The first part of this series dealt with the introduction of myths that we believe are the reason for the scarcity of non-abstinence treatment programs in the United States (Europe and Australia don’t have such an obvious gap).
As a review, the following are the reasons we had listed in the previous article:
- The idea that we allow “true alcoholics” to continue drinking.
- People currently abstinent will now decide to drink again, thinking they would be able to moderate.
- The belief that mind altering substances should never be used as a means of escape, specially by those that previously struggled with them.
The first reason was explained in the previous article, so this piece will focus on the next reasons.
Abstinent Alcoholics everywhere will try to return to drinking
This statement is disconcerting, since it seems to imply that people are paranoid that the recovery community has very little control over their life. Indeed, this is nothing but a Red Herring. Of course, this only applies if you believe that the mere availability of different treatment options will cause an individual to completely disengage from their current program. This “belief” also suggests that such an individual is not at all satisfied with their present treatment. Consequently, this would seem to promote the idea that there is a problem with our current treatment system for alcoholic drinkers and we need to adopt a new approach to solve this problem.
Now Sure, I am positive diabetics would jump at the opportunity to stop injecting insulin, but the freedom to take on such an experiment is always available to them regardless of our recommendations. The same applies to abstinent individuals in recovery, they still have the free choice to drink again, and in fact many do. This explains the low success rates seen for abstinence 12-months post-treatments, which usually ranges from 5% to 15% of people successfully achieving complete abstinence.
Fortunately, this specific fear, abstinent individuals will drink again, can easily be handled by ethically-sound admission principles. For example, Alternatives will not accept abstinent clients who are trying to find out if they can drink again. For the simple reason, Alternatives only treats clients with current drug and alcohol addiction problems. In the situation where a person was interested in trying drinking again after an extended abstinence period, they can attend some self-help and peer-support meetings targeted to their needs like Moderation Management. Since only 0.5% of phone calls have inquired about such a course for treatment, this is only a small factor to consider.
The truth is many people who have successfully reached abstinence are satisfied with their achievement and have no interest in resuming alcohol consumption. Therefore, this obviously is not the correct issue to dwell on. The real problem is that most individuals who struggle with substance use (90% to be exact) never even enter or start a treatment program (SAMHSA, 2010; Center for Substance Abuse Research, 2012). Furthermore, those small amounts of people who do decide to enter a treatment program, only a small percentage of them are actually successful. Currently only about 1% of individuals with addiction problems are being successfully treated. Therefore, the goal is to introduce treatment options that can increase the reach of treatments, and fill in the gaps that abstinent only approaches are causing.
Interestingly, research shows that offering non-abstinent treatment programs would increase treatment availability to millions of Americans. For example, the Center for Substance Abuse Research found that 40% of individuals who did not enter treatment cited “Not ready to stop using” as a major reason. My own UCLA and NIDA research (Jaffe, 2013) supports that finding in a group of people seeking treatment online. All of this suggests that rather than serving as an excuse, offering non-abstinence methods is a necessary step to open up solutions for the tens-of-millions of Americans struggling with substance use problems. Their struggles with depression, anxiety and other co-occurring conditions (Jaffe, 2007) will be considerably eased if we stop sticking to outdated dogma that simply are not effective enough.
Citations:
CESAR (2012). Lack of motivation to quit and health coverage: Top reasons for not receiving needed alcohol or drug treatment.
< http://www.cesar.umd.edu/cesar/cesarfax/vol21/21-07.pdf >
Jaffe A., Colman A., & Strahl W. (2014, August). Not ashamed but still too poor: Longitudinal changes in barriers to treatment entry for online treatment seekers. Paper presented at the 3rd Annual Addiction Research and Therapy Conference, Chicago, IL.
< http://omicsgroup.com/conferences/ACS/conference/pdfs/13786-Speaker-Pdf-T.pdf >
Jaffe, A., Shoptaw, S., Stein, J. A., Reback, C. J., & Rotheram-Fuller, E. (2007). Depression ratings, reported sexual risk behaviors, and methamphetamine use: Latent-growth-curve models of positive change among gay and bisexual men in an outpatient treatment program. Experimental and Clinical Psychopharmacology, 15, 301-307.
< http://www.ncbi.nlm.nih.gov/pubmed/17563217 >
Substance Abuse and Mental Health Services Administration (SAMHSA), Results from the 2007-2010 National Household Survey on Drug Use and Health: National Findings, 2010
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