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The Disparity of Treatment Approaches

The New York Times recently featured a story on a Russian treatment approach (“In Russia Harsh Remedy for Addiction Gains Favor” New York Times, 3 Sept 2011) that involves incarcerating addicts for one year or more with nothing more than peer support, water and bread or gruel. They provide no medications; they provide no formal counseling or therapy. The article notes that addicts, on entry, are no longer handcuffed to their beds but supported through what is often a very uncomfortable opiate detoxification from older peers who remind newcomers that the withdrawal and cravings will pass. This ‘program’ is designed to meet the exponential growth of opiate drug addiction as the result of the proliferation of the Afghanistan opiate supply. The directors of this program claim 70% success rates among their ‘graduates’ but have no statistical data support this.

James Twitchell has offered his American version of affordable therapy (see For Shame: The Loss of Common Decency in America, James B Twitchell, 1996) that gained some popularity soon after its publication. He believes that by imposing a sense of moral shame on those who violate societal norms, laws and boundaries, societal pressure forces personal change. Mr Twitchell scoffs at the psychologists who posit that toxic shame motivates people to self-sabotage through addiction, crime or general misbehavior. Rather, imposing shame, and following the moral theory of addiction, people are pushed to better themselves through peer and societal pressure. Certainly, peer and community pressure does sway behaviors and mindsets, however, in treating addiction shame-based therapy is not only ineffectual, it’s dangerous.

Faith based or religious models of therapy were certainly supported during the Bush administration. There’s merit to these types of programs despite the skepticism that many addiction professionals have toward spiritually based therapy. Community- faith based programs have been underrated on the good they can provide: acting like a welcoming family, not imposing negative judgment and providing structure has proven to be a welcome opening for addicts who carry shame and the negative stigma of having a substance abuse problem. Community churches can offer comfort and emotional respite like no other organization. What became clear during the rise of faith based programs was that too many programs lacked professional skills to deal with the complexities of addiction and co-occurring disorders; the data and tracking regarding success was omitted; too many churches or faith programs lacked any type of structure or foundational approach. Their dubious success rates – some reporting 100% – were simply wrong and thus have led to a remarkable decline in faith programs in recent years.

Medication Models, for instance Ibogaine and Naltrexone, are not the magic bullet cures for addiction that was hoped. The neuro-complexity of addiction along with the various substances and behaviors are not likely to be nullified by any medication. Of course medications help, yet the ideological ice becomes thin making sweeping generalizations about psycho-pharmacology.

So, we’re left with 12 step treatment models. We can put behavior modification mediation as best exemplified by the Russian incarceration technique noted above as somewhat effective but too often inhumane.

What model or models work?

Several proven models show the most promise to breaking the cycle of addiction. However, there is no proven model that can instill any addict with the motivation to change. Ironically, attrition via pain (emotional, physical, psychological and spiritual) appears to be the critical element that inspires addicts – and all humans – to change. That element of relieving pain via recovery is highly individual but there are sweeping generalities that we can make.

“Sick and tired of being sick and tired.” How one gets there is as individual as snowflakes, yet addicts seeking any type of recovery arrive there because they tap into the primal desire to survive. Treatment guides people from surviving to thriving – and the taste of happiness, the avoidance of searing pain and achieving a state of contentment becomes priceless.

The best practices of treatment facilities include spiritual help, a safe place to share feelings, a means where patients can talk about very private emotions, but experience emotions safely and without using and without judgment. The best facilities also rely on restoring emotional, psychological, physical and spiritual health through diet, mild exercise, 12 step meetings, peer support, professional direction and less reliance on long term medications. The best of treatment centers provide their patients with validation toward health and re-direction when seeing relapse thinking, behavior or negative emotions.

After centuries of puzzling over what to do with addicts we’ve found that the worst incarceration occurs when we’re condemning and intolerant. To give a person mental, physical and spiritual hope helps them through their pain and is the miracle of recovery. Treatment isn’t perfect yet, but it has evolved to the point that most countries are borrowing the American model because we’ve proven more success than failure and saved more lives than have been lost.

S. Darcy
Vista Taos Renewal Center

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