Proven Programs, Persistent Resistance
If you’ve read some of the earlier posts in this series, you’ll recognize the foundation I’m about to revisit. And if you’re joining for the first time, this context will help frame what follows. I return to this information because it remains one of the most important—and least known—facts about substance-dependence treatment: most programs report one-year abstinence rates of 30% or less.
That reality makes it essential to begin with the rare programs that consistently deliver strong, long-term outcomes. Two professions—pilots and physicians—participate in highly structured monitoring systems that achieve remarkable results:
- Pilots: 92% continuous abstinence at two years (1998 Hazelden Voice)[i]
- Physicians Health Programs (PHPs): 78% continuous abstinence at five years[ii]
These programs stand alone in their verified success, supported by five years of mandatory drug testing and rigorous oversight. They offer a clear, evidence-based model—one that can reshape how we think about helping someone we love.
Opposition from the Treatment System and AA/Al-Anon
Despite the strong evidence behind the physician and pilot programs, many treatment centers, interventionists, and AA/Al-Anon sponsors push back against this model. If your loved one is currently in treatment or attending AA, he/she may be hearing messages that discourage participation in a structured, family-supported case-management approach. And when a family member or advisor sincerely believes in the “rock bottom approach”, the resistance becomes even stronger. However, dialoguing with dissenters is a must, as families are most effective when everyone is aligned around the same recovery plan.
It’s worth noting that AA itself acknowledges the importance of early intervention—something many people, including long-time members, don’t realize. In the AA Big Book, the preface to the second set of personal stories is titled “They Stopped in Time,”[iii] emphasizing that individuals sought help before catastrophic consequences occurred:
They saw that they had become actual or potential alcoholics, even though no serious harm had yet been done…. Certainly, no sane man would wait for a malignant growth to become fatal before seeking help.[iv]
For those who object to early intervention or dismiss the structured doctor/pilot model, this passage can be a helpful reminder that the principle of “bringing the bottom up” exists within the AA tradition itself. More importantly, today’s drug landscape leaves very little margin for waiting. With fentanyl-adulterated substances and an unpredictable supply, even a single use can be fatal. Too many families have learned this the hardest way. Rather than engaging in arguments, offer clear, compassionate facts—and refocus the conversation on why early, coordinated action saves lives.
Despite these barriers, the question remained: if we know what works, why aren’t we offering it more broadly? That question ultimately led me to look deeper into how these programs function—and whether their principles could be effective in my work with families.
What I Did When I Learned Pilots Were Actually Getting Better
After learning about the exceptional outcomes of the pilot recovery program, I couldn’t shake the question of why these results weren’t being replicated elsewhere. I had known—both personally and through heartbreaking stories in the news—people who traveled to Minnesota for treatment full of hope, only to relapse afterward. Some of them didn’t survive. The idea that a proven, structured model existed while families continued to bury loved ones was impossible to ignore.
So, I contacted administrators at Hazelden to ask a straightforward question: could patients outside the aviation world enroll in these specialized services? I assumed the answer would be yes—what family wouldn’t want the highest level of support, especially when lives were on the line?
The answer was no.
I was told that the physician and pilot protocols “could not be applied” to the general population because pilots (and doctors) were supposedly so unique that what worked for them would not work for anyone else. The implication was clear: these life-saving tools were reserved only for certain professions, not for the average parent, spouse, son, or daughter fighting the same disease.
That explanation didn’t sit right with me. It didn’t sit right with the families I knew who were losing loved ones. And it certainly didn’t sit right with the reality that addiction doesn’t discriminate—only access to effective care does.
So, I kept digging.
I soon learned that doctors were achieving similarly remarkable outcomes in their state Physician Health Programs (PHPs). I reached out to the administrators running them, looking for the underlying principles that made these programs work. Slowly, a picture emerged: accountability, structure, leverage, and consistent monitoring—elements that didn’t require a medical license to be effective.
From there, I began exploring whether families could use access to resources as incentives to promote treatment compliance—just as medical boards and airlines use professional licenses. And gradually, I saw that it did work. Families could create their own version of that structure and loved ones could stabilize and recover. But I also realized something equally important: the resistance I encountered wasn’t truly based on clinical concerns. So, to test that claim directly, I enrolled in the Hazelden Graduate School of Addiction Studies and became a Licensed Alcohol and Drug Counselor. If there were legitimate clinical barriers to expanding the PHP/pilot model, I wanted to understand them.
Spoiler alert: there aren’t any.
The real obstacles come from treatment centers, interventionists, and AA/Al-Anon members who oppose this structured, family-supported approach.
During this same period, an in-law family member entered Hazelden for heroin addiction and died from an overdose six months later. That loss was devastating—and it pushed me to take on the treatment establishment more publicly. No family should be denied access to a model that consistently saves lives. Not when the alternative is burying the people they love.
That conviction is what brought me here, and what continues to drive my work today.
PHP Doctors Advocating for Using Their Protocols with Other Groups
As I continued my research, I discovered that physicians administering PHP programs were not only achieving remarkable outcomes—they were actively advocating for applying their protocols to broader populations. At the time, the very concept of “Recovery Management” faced fierce resistance from many treatment centers and AA/Al-Anon circles.
One notable example appears in the book Addiction Recovery Management: Theory, Research and Practice[v]. Within it, a 2011 chapter titled The Physicians Health Program: A Replicable Model of Sustained Recovery Management[vi], clearly illustrates the ongoing tension between evidence-based practice and traditional treatment ideology.
Dr. Greg Skipper and Dr. Bob DuPont wrote the chapter to show how PHP principles could work beyond physicians. Dr. Skipper, for instance, oversaw a program requiring patients to participate in daily random alcohol and drug testing. For alcohol monitoring, patients used SoberLink[vii], a handheld device that prompted random breath tests and transmitted results online—an approach rooted in the principle of trust but verify.
When I began recommending SoberLink to my clients, I encountered vigorous opposition from nearly every professional I approached. Parents, however, immediately recognized its value, understanding intuitively the benefit of structure, accountability, and immediate feedback.
The advocacy didn’t stop there. In 2013, Dr. DuPont hosted a national symposium examining programs that were already applying PHP-model concepts to broader populations. The resulting report, The New Paradigm of Recovery: Making Recovery – and Not Relapse – the Expected Outcome of Addiction Treatmentt[viii], provided a detailed evaluation of these initiatives and offered recommendations for adapting the model to additional populations. I attended the symposium alongside representatives from major treatment centers, witnessing firsthand both the possibilities and the resistance.
And yet, despite the clear evidence, the national conversation, and the momentum generated by this research, adoption of these methods remained minimal. The resistance from traditional treatment systems and entrenched beliefs was—and continues to be—remarkably stubborn.
Why the Opposition to the PHP/Pilot Model?
From my perspective, much of the resistance within the treatment industry comes down to financial incentives. Treatment center administrators earn high salaries, and a steady flow of relapsing patients can account for as much as half their clientele. Why adopt a model that dramatically reduces relapse when recurring admissions generate revenue? The same applies to some interventionists, many of whom earn substantial fees for just a day or two of work—often without advanced clinical credentials. Families in crisis, seeking guidance and hope, can become vulnerable to exploitation at the very moment they need honest, evidence-based support.
AA and Al-Anon sponsors operate under different motivations, but too often I’ve observed dynamics of power and control. Newcomers may be told how to live, what to eat, who to see, which meetings to attend—even being discouraged from evidence-based practices such as medication-assisted treatment or therapy. Some major treatment centers maintain informal relationships with favored sponsors—often alumni or donors—who then receive referrals for well-known or well-off patients. In some cases, insiders notify these sponsors when high-profile individuals enter sober housing or support groups. It’s a system ripe for misuse, and many families never see it coming.
Patients frequently leave treatment hearing the same message: find a sponsor and do what you’re told, or risk relapse. For vulnerable newcomers, this dynamic can actually contribute to relapse when a sponsor’s personal motivations become apparent.
For years, post-treatment care often consisted of little more than a referral to AA and, perhaps, a weekly supervised group for several months. Because AA is self-led and unsupervised, newcomers are left exposed to predatory behavior—from financial exploitation to emotional manipulation, and in some cases even drug dealing. Treatment centers favor AA largely because it is free, requires no staffing, and—critically—no one is accountable for outcomes. Without objective data, such as drug testing, there is no way to verify whether these referrals are genuinely helping.
Research shows that a wide variety of mutual-help groups can support recovery—not just AA—so long as they incorporate five key mechanisms of change. In other words, there is nothing uniquely magical about AA. Recovery works when programs are structured effectively.
Personally, I prefer groups led by clinically trained professionals, even if that means continuing in outpatient programs after treatment. Many people with substance use disorders carry significant trauma histories, and trauma requires trained clinicians—not peer sponsors. And unfortunately, AA and Al-Anon, in their current form, often unintentionally divide families at the very moment when unity is most critical.
The good news is that incentive-based approaches—like those used successfully in professional programs and even for individuals in the justice system—can work across all populations. Some maintain sobriety for something as simple as a Target gift card. The principles that drive recovery in pilots and physicians can be applied universally. Too many deaths occur simply because these evidence-based approaches are withheld.
Unneeded deaths. Sobering losses. Preventable pain.
In the next blog, we will explore ten core principles for implementing the PHP model with other populations—and how families can use these strategies to protect and save their loved ones.
[i] Hazelden Voice, Vol. 3 Winter 1998
[ii] The New Paradigm for Recovery: Making Recovery – and not Relapse – The Expected Outcome of Addiction Treatment. A report of the John P. McGovern Symposium hosted by the Institute for Behavioral Health (Nov. 18, 2013.
[iii] Alcoholics Anonymous, 3rd edition, p. 315
[iv] id
[v] Kelly and White, Current Clinical Psychiatry
[vi] Id. Chapter 15 Gregory E. Skipper and Robert L. Dupont
[vii] www.Soberlink.com
[viii] Id ii