what is addiction treatment? Why can’t most drug addicts just quit on their own? How effective is addiction treatment, when is it necessary, and is addiction treatment worth the cost? Why isn’t more treatment available? What can we all do to help? There are about five federal government agencies now tripping over each other trying to get a clearer grip on these issues. We’ve got the National Institute on Drug Abuse (NIDA) and the National Institute of Alcoholism and Alcohol Abuse (NIAAA), both of which are part of the National Institutes of Health (NIH); we’ve got the Substance Abuse and Mental Health Administration (SAMHSA), which is part of the US Department of Health and Human Services (HHS); we’ve got the White House Office of National Drug Control Policy (ONDCP); we’ve got the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF); and the Drug Enforcement Administration (DEA).
Some of these agencies focus on research, including research on treatment approaches, some focus on providing information and policy, and some are concerned specifically with law enforcement. As far as policy and law enforcement, among my favorite things to pick on is the “war on drugs” because, as I’ve said, it is not a war on drugs; it’s a war on people. Throwing somebody in jail for simply using drugs does little to nothing to change individual behavior and serves no socially useful purpose. Even in some jails and prisons drug use is widespread, and the cost in dollars and human terms of incarcerating people for drug use is absolutely preposterous.
Addiction is a complex illness. It persists in the face of extremely negative consequences. If somebody burns his hand on a hot stove he generally learns from his experience and doesn’t go close to that stove again. Even my basset hound won’t go near the stove because a while back he burned his nose jumping up there. But an active addict will keep putting his hand in the flame or his nose on the stove. His thinking has become so distorted that he rationalizes “this time I won’t burn myself.”
Addiction is a brain disease that has direct impacts on thinking. The thought processes of someone who is addicted can be bizarre, as evidenced by his or her continuing to put his or her hands in a hot flame, thinking that “this time it’s going to be different.” If every time you drink you wind up in trouble, end up in jail, bleed from your stomach, and yet keep doing it again and again, that’s a special type of twisted thinking. Two impressive examples of the cognitive warping that takes place in active addiction that I’m familiar with involve a man with a gambling addiction who moved to Las Vegas to quit gambling, and a woman addicted to cocaine for more than ten years who switched to crystal meth to stop using cocaine.
But distortions in thinking related to addiction are not exclusive to addicts. Society still commonly sees addiction as a disorder of willpower and personal choice, so addicts tend to be viewed and judged differently than people who struggle with other chronic illnesses. Because addiction is a chronic disease, relapse is possible even after long periods of abstinence. Sometimes professionals, as well as lay people, challenge me on this point, saying that I don’t “cure” anybody because addicts in recovery often relapse and end up coming back to treatment.
But then, so do patients with congestive heart failure. Those patients are on heart medications and do well for a few months or a few years, but then have to come back to the hospital for a “tune-up” due to a relapse—a recurrence of their heart failure. Heart failure is an excellent example of how chronic illness works. Asthmatics frequently go through cycles of remissions and exacerbations (or relapses) of their symptoms, and have to come back periodically for breathing treatments, but we don’t pass negative judgment on them or consider giving up on them. Asthma is a chronic illness.
Most people, including many medical and behavioral health professionals, have an understanding that chronic conditions are managed rather than cured. But for some reason they think that if somebody with addiction relapses and needs to return to treatment again, it’s a treatment failure. It is not a failure. It is the natural course of the disease as it often manifests in those who suffer from it just like heart disease, diabetes, and asthma. Treating alcoholism and addiction involves management of a chronic disease.
Successful recovery from addiction means a stop to using drugs including alcohol and maintenance of a drug-free lifestyle, while regaining/achieving productive functioning with regard to family, relationships, work, and in society generally. Some people think that recovery is just about not using, and, of course, to a certain extent it is about not using, but I could handcuff patients to the wall and they won’t use, but that doesn’t mean they would be in recovery.
So recovery is more than just not using; it involves being a contributing member of one’s community, and making progress toward internal states of acceptance—not only of the need for ongoing abstinence, but also of people and situations that one has no control over—and peace of mind, otherwise known as serenity. This only comes with time and practice working a program of recovery by engaging in recovery-supportive activities.
In contrast, in very early recovery, many people are effectively “white-knuckling” it, holding on to their abstinence for dear life. It is in the days, weeks, and few months immediately after the cessation of using, whether the person went through professional treatment or not, that he or she is especially vulnerable to relapse.
It may come as a surprise to a lot of people, but addiction treatment is as effective as treatment for other chronic medical conditions. In other words, addiction treatment has basically the same outcomes—the same rates of success and relapse—as treatment for asthma, diabetes, congestive heart failure, high blood pressure, low-back pain, and other chronic medical conditions.
Effective treatment for addiction varies depending on severity, the types of drugs involved, and the characteristics of the patient. The best treatment programs provide a combination of therapies and other biopsychosocial services.
Since 1999, the National Institute on Drug Abuse, part of the National Institutes of Health, has maintained the following thirteen principles of effective treatment for drug addiction:
1 No single treatment is appropriate for all individuals.
2 Treatment needs to be readily available.
3 Effective treatment attends to multiple needs of the individual, not just his or her drug use.
4 An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person’s changing needs.
5 Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
6 Individual or group counseling and other behavioral therapies are critical components of effective treatment for addiction.
7 Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
8 Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
9 Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.
10 Treatment does not need to be voluntary to be effective.
11 Possible drug use during treatment must be monitored continuously.
12 Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
13 Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment.
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