Inside Rehab

Practical information about addiction treatment and recovery

Abstinence: The Only Solution for Addiction? Part 2

Since only about 1 out of 10 people with a drug or alcohol use disorder seeks treatment, it’s high time that we offer more flexible and inviting approaches for addiction, regardless of whether clients are willing or ready to be abstinent. With more roads to recovery, more people will be helped. Read More

HARMS and Forgiveness

This is very good article on the benefits of HARM Reduction. Ironically another form of Harm Reduction can be found in Christ Recovery. Christ Recovery is about Reality, Research and Responsibility. It isn't rocket science, it's good science, in the support of modern day principles and precepts of psychology and neurobiology. It is based on values, character, empowerment, motivation and the ability to change your thinking and change your life. Folks are not denigrated for relapse. While CR promotes abstinence as the ideal for many, Harm Reduction is at its core.
Take a look it may shock you. http://christrecovery.discussioncommunity.com/

Celebrate Recovery is

Celebrate Recovery is abstinence only. I have been to meetings.

A new viewpoint is sorely needed

I think we need to talk about Moderation and Harm Reduction first when someone is having issues and that AA should never been a resource for someone under 40 !!! AA is a sick and dangerous place and I think AA is better for old farts like Bill W and Marty Mann. No teenager is an alcoholic like Bill W . Most are clearly not even dependent.

Please keep talking about other options. Our culture has been highjacked by AA and young people are dying because of it in rehabs and sober living!

Options for young people

"Massive" makes good points about needing far more options for teens and young adults. Most of what's available has just been modified from adult approaches and not based on scientific evidence. There is little or no sound evidence that 12-step-based treatment is effective for adolescents - while it seems to help those who get involved after they've been through treatment, most don't get involved and the majority drop out over time. And the disease model and a number of 12-step tenets are inconsistent with what we know about adolescent development. In Inside Rehab, I describe a number of adolescent approaches that HAVE been found to be effective, but very few treatment facilities employ them. I'll do a column about this in the future. (And "Massive" is right that many teens are not "dependent"/truly addicted, and many who are "mature out" of their problems with time.)

Naming non-abstinence based treatment

Great article as usual by Anne Fletcher. In the work and research I am doing I am trying to develop more appropriate treatment models for local communities. I am now calling my modality "cumulative continuum based" treatment.

"Cumulative" because it can be delivered in various stages that build upon each other.

"Continuum" because these cumulative components can be delivered along both the continuum of severity of substance use disorder and according to the current levels of motivation for change around substance use.

I find that this helps bring the principles of harm reduction and abstinence into the same framework, and helps treatment services to view them both as important aspects of treatment without being mutually exclusive.

cumulative continuum based" treatment

Shaun,

Would you be so kind as to give us a link for your approach?

Thanks

Cumulatice continuum based treatment

Hi Anne

Currently this is the subject of my PhD research, so there is nothing in the formal literature yet. I am busy putting a brief explanation together which I will post on my website in the next little while and I will let you know. Very briefly:

The aim is to develop a program that has very low barriers to entry and can be delivered effectively with a limited number of resources and embraces different treatment needs along the continuum of substance use and stages of change. Currently we are trialing various components in a community based out-patient setting.

Each person that seeks help is assessed. This assessment includes asking them what their goals are along a continuum from "use with less consequences" to "complete abstinence". They are also asked about motivation as well as things like "what has worked in the past" and other co-occuring issues from social circumstances to trauma. They also get a medical and psych assessment. From this a treatment plan is developed using various group and individual elements as components. These range from "drop-in harm reduction" groups to "contemplation groups" to "early recovery" CBT groups to "Relapse prevention" to "life skills" groups. The person also gets assigned an individual therapist/counsellor who works with them throughout the process and does regular follow-ups for as long as they need it. This individual work also has component parts such as trauma work, family work and the like as needed with an emphasis on MI. Those who don't do well in groups get only individual work and those that require any form of in-patient intervention from detox to longer term residential treatment get referred to services but are still case managed by us.

These interventions are based on modalities/evidence based principles such as motivational interviewing, CBT, mindfulness, relapse prevention, problem solving therapy, imaginal exposure etc

Every component can be stand-alone - even the initial assessment contains a brief intervention and a decisional balance component, and the components can build on each other.

We have two essential aims:
1) to assist individuals make conscious decisions around their substance use
2) to provide the tools for the individual to be able to implement these decisions.

We carry neither the expectation of abstinence nor the presumption that it is not possible. We discourage "group think" and believe each individual has their own issues and goals regarding substance use. We see therapeutic bond as vital, both with the individual therapist and with the program as a whole. We believe that addiction is multi-dimensional and often relational, and to focus only on the substance use is not the most helpful approach, rather we look at other issues such as family relationship, what purpose the substance use serves, past trauma, co-occuring psychiatric issues, life purpose, social environment and the like.

To perhaps understand the approach from a theoretical point of view it could be considered similar to the Common Elements Treatment Approach (CETA) used in the treatment of anxiety/mood related disorders in lower and middle income settings: http://www.sciencedirect.com/science/article/pii/S107772291300062X

I hope this is helpful to some degree, and if you have any further questions please don't hesitate to contact me directly via e-mail.

Thanks

Abstinence

When you’re using drugs, you’re driven by this mystical black energy, a force inside you that just won’t quit. And the weaker you get, the more you feed into that energy. I’ve seen it so many times with addicts.

Mystical black energy? A

Mystical black energy? A force inside you? I swear to God I hate people like you. I can only hope your not in the addiction field. I wish you gave your full name so I can ruin your life the way I'm sure your ruining others if your in the field.

Harm reduction

Addiction is a chronic, progressive brain disease of the Limbic "reward" system, which is not only involved in the experience of pleasure, but is also central to learning, decision-making and motivation. Addicts make terrible decisions because it is their brain's decision-making apparatus that malfunctions.

But it's a disease with stages. For those in its earliest stages, harm reduction strategies may be appropriate whereas absolute abstinence may be necessary for those in late stages.

For a website that discusses the science of addiction in accessible English (what makes it a chronic, progressive disease; what parts of the brain malfunction; how that malfunction results in addict behaviors; how addicts' decision-making is skewed by substance abuse; why some get addicted while others don't; how treatment works; why relapse is common; what family and friends can do; etc.) please click on www.AddictScience.com.

Science

steve castleman wrote:
Addiction is a chronic, progressive brain disease of the Limbic "reward" system, which is not only involved in the experience of pleasure, but is also central to learning, decision-making and motivation. Addicts make terrible decisions because it is their brain's decision-making apparatus that malfunctions.

But it's a disease with stages. For those in its earliest stages, harm reduction strategies may be appropriate whereas absolute abstinence may be necessary for those in late stages.

For a website that discusses the science of addiction in accessible English (what makes it a chronic, progressive disease; what parts of the brain malfunction; how that malfunction results in addict behaviors; how addicts' decision-making is skewed by substance abuse; why some get addicted while others don't; how treatment works; why relapse is common; what family and friends can do; etc.) please click on www.AddictScience.com.

Hard to argue with science guys. How could the leading scientist be wrong?

Harm Reduction: Why the polarization of addiction professionals regarding "abstinence-only" or "harm reduction" therapy is so absurd.

I will state for the record, I believe more substance users will be attracted to treatment facilities that are not abstinence-only, where patients lives will be saved by being medically monitored by trained professionals. Once stabilized, every patient--regardless of their clinical needs, has the right to have reasonable access and education regarding current evidence-based treatment.

Ultimately, it is the patient's right to be empowered to make choices regarding his or her own health and treatment.

Unfortunately, the polarization of professionals who see harm reduction and abstinence as opposing treatment models often do not empower clients with education of all current treatment options for substance use disorders.

This is a serious bias in our field that dis-empowers patients ("knowledge is power"), with potential to cause more harm to the suffering substance users out there.

By SCOTT W. STERN, LCSW Psychotherapist|Empowerment Professional

Scott W. Stern, Empowering Psychotherapy and Corporate Services
New York, New York

Private and Corporate Services Focusing on Addictions, Anxiety, OCD, Trauma and PTSD

http://www.Empower-SWS.com

Harm Reduction

Scott W. Stern, LCSW wrote:
I will state for the record, I believe more substance users will be attracted to treatment facilities that are not abstinence-only, where patients lives will be saved by being medically monitored by trained professionals. Once stabilized, every patient--regardless of their clinical needs, has the right to have reasonable access and education regarding current evidence-based treatment.

Ultimately, it is the patient's right to be empowered to make choices regarding his or her own health and treatment.

Unfortunately, the polarization of professionals who see harm reduction and abstinence as opposing treatment models often do not empower clients with education of all current treatment options for substance use disorders.

This is a serious bias in our field that dis-empowers patients ("knowledge is power"), with potential to cause more harm to the suffering substance users out there.

By SCOTT W. STERN, LCSW Psychotherapist|Empowerment Professional

Scott W. Stern, Empowering Psychotherapy and Corporate Services
New York, New York

Private and Corporate Services Focusing on Addictions, Anxiety, OCD, Trauma and PTSD

http://www.Empower-SWS.com

Harm Reduction

Scott W. Stern, LCSW wrote:
I will state for the record, I believe more substance users will be attracted to treatment facilities that are not abstinence-only, where patients lives will be saved by being medically monitored by trained professionals. Once stabilized, every patient--regardless of their clinical needs, has the right to have reasonable access and education regarding current evidence-based treatment.

Ultimately, it is the patient's right to be empowered to make choices regarding his or her own health and treatment.

Unfortunately, the polarization of professionals who see harm reduction and abstinence as opposing treatment models often do not empower clients with education of all current treatment options for substance use disorders.

This is a serious bias in our field that dis-empowers patients ("knowledge is power"), with potential to cause more harm to the suffering substance users out there.

By SCOTT W. STERN, LCSW Psychotherapist|Empowerment Professional

Scott W. Stern, Empowering Psychotherapy and Corporate Services
New York, New York

Private and Corporate Services Focusing on Addictions, Anxiety, OCD, Trauma and PTSD

http://www.Empower-SWS.com

Can we be civil?

Come on. Can we please be professional and polite with each other?

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Anne M. Fletcher, M.S., R.D., is the author of Inside Rehab: The Surprising Truth about Addiction Treatment – And How to Get Help That Works.

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