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The Truth About Addiction Treatment

The Problem with Addiction Treatment

Despite the importance of outstanding addiction treatment, much of the industry is offering substandard care. Here are some examples:

Clinician Training

 

As the rehab industry began expanding in the 1970s, its profit motives dovetailed nicely with AA’s view that counseling could be delivered by people who had themselves struggled with addiction, rather than by highly trained (and highly paid) doctors and mental-health professionals. No other area of medicine or counseling makes such allowances. There is no mandatory national certification exam for addiction counselors. Fourteen states had no license requirements whatsoever ‒ not even a GED or an introductory training course was necessary ‒ and yet counselors are often called on by the judicial system and medical boards to give expert opinions on their clients’ prospects for recovery.

Gabrielle GlaserAuthor ofHer Best-Kept Secret: Why Women Drink — And How They Can Regain Control”

 

So we developed this history of providers being people who are themselves in recovery ‒ originally with no educational requirement at all. In New Mexico, we now have a Bachelors degree required to be a substance abuse counselor and it was quite controversial to do that. I don’t know of any other life‒threatening illness where it’s controversial if you should have a college education to treat it, but it has been in the addiction field.

William R. Miller, PhD ‒ Emeritus Distinguished Professor University of New Mexico

 

Lack of Evidence-Based Treatments

 

Currently most people who enter treatment are subjected to archaic care, some of which does more harm than good. Only about 10 percent of people who need treatment for drug-use disorders get any whatsoever. Of those who do, a majority enter programs with practices that would be considered barbaric if they were common in treatment systems for other diseases. Many programs reject science and employ one-size-fits-all-addicts treatment. Patients are often subjected to a slipshod patchwork of unproven therapies. They pass talking sticks and bat horses with Nerf noodles. In some programs, patients are subjected to confrontational therapies, which may include the badgering of those who resist engaging in 12-Step programs, participation in which is required in almost every program. These support groups help some people, but alienate others. When compulsory, they can be detrimental.

David Sheff – Author of “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy”

 

The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.

National Center on Addiction and Substance Abuse at Columbia University in 2012 Annual Report

 

I became the Director of the Alcoholism Treatment Unit at Harvard’s McLean Hospital. I’ve probably treated a couple of thousand people who have one addiction or another. Almost all residential treatment programs in the United States are 12 Step based, so their effectiveness will depend entirely on whether 12 Step programs work and the statistics for AA are not good. It is helpful for 5‒10% and that’s a good thing. That’s 5‒10% of people who are being helped by A.A. ‒ it’s a lot better than zero percent ‒ but it shouldn’t be thought of as the standard of treatment because it fails for most people ‒ for the vast majority of people.

Lance Dodes, MD ‒ Addiction Expert & Author ‒ Harvard Medical School Graduate

 

12 Step programs are very popular, but if you’re looking for figures and randomized trials and scientifically rigorous studies of how they work and for how many people they work ‒ you will not find those studies. You will find anecdotal evidence ‒ for people that it did work [for] ‒ but unfortunately we don’t have the scientific basis to say how many of all those people that tried a 12 Step program ‒ how many of those did not succeed.

Ruben Baler, PhD ‒ Health Scientist, National Institute on Drug Abuse

 

AA is not really a treatment ‒ it’s a fellowship. If you go to your doctor to be treated for cancer or heart disease you expect your doctor to be doing what the science says is the best treatment available for what you have. That has not been the standard in addiction treatment.

William R. Miller, PhD ‒ Emeritus Distinguished Professor University of New Mexico

 

The disastrous state of the system suggests that addiction-medicine specialists don’t know how to treat substance-use disorders (or even if they can be treated). It’s not the case. The National Institute on Drug Abuse (NIDA) and organizations of addiction-care professionals like the American Society of Addiction Medicine (ASAM) and American Association of Addiction Psychiatry (AAAP) have identified effective treatments. There’s no easy cure for many complex diseases, including addiction. However, cognitive-behavior therapy, motivational interviewing, and addiction medications, often used in concert with one another and in concert with assessment and treatment of dual diagnoses, are among many proven treatments. However, most patients are never offered these treatments because of a fatal chasm between addiction science and practitioners and programs.

David Sheff – Author of “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy”

 

Individuals entering treatment should be presented with an informed discussion about treatment options that include effective, research-based interventions.  In our current system, treatment recommendations vary widely and may come with bias; medication treatments are either not offered or may be presented as a less desirable option in the path to recovery. Treatment should be individualized, and if the same form of treatment has been repeated over and over with poor results (i.e. relapse), an alternative or more comprehensive approach should be suggested.

Larissa Mooney, MD – Director of the UCLA Addiction Medicine Clinic

 

 

Co-occurring Mental Health Issues

 

People with alcohol problems also suffer from higher-than-normal rates of mental-health issues, and research has shown that treating depression and anxiety with medication can reduce drinking. But AA is not equipped to address these issues—it is a support group whose leaders lack professional training—and some meetings are more accepting than others of the idea that members may need therapy and/or medication in addition to the group’s help.

Gabrielle GlaserAuthor ofHer Best-Kept Secret: Why Women Drink — And How They Can Regain Control”

 

People afflicted with this disease are almost never assessed and treated for co-occurring psychiatric disorders, in spite of the fact they almost always accompany and underlie life-threatening drug use. If both illnesses aren’t addressed, relapse is likely. Patients should undergo clinical evaluation, which may include psychological testing. Those with dual diagnoses must be treated for their co-occurring disorders. Finally, initial treatments must be followed by aftercare that’s monitored by an addiction psychiatrist, psychologist, or physician. In short, the field must adopt gold-standard, research-based best practices.

David Sheff – Author of “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy”

 

Residential “Rehab” Treatment

 

When addicts want to get clean, the most common path, at least for those who can afford it, is a brief chemical detox followed by a 28-day inpatient rehab. In South Florida, rehab is often followed by a much longer stint living in a halfway house (typically a low-rent apartment) with other recovering addicts. People staying in those “sober living” homes are often encouraged to get additional support from outpatient programs that offer one-on-one counseling, group therapy, and 12-step programs. But there’s little scientific evidence that any of these recovery approaches work. Most inpatient rehab programs last for 28 days only because of a historical oddity: It’s the standard cap insurance companies agreed to decades ago, when rehabs first became a regular part of addiction treatment.

Cat Ferguson – International Consortium of Investigative Journalists

 

Staying overnight together confers no outcomes advantage. Research has long shown that, in most cases, outpatient treatment is as effective as inpatient care for alcohol use disorder and other addictions. Given the expense of inpatient treatment,  it makes sense to limit inpatient care to the shortest possible period necessary for medical stabilization. People also do better at recovering from all types of illness when they are surrounded by their loved ones and can sleep in their own beds. Of course, for people who live with drug dealers and are in a social setting in which they have no friends or relatives who aren’t also drug buddies, a change of locale could well be beneficial. But that doesn’t mean that living in a treatment program that costs thousands of dollars a day for a month or longer is the best way to accomplish this.

Mark Willenbring, MD – Former Director of Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Rehab: Last Week Tonight with John Oliver (HBO)

Dr. Ryan Concierge Addiction Treatment

Offering Evidence-Based Treatment

Clinician Training: After completing my PhD in Clinical Psychology at Saint Louis University (American Psychological Association Accredited), I went on to complete an internship at the Hines VA Hospital in Chicago, IL (APA accredited). I then completed an APA accredited postdoctoral fellowship at the VA’s Center of Excellence for Substance Abuse Treatment at the Seattle VA Hospital. In 2016, I completed the rigorous Board Certification process in Clinical Psychology, making me the only Board Certified Psychologist in Chicago, exclusively specializing in Addiction Treatment.

 

Evidence-Based Treatment: I believe in the importance of providing the best treatments that we have available. As mentioned above by several experts and shown through the research literature, there are evidence-based treatments for addiction. Just as with any form of mental health treatment, these treatments depend on many factors for their effectiveness including willingness and engagement of the client, but when provided by a caring, empathic expert they can be highly effective. I provide Cognitive Behavioral Therapy (CBT), Motivational Interviewing, and Contingency Management treatments. In addition, I collaborate with board certified addiction psychiatrists, to provide medication assisted treatment (MAT) for alcohol and opioid use disorders.

 

Co-Occurring Mental Health Issues: One of the biggest advantages that I offer my clients is my expertise in co-occurring mental health treatment. Upwards of 8 million adults in the United States experienced co-occurring mental health and addiction issues in the past year. Addressing both conditions at the same time is important in order to achieve long-term success. I have expertise in treating a wide range of mental health issues including mood disorders, anxiety disorders, and trauma disorders.

 

Outpatient Treatment vs. Residential “Rehab” Treatment: Even if a brief period of residential treatment is needed for medical stabilization, outpatient treatment is where the real work happens. Outpatient treatment is where you begin to integrate recovery into your real life. I make myself available to you as much as needed in early recovery and then we make a plan together to slowly reduce your reliance on treatment in order to get you back to your life.

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