Supporting All Paths to Recovery
Fostering the ‘Addict Personality’
Sadly, many rehabs have very little formal therapy, and patients needing and potentially benefiting from consistent evidence-based therapeutic interventions, are instead subjected to the opinions and whims of ‘staff’ with little formal training in evidence-based therapies or developmentally appropriate interventions or effective communication strategies. It is standard operating procedure to force clients to admit to being liars and manipulators –not to be trusted, and not ‘ready to get better yet’. Clients are shamed and verbally abused, and their own rational and valid insights into their own substance use behaviors are often ignored. In essence, these practices constitute brainwashing. “It is no wonder that rehabs teach people to have addict personalities by the time they graduate” (Anderson, 2013).
‘In Recovery’ Forever or ‘Recovered’
Recovery is not a rare outcome of addiction that occurs in a lucky few, it is a typical event experienced by most addicts at some point during the course of their addiction. (Kurti and Dallery, 2012)
Just as there are successful dieters, there are successful ex-addicts. In fact, addiction is the psychiatric disorder with the highest rate of recovery. (Heyman, 2010)
In the clinical world of addiction treatment, relapse is defined as a normal part of the ‘chronic’ nature of addiction. Addiction treatment professionals maintain that “relapse is a normal part of the recovery process”. “Most of you will not succeed in ‘staying clean’ when you leave here,” they admonish their patients. These communications contribute to the perception that recovery is a process –of desperately trying (and rarely succeeding) to stop using drugs, rather than a stable achieved state. And yet, surveys of the recovery community reveal that most people in recovery from drug and alcohol problems either experienced no problematic use (54%) or only a single brief episode (16%) during their recovery. (White, 2012)
Supporting Recovery
In an analysis of 415 studies by the Center for Substance Abuse Treatment (CSAT), the average remission/recovery rate across all studies –without regard for drug of choice, method of treatment, or no treatment, was between 48% and 54%, with some studies reporting rates as high as 80%. However, only about 18% of those in remission did so through a strategy of complete abstinence from all substances, opting instead to use alcohol and/or other drugs in ways that were less harmful or dangerous or not symptomatic of a substance use disorder (White, 2012).
So while remission is likely, the paths to attaining it are varied and diverse. If addiction is a chronic, relapsing disease like diabetes or asthma, then society is obligated to treat addiction like diabetes or asthma, by researching and developing new pharmaceuticals. However, understanding addiction as a disease might contribute to an approach that promotes pharmaceutical interventions and undermines the demonstrated efficacy of behavioral interventions. Conversely, if addiction is viewed as a behavior, those who hold a naive view of choice, viewing self-destructive choice as willful and irrational rather than caused by contextual variables, might view funding for research and treatment as unnecessary, supporting instead a legal response to the problem. (Heyman, 2010)
The truth is that what helps one person harms another. Conundrums exist throughout the data. The same treatment method that saves one person is lethal for another. The same cost that motivates one person to stop drug use is the same cost that motivates another person to increase their drug use, or worse. Thus, the causes, as well as their respective treatments, must be viewed on a continuum, if we, as a society, are going to ensure that a solution exists for everyone.
An Unnecessary and Unhelpful Debate
Individuals who have problems with substances represent a complex population with a hugely diverse set of needs. Yet treatment practitioners and public policy experts at times seem to be striving to come up with a single solution as if there is a magic bullet that will suddenly heal all of the multi-faceted causes at the root of addiction. They talk about “the gold standard” in treatment care and shift funding from one solution du jour to another, with little analysis or measurement of what has been successful and what has not.
Rarely are the individuals with the problem educated about all options, along with side effects and success rates, and presented with choices for their own medical and/or behavioral condition. More often, treatment seems to be chosen for them, based on what is convenient or profitable, rather than what is effective or fiscally responsible.
It can be difficult to find coordinated care with the range and type of services necessary to achieve optimal outcomes for individuals with an opiate-use disorder. The result can be an overreliance on single elements of care –counseling or medication or supportive housing, dependent upon whatever service a particular provider is able to get paid to deliver –and lasting for only as long as that particular provider is able to get paid for delivering it.
Debates rage over whether the problem is a medical disease or disorder or a behavior, whether the solution lies in long-term abstinence-based residential treatment or medication-assisted treatment, whether the medication should be short-term or long-term or opiate-based or non-opiate based, and which psychosocial therapies, if any, work best. Potentially viable alternative treatments, without the funding to get the blessing of the FDA, or to pay for high-profile marketing and lobbying campaigns, are ignored at best and maligned at worst, and kicked to the way-side of the care compendium. In the end, it is the practitioners who stand to profit by promoting whichever brand of rhetoric supports their bottom line, who are able to control the messaging that shapes public policy, and ultimately influences the options available to consumers. The consumers themselves, with lived experience and personal insight into what is helpful and what isn’t, are rarely consulted.
The controversial debate makes little sense; prejudice and invested interests have more weight than an appreciation of the facts. In an era of individualized medicine, there is no argument against having multiple evidence-based treatment options where individual planning can be tailored to patient risks and needs. Instead of discussing which modality is superior, the debate must evolve into how to make best use of all options. (Uchtenhagen, 2013)
If we are to reduce the overdose death toll, we must begin to value lives over profits, and we must begin to create policy that reflects those values. We must support what works, rather than allow what doesn’t. In order to determine what it is that works, we need to focus on measurable outcomes, and allow those impacted to determine what is important to measure and what is not.
Treatment needs to be more about making peoples’ lives better, rather than simply suppressing alcohol or drug use, regardless of the treatment modality that an individual prefers. Treatment goals must become more about well-being and assisting people to develop happier and more meaningful lives, and not merely whether they are still alive at the end of the day. (Uchtenhagen, 2013)