catch 22. If addicts think the program will probably fail, it will probably fail. Addicts are addicted to failure....Rehab programs for the most part don't work the first time. They do, however, give many addicts the strength to keep looking for recovery. Sometimes it takes more than a few trips. Think of it as resistance training. It takes a few trips to the gymn to look like Schwartzenegger.

m00se said...

I worked for some time as a contractor at a drug rehab center. The saddest thing about drug rehab is that even with its poor track record, it still works better than incarceration at preventing recedivism. That said, it bears pointing out that drug rehab programs are black holes where funding disappears.

Most of the software written to administer drug rehab programs have a function whereby you can hide patient records. Why? Because so many people who work in rehab programs were once patients.

Not sure it thats good or bad.

The difficulty is that drug abuse used to take care of itself, after a fashion. And it would seem that the "legalize it" people would want to revive that. Let people just do what they want. Then those without self control would just eliminate themselves a problem.

Jeremy said...

Simon, I think the phrase you're looking for is "Her knees are too sharp."

PatCA said...

None of these groups that receive federal money (our money) need to prove the work; they are just a newer version of Tammany Hall politics.

Cedarford said...

Roger Sweeny said...
I don't want to sound like a broken record but education is an industry where there is very little good research about "what works."

You could change one word in the opening quote and be completely accurate:

"No one knows which approach is best for each [student], because these programs rarely if ever track clients after they graduate."


And you would have to change the amount from 20 billion to 1,2000 billion spent.
(Though some professional schools do track graduate outcomes - though obfuscating some of the data so affirmative action students don't look as bad as they performed during and after school.)

Add Peter Hoh's note that we spend 200 billion (his number) on the war on drugs.

Another trillion-plus area is medicaid/medicare....where no one wishes to learn what spending works and what doesn't. We spend more per capita on health care than any other advanced nation yet from common vital statistics between nations we know we don't achieve outcomes commensurate with spending.
1. Why does the "Free Market! and Competition!" fail to lower US heathcare prices?
2. Why are nursing home owners here far wealthier than elsewhere, costs higher, and staff less well paid?
3. Why do Americans pay more for drugs than citizens of any other country?
4. Why do we have affluent seniors on TV bragging they got a 3,850 dollar scooter rather than a walker or wheelchair and "It didn't cost me a PENNY out of pocket - taxpayers paid for it all!"

For the Leftists, we also have Bush's 3 trillion indebted "War on Evildoers" that was financed by Chinese, Japanese,Saudi, French, and Wall Street plutocrat's money - all while tax cuts for the rich flourished. What exactly did we get for that? 300 less American deaths from terrorism balanced against 33,000 casualties we suffered for "noble Iraqi freedom lovers", and Afghan opium smugglers who declared loyalty for Karzai each year as long as their suitcase of 100 dollar bills is paid annually?

Contrast what we do inside the Imperial City with what the average US citizen wants the government to do. Big disconnect. The People have lost control of what they wanted their gov't and the courts to do, and their vote to the more compelling allure of loud special interest groups, power-hungry lawyers, and the moneyed global Elites.

tim maguire said...

The AA literature sums it up pretty well: "Rarely have we seen a person fail who has thoroughly followed our path."

The bottom line is the person has to want it and be willing to work for it. The rehabs lead the horse to water. That's it, that's all they can do. Like it or not, you can't judge them by whether the horse takes a drink. So to speak.

And AJ Lynch is right--AA has never and will never take a dime of taxpayer money. Self-support is a fundamental principle.

MadisonMan said...

Are you now beginning to realize why conservatives loathe government spending programs?

And are you beginning to realize why liberals like oversight?

Chip Ahoy said...

Is this post about spending $20 billion with uncertain results or is it about wedding in movies or actresses in bathtubs? Sometimes I get confused. Because, if it's about weddings, well, weddings make me hurl. I dread going to them. Except for one thing I found delightful. There's a blog I've become fond of, to me interesting, chiefly food-related but not entirely, written by Lucy, an expat living in Southern France. She describes a French wedding that held my interest all the way through.

She writes about weddings at other times too, but I especially like this one. The link takes you to the end of the post, not to the beginning so you must scroll back to the top, if you click.

Another story that really got me was her first Thanksgiving she cooked which was in China. Best Thanksgiving story I ever read.

Salamandyr said...

The AA literature sums it up pretty well: "Rarely have we seen a person fail who has thoroughly followed our path."

But that is tantamount to saying, "if you pray hard enough, water will run uphill." How hard do you have to pray? "Why, hard enough to make water run uphill, of course!"

If the person succeeds it's because of the program, if the person fails, it's because he didn't successfully follow the program. The question then is, does the program actually do anything except take credit for the patient's willpower?

AJ Lynch said...

"And are you beginning to realize why liberals like oversight?"

LOL. Stop it you are killing me!

madawaskan said...

Did he say oversight or slight of hand...?

Hey who oversees the oversee'ers and damn it-who the hell pays them?

Liberals just loooooove oversight in Chicago, any big Liberal city where things are not over budget and on the up and up....

You know places where they usually have Democrat mayors.

Sarge Charlie said...

As a 22 year recovering Alcoholic I can tell you the success rate of AA and NA, less than 10%, those that keep coming back after failure eventually will make it out. I came by through American Power who had good things to say about your blog today.

madawaskan said...

I'll tell you what Liberals like-it ain't oversight-it's hindsight-

Waaaa, complain, complain, complain-how the hell are you guys gonna give that up?

Brian O'Connell said...

Hah. Wedding porn.

Those 12-step programs are cults. Now applying cult tactics to the goal of getting addicts off of drugs and alcohol is probably better most of the time than letting them do what they will. But still.

Steve said...

Well, my wife always complains that just about every movie has a man relieving himself. Sounds like a good game of over/under for Vegas lines and parlays.

fivewheels said...

"there's an assumption that women love weddings and if there's a wedding in the movie, women will want to see it."

Sadly, it's not an assumption, Ann, it's a fact. American women are so Pavlovianly wedding-obsessed that any movie with "wedding" or "bride" in the title will make a mint, even if they're horrible.

Wedding Crashers? Huge hit. Wedding Singer? Hit. My Best Friend's Wedding? Hit. My Big Fat Greek Wedding? Biggest indie movie ever. Crappy movies that made over $100 million? -- American Wedding, The Wedding Planner. The entire indie revolution was started by? Four Weddings and a Funeral.

The alternative explanation, of course, is that all of these enormously successful movies are wonderful examples of cinema. Right.

peter hoh said...

Even I have a favorite wedding movie: Monsoon Wedding.

John Lynch said...

Intent vs. results... again.

So many programs are funded with good intentions and no proof that they actually do anything useful.

Results based funding is cold and heartless, but saves more lives.

MadisonMan said...

Chip, that does read like a very nice wedding, but I'll say my favorite wedding urls are the ones that describe Bridezillas.

I'm not a fan of mingling and small talk, so I generally don't like weddings, unless there's an open bar.

Dust Bunny Queen said...

Are you now beginning to realize why conservatives loathe government spending programs?

"And are you beginning to realize why liberals like oversight?"

They might actually try it some times, then.

Stephen said...

Eww, I don't like that Rachel. But then this Rachel getting married seems divine.
Plus, note her dog blogging skilz.

Simon said...

MadisonMan said...
"And are you beginning to realize why liberals like oversight?"

Still trying to peddle this as a failure of deregulation, huh?

An Edjamikated Redneck said...

When it comes to poor movie weding scenes none can be as bad as the one in 'The Deerhunter'. That whole movie was a waste of three hours, but the wedding reception was absolutely the bottom of a very deep barrel.

On recovery programs, until the addict WANTS to become clean, absolutely nothing will help; once he wants to become cleaan,nothing will stand in is way.

Darcy said...

Wedding Crashers really surprised me. I thought it would be pure trash. Well, actually it was, but I laughed pretty much all the way through.

siyeh pass said...

If one accepts that addiction is a disease (which is a widely accepted premise within and outside of the recovering world), then relapse can be a part, although not a necessary step, of recovery. No one points a critical finger at the cancer patient whose tumor returns. This is a fundamental misconception that flies in the face of treating addicts as individuals who suffer from a disease.

JohnAnnArbor said...

3. Why do Americans pay more for drugs than citizens of any other country?

Easy. The rest of the first world has price controls. We don't. So, we're subsidizing worldwide pharmaceutical development, essentially.

blake said...

1. Why does the "Free Market! and Competition!" fail to lower US heathcare prices?

Because it's not a free market. Medical training is a government-enforced monopoly. You could come up with a 50-cent cure for cancer tomorrow and if you tried to give it away, they'd throw you in jail.

Also, the government controls huge sums of market-distorting money which is the answer to:

2. Why are nursing home owners here far wealthier than elsewhere, costs higher, and staff less well paid?

Because the gov't sets the price and the nursing home lobby is more powerful than the medical staff lobby?

3. Why do Americans pay more for drugs than citizens of any other country?

John from AA--er, not Alcoholics Anonymous but Ann Arbor--nailed that one. Other countries hold a gun to the pharmco's heads: "Sell it cheap or we'll steal it and sell it cheap." The rest of he world free-rides on American largesse.

If we socialize medicine, kiss any new drugs goodbye.

4. Why do we have affluent seniors on TV bragging they got a 3,850 dollar scooter rather than a walker or wheelchair and "It didn't cost me a PENNY out of pocket - taxpayers paid for it all!"

See, you answer your own question: It's tax money. Tax money distorts markets. Housing, education, health...doesn't matter.

Finally,

For the Leftists, we also have Bush's 3 trillion indebted "War on Evildoers" that was financed by Chinese, Japanese,Saudi, French, and Wall Street plutocrat's money - all while tax cuts for the rich flourished.

Enough with the stupid "tax cuts for the rich" meme. Those tax cuts saved me thousands, and I was on the ragged edge of poverty.

blake said...

I was hoping Althouse would see it, though I didn't recommend it to her. (I voted for Slumdog and...I forget.)

I liked it. It's not for everyone.

Like, ZPS had the reaction I would expect a lot of people to have: Why am I watching this interminable wedding scene?

For whatever reason, while I'm watching it, I'm on the edge of my seat. Will she or won't she? There are so many opportunities....

Meanwhile, I'm not sure if women can be held accountable for the success of Wedding Crashers. That's a total guy movie.

blake said...

Oh, and substance-abuse-wise, that's an interesting dilemma: Even if you do keep detailed records of graduates, how do you prove your success withou violating your graduates' privacy?

dick said...

Mad Man,

Liberals do not really like complete oversight. They like the look of oversight. Look back at the Great Society programs. Most of them have a flimsy oversight and then it stops. The programs just keep growing and growing without working and if you try to get a real review of them to ensure that the money is going where it is supposed to go every liberal in sight will scream out against you. conservatives have tried this for 40 years and the programs keep getting more funding without ever having to prove they work at all.

Darcy said...

Did...blake just call me a guy? :)

blake said...

Heh. I was referring to demographic appeal. The idea is that "wedding" triggers a response in women like "Let's go to the movies!"

But I doubt that's true if the movie stars Vaughn (and maybe Wilson), and is centered around exploiting women's sentimentality about weddings. That's kind of insulting your audience.

Now, I liked the movie quite a bit. And I note that IMDB has men giving WC a 7.2 while women give it a 7.1 (on average).

But five times as many men than women have voted on it.

So, you have to be cool enough (as a chick) to get over the before you go out to see it--and if you're that cool, you'll probably like it.

Heh.

blake said...

"get over the possibly off-putting theme" that is.

Darcy said...

Great points about the movie, blake. I shouldn't have called it trash, though some parts definitely are. Really funny, and charming (I think), in spite of the wedding mockery.

fivewheels said...

It's been a while since I saw Wedding Crashers, so tell me if I have this wrong: In the end, the incorrigible guys learn the true meaning of love and have a fairy-tale ending with with the ladies who victoriously have tamed them, do they not?

That's not insulting the target audience; the women win in the end. It's just that the first half-hour, which is the funny part, is just having your cake and eating it too, from the filmmakers' perspective. Part of the success is providing something for everyone (or for most).

But more importantly, I got frontpaged! w00t!

Darcy said...

LOL, fivewheels. Somehow, I didn't feel that the women ended up with the better end of the deal in that movie. ;-)

Lem said...

In the adaptation My Zinc Bed playing now on HBO on demand, the characters discuss AA being like a cult.

It's perfect, if you are always in recovery then you are never "cured".

blake said...

fivewheels,

I did think about that.

But consider this: It's the crazy couple (Vaughn and Fisher) that gets married where the more normal couple (Wilson and MacAdams) end up (presumably) dating.

And both get the girl of their dreams through deception.

Kite said...

If you're cured you can go back out and drink normally, right? Let me know how that works for you.

AA originally was for the hopeless alcoholic, but even today most people who attend aren't likely to have any chance of quitting on their own. That's why they're there. How do you suppose sentencing people to a voluntary program affects success rates?

PatCA said...

To catch up....

I also love Monsoon Wedding.
I also hate "men at urinal" scenes.

Finally, I laugh heartily along with AJ at the thought of the oxymoron, "government oversight."

Salamandyr said...

Kite, that's one way of looking at it. Another definition might be you simply no longer need drink to get through the day.

For instance, I quit smoking a couple years ago. I don't consider myself a "recovering" smoker. It's just, I once smoked, I no longer do.

ballyfager said...

Hey Ejamikated Redneck, you and I are definitely on the same page. The Deerhunter was ridiculous bullshit. It was a movie made by a man who obviously didn't understand the people he was portraying. It was successful because it appealed to clueless liberals who need someone to look down upon.

Also agree that no rehab program can supply the motivation, without which the addict won't reform.

Brian O'Connell, also agree with you that AA is a cult with all that that implies.

Isn't the first step - We had to admit we were powerless over this?

If you really believe that you ought to lay down and die.

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