Statistical Analysis of Addiction Recovery 2023
By Dr. Stan Eisen
Dr. Stan Eisen
Retired Biology Professor
I. The statistics in Israel are daunting.
According to a July 2018 article appearing in Ynetnews.com, there are 120,000 addicts in Israel, accounting for about 1.28% of the total population. Drugs, alcohol, gambling, sex, and online shopping are the most popular choices. Of these 120,000 addicts, only 1 of every six addicts seeks treatment. The most common drug addictions mentioned in this article include alcohol (32%), cannabis (32%), heroin and morphine (14%), cocaine (6%), and designer drugs (5%).
Not surprisingly, the percentage of Israeli citizens who have used illicit drugs at any time in their lives is higher. For example, Bonny-Noach (2019) reports that among Israeli adults aged 18-65, 27% of the population used cannabis and 2% other illegal drugs. In the European Monitoring Centre for Drugs and Drug Addiction’s report, “Israel Country Review” (2016), the results of the 2009 Drug and Alcohol Epidemiological Survey indicate the following lifetime prevalence trends:
The outlook is not encouraging, either. In an article appearing in Haaretz (2022), 15% of Israelis suffer from addiction, and about a fifth of those who are addicted are young, up to age 35. The cost of addiction to the Israeli economy is approximately 7 billion NIS (over $2 billion). Clearly, there is an urgent need for effective treatment and rehabilitation facilities and programs to address the problem. How success in treatment and rehabilitation is measured can include the following goals (Gerstein and Harwood, 1990):
substantially reducing the treated individual's use of illicit drugs—or, more stringently, ending it altogether;
substantially reducing—or ending altogether—violent and acquisitive crimes by the treated individual against others;
substantially reduce—or end altogether—the treated individual's consumption of legal psychoactive drugs, including alcohol and medical prescriptions such as methadone;
reducing the treated individual's specific educational or vocational deficits;
restoring or initiating legitimate employment of the treated individual;
changing the treated individual's personal values to approximate more closely mainstream commitments regarding work, family, and the law;
normalizing or improving the treated individual's overall health, longevity, and psychological well-being;
reducing specific drug injection practices and hazardous sexual behaviors, such as multiple unprotected sexual encounters, that readily transmit the AIDS virus between the treated individual and others;
reducing the overall size, violence, seductiveness, and profitability of the market for illicit drugs; and
reducing the number of infants born with drug dependence symptoms or other immediate or longer-term impairments owing to intrauterine exposure to illicit drugs.
All of these are ambitious goals that require multiple services provided to clients who enter a drug treatment facility. The duration of some treatments is measured in only weeks to months, so the goals of such treatment facilities are far more modest than the list mentioned earlier. These treatment centers help the client start the recovery process as suggested in a twelve-step program, with the understanding that (s)he will continue the process after discharge. In virtually all cases, drug treatment centers understand addiction as a disease in which the functioning of the brain has changed. As such, relapses are to be common, and complete abstinence is very difficult to attain.
From its own description, the AZ House in Jerusalem, Israel, has more ambitious goals. With its experienced staff, 24/7 supervision, groups, relapse prevention, and 12-Step meetings, it is dedicated to assisting its clients to become productive members of society by providing the following:
To provide its clients with life skills classes;
To provide employment support so that the client can become a productive member of society;
To provide housing; and
To preserve sobriety long-term.
II.Description of the AZ House Jerusalem Program
AZ House is a residential addiction recovery program, offering residents the chance to live in a community, develop self-discipline and become respectful contributors to society, alongside freedom from active addiction.
Its 12-step-based curriculum allows residents to disconnect and focus solely on their recovery. Their agenda is that the addict and his family need not experience financial destruction while simultaneously dealing with an addiction, which is why every resident receives a full scholarship upon entry to the Jerusalem program.
The AZ House in Jerusalem, Israel, based on the successful model and philosophy introduced by Jack Mulhall in Cleveland, Ohio, in 1991, is a residential addiction recovery program established in 2016 in Israel by Eric Levitz, Yehuda Freedman, and Moshe Zalman Olive. It was established in response to the growing rise in drug addiction in the Jewish community. It aims to provide a much-needed service with a proven track record of treating individuals with addiction. Jack's goal was to create a therapeutic community where individuals struggling with addiction could focus solely on their recovery with the support of peers and knowledgeable staff. The Jerusalem AZ House program emphasizes the importance of work and household responsibilities in the recovery process and incorporates the 12 steps, as taught by Alcoholics Anonymous, into daily meetings and group sessions. Similar to the Jack Mulhall Center in Cleveland, the AZ House is a fully subsidized and free option for struggling young men and their families, just in Jerusalem, Israel.
To begin, residents receive room and board at their Israel-based facility. Their serious yet encouraging program structure and schedule help residents develop a strong foundation. They see that this opportunity to focus intensely on their recovery serves them for the rest of their lives. The program's second stage guides our residents to develop self-sufficiency and seek employment in Jerusalem. Once settled into a job while also reliably maintaining their responsibilities and commitments to the House, residents begin re-establishing themselves in society and become ready to plan their new way of life. However, there is no rush to leave the House, and residents are encouraged to stay as long as they need to.
In addition to the staff providing hands-on guidance, the Jerusalem sober community is a huge part of theirs, with volunteers who help in many ways, including several professionals who run some of their group therapy during their daily structure at the House.
As of now, few centers provide programs sensitive to the Jewish community. AZ House, in Jerusalem offers their frum residents the opportunity to focus on their recovery while having the freedom to continue living a frum, kosher, and shomer shabbos life. On the other hand, they also do not demand any level of religious behavior - they have residents who are not as observant, and their sole focus is a resident's journey to recovery.
The purpose of this report is to assess how well the residents of AZ House in Jerusalem attain and maintain sobriety. The data that are included in this report were provided to me by Shmuli Weissler, their Director of Outreach. This assessment is based on the outcomes of 106 clients who were admitted to the AZ House and who had an average age of 29.2.
Like other inpatient programs, participation is voluntary, and some residents leave on their own while others are asked to leave prior to the completion of their program because of a clear lack of willingness to be there. (Figure 1):
There is a passage in the Foreword to the Second Edition (Wilson, 1955) of Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, which provides an early benchmark to measure the success and efficacy of a treatment program. In it, the author states, “Of alcoholics who came to A.A. and really tried, 50% got sober at once and remained that way: 25% sobered up after some relapses, and among the remainder, those who stayed on with A.A. showed improvement. Other thousands came to a few A.A. meetings and first decided they didn’t want the program. But great numbers of these –about two out of three—began to return as time passed.” From this passage, three things are clear:
That the initial motivation to seek help is complex. While many individuals may have legal, marital, or financial problems, they may not see a connection between those problems and their alcohol misuse;
Addictions such as alcoholism or drug misuse are tenacious. Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism refers to alcoholism as “cunning, baffling, and powerful.” As a result, relapses are common and are a hallmark feature of alcoholism and drug misuse;
Repeated exposure, over time, is likely to cause some improvement.
The timing of the publication of the second edition of Alcoholics Anonymous is significant. The approach to alcoholism and alcoholics shifted numerous times between perceiving it as a disease that can be treated medically and as a moral weakness requiring incarceration or isolation from society. By the 1930s, treatment options for alcoholics had disappeared in the United States (Henninger and Sung, in Bruinsma, G. and Weisburd, eds., 2014). By that time, therefore, the general attitude towards alcoholism was that it was indicative of moral weakness. The development of the AA program provided the basis for other recovery programs (Narcotics Anonymous, Cocaine Anonymous, and Overeaters Anonymous) that are used in alcohol and drug treatment centers.
Most of the residents in the database stayed in the AZ House once (Figure 2):
Of these residents, the AZ House reports that over 50% of them are sober today (Figure 3):
Among those with negative outcomes, a few, unfortunately, have passed away during the seven years of AZ House, Jerusalem’s existence (Figure 4), while others relapse. Interestingly enough, if we look more closely at those individuals who stayed at the AZ House more than once, a substantial percentage (>60%) did not relapse after their last time there (Figure 5):
Data suggest a bimodal trend in how long it takes for a resident to relapse after staying at the AZ House. Not surprisingly, the peak frequency of relapse events occurs immediately while the resident is in the house or shortly thereafter. This should not be surprising since it is at this time that the resident is trying to replace counterproductive thoughts and behaviors with healthy ones, and this is when the resident is most vulnerable and confused. The second peak occurs 1-3 months later, which may coincide with the realization that although 12-step programs emphasize a daily reprieve from their addiction(s), the recovery process is a lifelong endeavor (Figure 6):
Here, I need to emphasize the distinction between the 12 steps outlined in the Alcoholics Anonymous book and addiction programs that utilize these steps as an integral part of their protocol. The quote I mentioned earlier from the second edition of Alcoholics Anonymous refers solely to the 12 steps of AA and not to treatment centers or addiction programs. The ability to discern distinct trends in sobriety and recovery is difficult since the program is inherently anonymous, and its members tend to avoid divulging personal details for a good reason.
It has been nearly 90 years since the publication of the first edition of Alcoholics Anonymous. Since then, it appears that the number of challenges facing those dedicated to providing treatment and rehabilitation services has increased for a number of reasons besides the natural increase in population:
Producing, purifying, and distributing illicit drugs is a large, potentially very profitable business. At the same time, it is a violent business as well;
Attitudes towards certain drugs, particularly marijuana, have changed. Whereas it was considered an illicit drug in the past, there are numerous communities that allow the production and sale of cannabis products for recreational and medicinal use. My opinion is that the jury is still out regarding the actual safety of these cannabis products;
Certain behavioral compulsions have arisen fairly recently as a result of the development of new technologies, e.g., internet gambling;
Some treatment centers engage in practices that may be legal but are, at best, very costly to patients and to their families, and at worst, increase the risk for continued relapses and addictions, such as:
Patient brokering – this is where a treatment center will pay a resident a little bit to stay at their facility so that the residents’ parents continue to pay the rehab facility;
Lack of residents’ engagement in the program due to a sense of entitlement;
Residents stay for longer than they need to because they are paying;
Residents being given an allowance to spend using drugs on the street every month for a week so that the facility can collect insurance again (insurance pays only for the first month so that a positive drug test will renew the insurance payments);
Treatment centers work together to transfer residents each month to renew insurance. A center can send a resident and replace him or her with a resident from the center they send them to. This allows both places to continue collecting insurance;
Families draining their resources so that they can’t afford to help in any way after the fact;
Staff not telling the residents what they need to hear out of fear of losing their huge price tags.
At the same time, however, there are reasons to be optimistic;
Even though less than 50% of residents admitted to the AZ – House actually completed the program (Figure 2), the percentage of residents who became and remained sober is remarkably high, comparing favorably to the initial 50% reported in the aforementioned Foreword in the second edition of Alcoholics Anonymous;
The doors of the AZ House swing both ways, allowing those individuals who have relapsed a venue to return to. Of those who do return, more than 60% did not relapse after their last reported stay at the AZ House;
With the exception of the 1-3 month period of time, there is a gradual decrease in the incidence of relapses (Figure 8). I interpret that as meaning that even for those individuals for whom complete abstinence was not possible, there was some improvement in functioning.
The excerpts from Alcoholics Anonymous, the Big Book are reprinted with permission of Alcoholics Anonymous World Services, Inc. (“A.A.W.S.”) Permission to reprint these excerpts does not mean that A.A.W.S. has reviewed or approved the contents of this publication or that A.A.W.S. necessarily agrees with the views expressed herein. A.A. is a program of recovery from alcoholism only – use of these excerpts in connection with programs and activities that are patterned after A.A. but address other problems or in any other non-A.A. context does not imply otherwise.
Bonny-Noach, H. Harm reduction drug policy in Israel: what has been accomplished and what still needs to be done?. Isr J Health Policy Res 8, 75 (2019). https://doi.org/10.1186/s13584-019-0343-3.
Henninger, A. and Sung, Hung-En, authors, in Bruinsma, G.; Wesburd, eds. 2014. Encyclopedia of Criminology and Criminal Justice (pp. 2257-2269). Edition 1st. Chapter: Henninger, A.; Sung, Hung-En, authors; History of substance abuse treatment. DOI: 10.1007/78-1-4614-5690-2_278.
Gerstein, D.R.; Harwood, H.J., eds. 1990. Treating Drug Problems: Volume 1: A Study of the Evolution, Effectiveness, and Financing of Public and Private Drug Treatment Systems. National Academies Press.
Institute of Medicine. 1990. Treating Drug Problems: Volume 1. Washington, DC: The National Academies Press. https://doi.org/10.17226/1551.
Kashti, Or. 2022. One Out of 7 Israelis Suffers From Addiction, and Most Don’t Receive Treatment. Haaretz Israel News.
Wilson, Bill. 1955. Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. Alcoholics Anonymous World Services.
Ynetnews.com.2018. From cocaine to sex: Addiction statistics revealed.