It’s interesting to speculate about the Center for Health Innovation Poll result that a large majority of mental health professionals endorse the treatment goal of abstinence over harm reduction. It is often the case that those addicts who end up seeking professional help are a particularly distressed and difficult to treat group. How do we know that? Ann Fletcher who wrote “Sober for Good,” learned from speaking with addicts themselves, that as many as 50% find their way to abstinence on their own, without ever seeking professional help, and without ever attending a 12-step program. We also know that a small number of alcoholics can actually drink on occasion without lapsing into more problematic use. This suggests that professionals in our survey may be reporting on their experiences with addicts who have not been able to help themselves, whose behavior is already more engrained and resistant to the tools and approaches at the disposal of our professionals, when compared with addicts who manage to get sober on their own. Hence, the professionals surveyed might advocate a tougher and more demanding abstinence approach with the people they treat.
It’s also likely that when asked to choose between treatment goals of abstinence versus harm reduction, professionals in our survey understandably report the more conservative and consensually endorsed one, abstinence. But in practice, the dichotomy may be somewhat misleading. Many professionals will begin, quite correctly, where their patient is at, so to speak, working initially with an addict’s stated preference for harm reduction, knowing that, to abrogate a patient’s treatment goal right off the bat, can be a recipe for failure. And for many addicts with years of use and a lifestyle to go with it, abstinence is an unfathomable leap. Harm reduction offers a way forward, but one that is stepwise, and for many subjectively more manageable. As a result, our wise and experienced professional might say, in effect, “Let’s try harm reduction and see how far we get. If this approach to moderation of your substance use works, then great. If not, we’ll reassess and go from there.”
The survey also provides hints about some very important principles in working with addictions. For one, recovery should address an array of often co-occurring and related problems, some of which are as important in addictive disorders as the substance use itself. Many addicts may have psychological problems underlying the addiction, including major depression, bi-polar disorder, anxiety, eating and personality disorders (lifelong maladaptive behavior patterns that interfere with work and relationships). If these co-occurring problems are not addressed, then detox and short term outpatient treatment, no matter how intensive, may afford the patient only temporary relief from the addictive pattern. That may be why, in their estimation, professionals feel that medical insurance to support treatment of addictions is less than adequate; the range of associated problems that may underlie the addictive disorder requires extensive rehabilitative resources. For an addict to remain well, he/she will often need not only to stop using drugs, but also to forge a new life that offers a compelling alternative to drugs and requires resources that may never have been available before the addictive cycle dominated their lives.
And on this last point, the involvement of family and friends is critical. An approach gaining in popularity, CRAFT (community reinforcement approach and family training), helps people learn to reduce the power of their addictions, and also equips family and friends with supportive techniques to encourage loved ones to begin and continue treatment. The approach also implicitly acknowledges that just as one addict can negatively affect the lives of so many others, so may others positively affect the life of the addict.
Written by
Jonathan Jackson, Ph.D.
Director, Center for Psychological Services
Derner Institute
Adelphi University
