What 50 Years in Addiction Treatment Taught Me

No single treatment approach or method of recovery can claim to be superior to all others. One size does not fit all. There is no such thing as what is the best way to treat somebody who has an alcohol or drug problem. If we've

learned anything over all these years is that the treatment has to be individualized, tailored to the needs of each individual person. It has to address a multiplicity of needs. Not only the alcohol or drug use itself, but the life context in which it's happening. certainly have to treat any

coexisting co-occurring problems, depression, anxiety, relationship problems, whatever dilemmas somebody is experiencing in their life have to be addressed because even though it may not be obvious at first when somebody first appears for treatment, their alcohol or drug use has taken on the function of being a form of self-medication, a way of adjusting their internal feeling states. They're using these substances as coping tools. And as I said, it may not be obvious at first, but once they become engaged in the process, it becomes clear that just addressing it in a mechanical way of do this, don't do that, follow these directions, don't follow those directions, uh, is not going to be sufficient unless you can address the function and the meaning of the substance in the person's life. So,

in the harm reduction model, we don't count sobriety days. And if somebody has been sober for a while, for example, has not been drinking at all, and then has a drinking episode, we refer to it as a recurrence or a return of of drinking rather than a relapse. The term relapse has a negative connotation. It kind of

conotes failure that you were doing well and now you have fallen down, fallen off the wagon, so to speak, which is a, you know, common term. In the AA program, you could have 10 years of sobriety and if you go out and drink, you start your day count back at one. In the harm reduction model, we look at it differently. We look for any evidence of

progress, not perfection. If somebody has a drinking episode after a period of sobriety or a period of marketkedly reduced use where they're moderating and then all of a sudden they have an intensive drinking episode, we look at it as a bump in the road. We look at it as simply a hurdle to be gotten past. We

focus on the progress not at the set on the setback and we encourage the person to learn from that experience and and move on. People who come for treatment uh more often than not report a pattern of drink binge drinking more than they do a pattern of daily drinking. It's much more likely that they are drinking in spurts rather than drinking on a daily basis and being physically addicted to alcohol. Many people think

that if they're not physically addicted to alcohol, if they're not getting the shakes in the morning, I mean, maybe the problem isn't that bad. But it's actually a minority of people who come to treatment for alcohol problems who are physically dependent on alcohol in that particular way. The more common pattern is what's known as episodic binge drinking, which means consuming large amounts of alcohol in a relatively short period of time, but not doing it every day. Some people are weekend binge

drinkers. Some people binge drink only on certain occasions when they're with certain people. The binge drinking episode can for some people mean having five or six drinks which gets them significantly intoxicated. And for some

people it could mean I see especially young guys who can have 10 or 15 beers in an evening over the course of six or seven hours and then continue drinking into the next day which is you know classic binge drinking. In many ways binge drinking is a harder pattern to break than daily drinking. And the reason is because people who binge drink often can go days or weeks at a time in between the binges without drinking anything and not have cravings and urges, not have withdrawal symptoms. And

so they say to themselves, and understandably so, I mean, if I could stay away from alcohol for weeks at a time, how is it that I could have a significant alcohol problem that would warrant some kind of treatment or professional help? The problem is that I don't have a reliable off switch. Once I start drinking, especially in certain situations or with certain people, I can't stop. I've tried time and time

again, but once I have three or four drinks, I go on to have five or 10 drinks. And it uh what begins as a a fun evening with with a group of friends um ends up being another drunken binge. In recent years, another model of treatment has developed, another model of addiction, actually a way of looking at alcohol and drug problems. And it's

known as the harm reduction model. And the harm reduction model says that uh there are many different types of drinking problems that they are problems that lie on a spectrum from mild to moderate to more severe problems. That they're not all in they don't all neatly fall into one category. And people with

less severe problems in particular may be people who don't necessarily have the disease of addiction. It may not be an all or nothing matter for them. They may be able to learn how to cut back on their drinking, drink responsibly, and drink in ways that don't cause problems.

It's been a long time coming and this model has taken a long time to gain traction because the traditional uh 12step approach of abstinence only has gained a very strong foothold in the addiction community and the recovering community and in the treatment community. I mean for good reason. Millions of people have been helped by AA around the world. It's a great

program. The biggest problem is its low level of acceptance among people who don't see themselves as alcoholics who will in fact never set foot in an AA meeting. Many people who go to an AA meeting and don't come back. And people

who feel like the treatment programs that they've made contact with require them to accept an identity as being an addict or an alcoholic. Embrace the 12step philosophy, stop drinking immediately, and get involved in a program to change their relationship with alcohol. and in fact to change the way they're living their life. And for

people who take to that program uh and uh are able to make use of it, it's a it's a wonderful program. And among the people who do participate in a meaningfully meaningful way, the success rates are good. The problem is that it's a program that's acceptable to only a very small fraction of the population of people who have alcohol problems.