The Drug and Alcohol treatment industry has failed to address the complexity of individuals who struggle with substance abuse problems. The above conclusion is reflected in recent publications that show the demonstrable disappointment of the drug and alcohol treatment field. In 2012, CASA at Columbia University, released a comprehensive review of research in the drug and alcohol treatment field and concluded that the treatment industry has been “failing” in treating substance abuse and addiction. In Anne Fletcher’s new book “Inside Rehab” she goes inside the drug and alcohol treatment industry and exposes the total malfunction of the vast majority of treatment programs. Ms. Fletcher notes the insistent one-size-fits-all approaches of 12-step based treatment programs and the inability of the treatment programs to address co-occurring disorders.
The industry has been unable to provide treatment for the majority of individuals and has alienated most people from seeking services to address their harmful substance abuse. There is a large population of individuals who have been discouraged from treatment or have been underserved by the current system. These recent reports call for a significant change to how we approach treatment for substance use disorders as well as a need for public education to dispel myths about addiction and substance abuse.
The future of addiction treatment needs a radical makeover. One major area of focus should be centered on making treatment individualized. This involves assessing all areas of one’s mental and physical health. Treatment providers need to be able to address not only an individual’s substance abuse problems, but also understand and be able to intervene with mental health concerns. Treatment providers, at the very least, need to be able to assess mental health issues and collaborate with professionals who can treat psychological disorders. Furthermore, clinicians and providers need to be able to attend to other health related behaviors that impact substance abuse and mental health.
Another significant fault of the addiction treatment field is that it categorizes all substance use into the same classification. Most treatment providers have ignored the multiple presentations of problematic substance use. Interventions have typically treated daily heroin users in the same way as weekend binge-drinkers. Research has repeatedly shown that treating these populations the same manner yields ineffective outcomes. We know that brief interventions are highly effective for individuals with problematic or risky substance use. On the other hand those with chronic substance addiction problems require long-term management and treatment. In most areas of medicine, treatment is individualized and based on the presentation of the disease or illness. Why is this not the same for addiction treatment?
Traditional treatment has also failed to implement evidenced-based interventions. Over the last number of decades, pharmaceutical and psychosocial interventions have been developed and researched for a wide range of addictions. However, the utilization of these interventions in the field has been marginal. These interventions include brief treatments for college students, family therapy for significant others, and cognitive-behavioral relapse preventions skills. On the pharmaceutical end there are many medications that have not been employed by traditional addiction treatment due to the belief that “we don’t want to replace one drug with another.” This mindset has prevented thousands of patients from having the option to receive beneficial treatments.
It is imperative that the concerns noted here, including those not mentioned, be taken seriously by the addiction treatment field. Like many other areas where there is a call for change, this process may take some time. However, mental health and health care professionals can continue to promote the science of effective interventions for addictions. Furthermore, there are currently programs and providers who do offer science-based intervention services for addiction and substance abuse issues. I would invite the readers who are seeking treatment to be cautious of places that use confrontational approaches, do not give you a wide range of treatment options, and require patients to attend 12-step meetings. I encourage you to ask about the types of treatments they provide and to seek out providers who are open to having you play a role in choosing your treatment options. For more information please consult the following:
- Addiction Medicine: Closing the Gap between Science and Practice
- Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol
Fletcher, A.M. (2013) Inside Rehab: The Surprising Truth About Addiction Treatment and how to get Help That Works. Penguin Group: New York.
The National Center on Addiction and Substance Abuse at Columbia University. (2012).AddictionMedicine: Closing the gaps between science and practice. New York: The National Center on Addiction and Substance Abuse at Columbia University.