For over fifty years the treatment industry has categorically failed. Personal experience of this writer as well as objective data has demonstrated that 3-5% of individuals who complete residential treatment will remain “sober” for a year or more. Additionally, according to the Baldwin Research Institute Inc., over 90% of all treatment in the U.S. is 12-step based and over 95% teach the disease concept. From any perspective and surely from a business perspective, a 95% failure rate is utterly unacceptable. Why does society and the medical/clinical community accept these findings? The answer seems to be “this is how we have always done it.”
The answer to the above problem is multi-faceted and unlike what the treatment industry readily offers which is one-size-fits-all, i.e., don’t drink, go to meetings, call your sponsor, read the Big Book, pray and help others. As Philip Flores, PhD., ABPP stated “It is highly unlikely that a one-treatment-for-all, cookie cutter approach will work for all patients suffering from addictive disorders.” Additionally, it is not uncommon when these individuals relapse for professionals to blame the addict for not having admitted powerlessness, not having prayed enough and not having attended enough meetings.
Bottom line is that the answer doesn’t exist and the suggestion that a patient can get well if they only are willing to “thoroughly follow our path” is limiting at best and potentially deadly at worst. Dr. Mark Willenbring, former Director at the National Institute for Alcohol Abuse and Alcoholism stated “You don’t treat a chronic illness for four weeks and then send the patient to a support group.” He went on to state that treatment needs to be multi-faceted, individualized and continuous “for as long as they need it.”
For example, I had a patient who came to me after having completed ten treatment facility programs in a ten-year span. The longest period of abstinence she was able to accomplish was two years and she stated “I don’t understand why I can’t get this, I went to meetings, had multiple sponsors and thought I worked the steps thoroughly.” She went on to state, “I just can’t get this, there must be something wrong with me.” Additionally, this woman reported that during the two years of continuous sobriety she achieved, she had multiple affairs and eventually divorced and repeatedly told that “at least you stayed sober.” Obviously, I am not suggesting this is the experience of everyone that espouses the 12-step method of sobriety, nor am I minimizing the potential benefits of 12-step support; however, I am suggesting that attempting to work steps prior to gaining an understanding and processing core issues is attune to putting the cart before the horse.
A Brief Example of an Alternative Evidenced Based Approach
As the statistics above indicate, there is a disconnect between what is currently being offered to individuals suffering from addiction and evidenced based modalities of treatment. Treatment should be more attune to evidenced based therapy rather than charging individuals for a program (the 12 steps) that is free. By way of example and not to the exclusion of other modalities, this writer focuses on the theoretical approach of Attachment theory to treat addiction. Attachment theory focuses on providing a “safe base” and a model for secure attachment. The primary concern is addressing underlying core issues created in childhood and assisting the patient to have a corrective experience that includes modeling secure attachment and development of self-love.
Flores states that “using substances becomes an adaptive approach for the individual to regulate emotions, where they have not learned to do so on their own. Addictive behavior acts as a compensatory behavior for a deficiency in the attachment system.” Essentially, Dr. Flores is saying that the problem is not drugs, alcohol or addictive behavior (the solutions), but rather, lack of a model to regulate emotions at a young age (the problem) (and other traumatic and abusive situations) must be addressed and furthermore modeled in treatment/therapy. Moreover, Dr. Flores states “When the patient learns to self-soothe and regulate their emotions they will stop looking to outside sources such as drugs, sex or relationships to achieve this goal.”
The idea of Attachment Theory to address addiction is but one evidenced based model that has been demonstrated to yield successful results. It detours from the all-too-familiar acceptance of current treatment modalities that state we continue to do things the same we because “we have always done it this way.” I believe that professionals have an ethical obligation to begin seeking alternative approaches to treating addiction and stop accepting failure rates near 100%. Addiction is a current epidemic and accepting the norm is not an option.