I need to apologize to those who work in the addiction treatment field, because some of my past posts have contributed to the perception that we have a broken addiction treatment system. While I have never said or even implied that the people working in the field are broken, I know from experience that it doesn’t feel good continually hearing that the system in which one works is broken. But before I apologize, I have some explaining to do.
I am currently finishing up the writing of my upcoming Guide to Addiction Treatment that should be available next month. One of the aha moments while creating the eBook came when I realized that maybe the system is not so broken after all.
Maybe we have a lot of good treatment for addiction available, but it often fails those who struggle because we expect one treatment program, therapist, or approach to do everything necessary to overcome addiction.
Addiction is a problem that goes beyond just additive behaviors. It involves addressing underlying traumas, developmental gaps, isolation, and other complicating co-occurring disorders, all of which require time and attention. But you can’t address all of these things at once. The most pressing and potentially harmful behaviors are addressed first, such as: daily drinking, suicidal behavior, potential for domestic violence, or lack of basic needs (food, shelter, safety). Later, once acute issues are stabilized, problems that require more time and management can be addressed, like: trauma, developmental gaps, and chronic emotional and medical issues.
Within our present system there exists a wide range of treatment experts working in hospitals, residential programs, outpatient clinics, and private practice that can effectively address all of the issues necessary to overcome addiction. But the key is knowing which professionals to employ at which time – which is why I am writing the guide!
For now, know that combining time with different therapists in different treatment settings means you proactively create your own individualized addiction treatment system that is far from broken. Doing this is not so hard once you know what outcomes you seek, have a general map for how to reach your outcomes, and know a bit about what interventions work best depending on where you are at on the map.
So, I apologize to all of those who work in the addiction treatment field for globalizing the idea that our addiction treatment system is broken. While improvements can always be made in the delivery of care, perhaps we should focus more on how to best utilize what we have available right now – which is more than enough to help anyone find their way out of addiction.
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This is an interesting article. I do not have much experience in this field, and from what things I have read and heard, it appeared to me that the system was broken. However, after reading this article it is apparent that the system is not broken, it is only a matter of finding which programs to apply at which time. I likened it to a puzzle. You cannot force a puzzle piece that does not fit. You have to find the correct piece of the puzzle to help develop the overall picture.
Yes, it is very much a puzzle and about finding the right piece at the right time. Sometimes it means trying a piece only to find it doesn’t fit like you say, and trying another. Thanks for the comment.
J
Addiction is a puzzle and this is a great article explaining it, you have to slowly pull the puzzle pieces back (or back on) and put your life back together. Doing it piece at a time can help ease your mind, and also help you with your goal in the long run. This may not work for everyone’s goals and outcome but it can work for a percentage of people, giving it a try and seeing if you will succeed is the goal to success.
This article is very interesting. I am a social work student right now and I am also a court appointed special advocate for children that have been neglected and abused. As I was reading this article I was thinking of people that I know as well as people that I have worked with. I have seen them go in and out of so many different programs trying this and that and never really making it through successful. This article could have really helped them through their times of unsuccessful programs. I also really like the puzzle analogy.
Thanks Cassie! The key is helping people learn how to put the puzzle pieces together to succeed over the long run, something we need to become much better at!
J
I never try drug in my life but when I saw people are abusing themselves my heart is broken. I wish if I can make them over night change and they become free of drug use but we all know once we are engage in to this kind it is not easy to get away from addiction. Many people are thinking once some one engage in to this kind of business they say it is impossible, but here is the truth we can prevente or reverse addiction. I am sure those people who are using drugs they may try to stop but no help. what we need is we should interfere help them to get away from this killer. we do not have to said when some one die of drug. We have to reach for them to day and save the life today may be this person one day when he get of this business will appreciate you.
I really enjoyed reading this. After knowing many people with not many successful stories on overcoming addiction, I did think it was a broken system. However after learning more and more about addiction and treatment, it is like a big puzzle. Finding the right pieces to make your puzzle pieces join together again is finding the right program or method for each individual. I think people get the misconception that every program needs to be same. Every person is different so overcoming something as powerful as addiction changes what works and doesn’t work for each individual.
Hi Dr. Fitzgerald,
For my Drug Education class we had to read a book called Tweak about a guy name Nic who is a recovering addict. In the book Nic felt that the 12 step program was not for him yet every time he went to rehab that is all they kept telling him to do so he decided to take a different approach that works for him. Your article is great because it pretty much lets people know that there is not just one way to deal with addiction but multiple ways you just have to find what works for you. That is so inspiring and hopeful. I, like most, thought the system was broken but you have shown me that if you really want to get clean and sober there is a way it’s just a matter of doing your homework and seeing what is going to benefit you. I wish more people thought like you did, Thank you!
Stefanie T.
“…know that combining time with different therapists in different treatment settings means you proactively create your own individualized addiction treatment system that is far from broken. ”
What about a place like Kaiser, that has arbitrarily decided to split patients apart by age, and funnel them to separate locations, so that if you’re not over 30, you can’t see any of the counselors at Location A, only Location B. And suppose by chance, you slip through the cracks and actually see a counselor at Location A, despite your age deficit. This counselor has helped you more than any of the counselors at Location B have, in less than 30 minutes. But, because you haven’t hit the magic age of 30, you can’t see the counselor you feel you connect with the most. No one can explain this rule, it’s just there and is absolutely the most frustrating thing when someone is trying to find a therapist who inspires and enlightens them. There is no logical reasoning behind this unnecessary barricade, but still, Kaiser’s addiction medicine team stands by it, without making any exceptions to the rule. Why risk losing a patient to uphold a baseless rule? They don’t know.
Laura, I could not agree more with you, seems like a very crazy rule. My point is very different from what you say Kaiser is doing, because the selection and use of different therapists over time is not arbitrary, but done very thoughtfully. Health organizations are often slow to change and do things more based out of money that clinical wisdom. I hope it gets changed.
J
Hello my name is Chad, I am a trauma and substance abuse survivor. I have been in and out of therapy since I was a child. I have also been in and out of treatment centers and groups. I am a veteran and man in recovery as well as a student working towards a social work degree. I was reading over your topic and as someone from the inside I wish to share my personal experiences in hopes that it will shed some light and help you on your quest for truth.
My program is of course my program, I could have all the water in the world in front of me but you cant make me drink it unless I am ready and thirsty. I know people get upset especially with the person in recovery who do a 30 day program then get out and disappear for days until they need something. This is a viscous cycle the family and the addict go thru. The people in the treatment center do there jobs but they have no control over someone else s choices. You can do 10 years for trafficking in prison and get out and go right back to it. So all I can say is that pain and suffering are the places that we the addicts know. We stay in that zone of uforia as long as possible and even though the withdrawals or come downs are vicious of course to the addict its all manageable as unmanageable as it really is. Another huge factor is being honest with the therapists and trust me, we are not really honest unless we are ready to be. Trust is huge and we know that everything is recorded and that creates fear and a barrier for the treatment to work unless fear is removed. Keeping secrets is like a ticking time bomb it becomes so much that it creates a relapse, its to much to keep in the mind so the addict wants to release this tension or the illusion is that we can do just that. So the truth stays within and relapse is usually inevitable because of this one dynamic. I will end right there and invite anyone to ask questions or reach out. Thank you for listening..
You can find me and my story of recovery at http://www.facebook.com/chappyUSN
Chad, wise words, thanks so much for sharing! You hit upon a key issue in helping those who suffer with addiction – the role of motivation. While it’s true that no one can do the recovery work of another, we fortunately have learned a lot over the past few decades about what influences motivation. We used to think confronting addicts to break down denial was helpful, now we know that just makes them drink or use more in the future. How to keep those working a program motivated over the long run is critical to long term successful outcomes. One reason people don’t tell the truth and eventually relapse is because they get stuck or plateau in their program and stop deepening their engagement with others and the world. This is why different therapists and treatments work best at different times. If you are interested in deepening your understanding of motivation, check out a colleagues work: http://www.primetheory.com/
Thanks again for the comment
J
Very interesting article. I don’t know much about addiction treatment plan until my wife mentioned a little of it recently. Therapist is trying to use different methods to help people with addiction. When people going through the treatment plan they tend to get angry and upset easy. At this time, therapist or counselor will suggest them to try acupuncture or acupressure. They are methods in Chinese herbal medicine to use needle and pressure to create stimulus at certain pressure point. The goal is to keep the energy flowing at those pressure point and that will claim the patient down. Different people will react differently to the same treatment plan. So it takes time and patient to figure out the right treatment plan for patients.
Dr. Fitzgerald,
I really appreciate this post. I am currently taking a drug education class and have been enveloped in information about how corrupt our system against drugs has been for over a hundred years. Because we have been so heavily focused on the actual facts about drugs and the War on Drugs in general, I have begun to have a very negative outlook on the treatment of drug addiction and abuse and our general attitude towards users. This article essentially gives me hope knowing that we do have a treatment system that works. After reading “Tweak” by Nic Sheff and getting an intimate look at life as a drug addict, I understand how important individualized treatment is. We need an all-encompassing approach to treatment because each individual has a wealth of events that carved their path towards drug abuse. Your “Map of Addiction” addresses that concept so well.
I believe that treatment in the United States gets a bad rap because of the stigmatization that surrounds drug users. Users are essentially dehumanized and there is a major lack of compassion towards them that may prevent them from seeking the help that they need in the first place. Do you find that the American attitude toward drug abuse hinders the reputation of our treatment facilities?
Of course, I would have never thought of this compassion approach prior to taking my drug education class, but I am thankful for having the chance to take it and being introduced to articles like this one that recognize the need for change in our system!