Statistically, if you know ten people in the US, at least one of them is expected to enter a near futile battle with addiction — chances of long-term recovery are low. Traditional drug rehabilitation alone isn’t working for enough people, not even slightly. Finally, the foundations for the creation of next-generation therapies have been laid that could help turn these numbers on their head.
Recent developments in our understanding of the biological and neural networks involved in substance abuse disorders and psychological theories of behavioral change, coupled with the rapid evolution of technology-assisted therapy mean that the pivotal time is now.
As we speak, over 30 of the World’s leading experts on ending addiction and facilitating life-long recovery—including expert scientists and therapists, TED speakers, thought-leaders, and international best-sellers—are speaking at the online Healing Addiction Summit.
And that is what it is going to take: The knowledge from the best minds in their respective fields, being united at the frontline in creating holistic, multipronged, therapeutic systems that adapt to the individual and their support network to effectively prevent relapse round the clock and reliably promote lifelong, successful recovery.
We are failing addiction sufferers and their families.
Most addicts in the US never receive treatment (estimated at 10% or less), and although heatedly debated it is clear that most conventional addiction recovery programs alone do not result in lifelong recovery for the majority of people. Tragically, this equates to lifelong suffering that ripples through the addict’s lives to their loved ones and our communities and society as a whole. As put by Summer Felix-Mulder, co-founder of Clear Health Technologies and host of the currently running Healing Addiction Summit:
Addiction doesn’t just affect the addict, it affects families, it affects friends, it affects every relationship.
Ultimately, the seemingly endless addiction cycle of sobering up, relapsing, and hitting rock bottom often ends in drug-related death. In the US, a shocking 100> people die every single day from the number one cause of injury-related death, drug overdoses and poisoning.
With such high stakes at risk, failing to treat and heal those suffering from addiction, the addicts themselves, and their families, is not an option.
Why do addicts relapse?
Behavioral change maintenance, also known as sustainable behavior change, is the ultimate goal in addiction recovery, where a recovering addict refrains from old addiction sustaining behaviors (e.g., drug seeking and use) and maintains new abstinent behaviors (e.g., use of craving coping and wellness strategies).
Think of a Jenga tower as the power to resist cravings and desires to use. It is made of many useful, interconnected blocks that represent the perhaps 100s of factors that can help prevent relapse:
- Some of these blocks are red. They represent the emotional and physiological resources (e.g., good sleep, low stress, neutral/positive mood) needed to start entraining a new behavior to make it an automatic habit while resisting an old habit.
- Some of these blocks are green. They represent the tools and abilities one has to self-regulate and exercise self-control over old addiction habits and behaviors.
- Some of these blocks are blue. They represent the good habits that prevent drug relapse. Self-control requires fewer resources the more that the behaviors that prevent relapse and promote recovery are entrained in the brain and become a habit.
- And then add contextual factors into the mix. Changes to the addict’s physical and social environment can shake things up. An emotional rock of a friend moves away, having to attend a wedding with an open-bar, or a new club opens next door and it’s like pointing a power fan at the Jenga tower. You better hope the right blocks are in the right places!
In reality, some of the blocks can be removed without too much fuss. One night’s bad sleep, so what? The tower might sway, cravings might even go through the roof in stressful moments throughout the day, but balance is regained and relapse is resisted—the tower stands strong. Remove a few more blocks and another couple fall off, create weak patches, or remove some of those important foundational blocks and, very quickly, when just a second ago the tower stood steady, it all comes tumbling down.
This is how falling off the wagon seems to creep up on addicts and their support network. No one can monitor all of these blocks all of the time, not even the addict, and certainly not their counselors, therapists, friends, and family.
All it takes is the wrong block to be removed at the wrong time. For non-addicts wanting to start new healthy habits or quit bad ones this equates to an “off day” or moment of poor self-control, but for addicts, this can be devastating and life-threatening.
Why aren’t conventional drug rehab programs enough?
One of the current mainstays of drug and alcohol rehab treatments involves engagement in a 12-step program pioneered by Alcoholics Anonymous that the majority of rehabilitation centers rely upon.
About 60% of public treatment programs in the U.S. report that the 12-step model is their primary approach, and most encourage or mandate 12-step involvement, with about half holding 12-step meetings onsite.
Research on the effectiveness of these programs is controversial and is subject to widely divergent interpretations and will not be discussed in this article. Nonetheless, it is resoundingly clear from the latest reviews and meta-analysis that while there are undoubtedly recovery-related benefits for some people, the most effective programs of the future will NOT be based on the 12-steps.
And why should we expect 12-steps-based rehab programs and treatments to work across the board today? It was created in 1935 (when we knew next to nothing about addiction) and is essentially a set of religious/spiritual principles that have changed surprisingly little over the years. It is not a carefully crafted system based on proof of what works best for the majority of people or under various circumstances. And it is certainly not tailored to the individual to maximize effectiveness and ensure that the recovering addict has maximal protection against relapse 24/7.
There is not one single reason to expect such drug rehab programs to be universally effective.
And how can future drug rehab programs be better at preventing relapse and promoting recovery?
- By evidence-based design.
- By providing round the clock assessment and care.
- By developing holistic approaches that take into behavioral change theory and account for psychology (mind), biology (the body and brain), and, for some, spirituality (soul).
- By helping addicts use interventions and tools tailored to the individual’s needs at the exact moment they need them, not simply learning about them in a meeting and hoping they are used when times are tough. Prompts and guidance are needed to guarantee success under stress.
- By helping addicts maintain the healthy habits and quality of life needed to stay clean that even the most healthy and successful individuals can struggle to maintain on the daily.
- By being affordable, desirable, and accessible for all.
This can only be achieved realistically by designing programs that integrally capitalize on smart devices. Objective biosensors and mobile phone applications can be used to detect and tell the addict and their support network when one block has been removed from the tower, when two blocks go, and when that power fan is trying to blow the whole blooming tower down. And can provide the tools to prevent relapse both before and when the crisis moments strike.
With recent research demonstrating both the effectiveness of predicting relapse from wearables and smart device-derived data, as well as reports of high user compliance and adherence to wearables and mobile phone applications that are used to tackle and study addiction, the time is now to develop dynamic, research-based, person-centered, technology-assisted drug rehab programs.
The future of substance abuse disorder treatment is bright, is holistic, is personalized, is round the clock, and most importantly, will be designed to help heal from addiction, brick by brick.
Grant, B., Saha, T., Ruan, W., Goldstein, R., Chou, S., & Jung, J. et al. (2016). Epidemiology ofDSM-5Drug Use Disorder. JAMA Psychiatry, 73(1), 39. doi:10.1001/jamapsychiatry.2015.2132
Huhn, A., Harris, J., Cleveland, H., Lydon, D., Stankoski, D., & Cleveland, M. et al. (2016). Ecological momentary assessment of affect and craving in patients in treatment for prescription opioid dependence. Brain Research Bulletin, 123, 94-101. doi:10.1016/j.brainresbull.2016.01.012
Humphreys, K., Blodgett, J., & Wagner, T. (2014). Estimating the Efficacy of Alcoholics Anonymous without Self-Selection Bias: An Instrumental Variables Re-Analysis of Randomized Clinical Trials. Alcoholism: Clinical And Experimental Research, 38(11), 2688-2694. doi:10.1111/acer.12557
Kaskutas, L. (2009). Alcoholics Anonymous Effectiveness: Faith Meets Science. Journal Of Addictive Diseases, 28(2), 145-157. doi:10.1080/10550880902772464
Kwasnicka, D., Dombrowski, S., White, M., & Sniehotta, F. (2016). Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychology Review, 10(3), 277-296. doi:10.1080/17437199.2016.1151372
McCarthy, M. (2015). Drug overdose has become leading cause of death from injury in US. BMJ, 350(jun22 3), h3328-h3328. doi:10.1136/bmj.h3328
Substance Abuse and Mental Health Services Administration. (2011) National Survey of Substance Abuse Treatment Services (N-SSATS): 2010. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
Substance Aabuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
Volkow, N., Wang, G., Fowler, J., & Tomasi, D. (2012). Addiction Circuitry in the Human Brain. Annual Review Of Pharmacology And Toxicology, 52(1), 321-336. doi:10.1146/annurev-pharmtox-010611-134625
This guest article originally appeared on the award-winning health and science blog and brain-themed community, BrainBlogger: The Future of Addiction Recovery: Holistic Tech-Assisted Rehab.