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Key points
- There is no single form of addiction treatment that is the best and most effective.
- Different addictions may require different treatment modalities.
- A treatment program should be judged on how well it works for the individual person.
- Someone's needs in recovery may change over time.
One size never fits all, whether it is a pair of stretch pants, the “universal” television remote, or an adjustable wrench. Why would we assume that there is only one method or program of recovery for addiction? Many people do assume there is only one path, especially if they themselves have become sober on it. With the best of intentions, they may exhort others to follow that same path. This view has a companion, namely that there are no viable alternatives. Combined, these two views produce a belief that if people fail with this method, they perhaps are not trying hard enough.
Each person’s addiction has its own trajectory.
People begin to use and abuse alcohol and other drugs for particular reasons, and these reasons may have a stranglehold on a person. Some are just looking for fun, while others seek release from trauma, grief, depression, or anxiety. This is not to say there are no commonalities to people’s addictions. While there are commonalities, it is important to recognize differences between people with the same addictions. Some people may have other physical or psychological co-occurring conditions, which means some treatment methods may not be effective.
Consider that some believe people in recovery must be abstinent from any kind of drugs, even those that are medically prescribed and used as prescribed. Would we tell someone with high blood pressure, high cholesterol, and kidney disease that they may not take medications to relieve these conditions? An addiction treatment program that does not allow for medically supervised prescription drugs to be used to treat a co-occurring condition or treat addiction may have a low chance of success.
Addictions vary dramatically in the sorts of pleasures or highs or other effects they produce.
The brain responds differently to different substances and behaviors. The frenetic high that is produced by cocaine is different from the on-beyond mellow of heroin is different from the dissociative effects of other drugs. Different drugs affect different parts of one’s psyche as well as the body itself. This matters in terms of what treatment options might be more effective.
Medication-assisted therapies (MATs) are evidence-based practices for treating some addictions. Campral may reduce cravings, while Vivitrol blocks the “rewarding effects” of alcohol. Antabuse is a deterrent; a person who drinks while taking Antabuse will become terribly nauseous. Medications such as Methadone or Suboxone are effective for people who are addicted to opioids. Those medications are themselves opioids, but they do not produce the euphoria of heroin or pharmaceutically produced opioids.
MATS are often greeted with the suspicion that a person is swapping one drug for another. The person remains an addict. They may still have a physical dependency. However, not all forms of physical dependency are bad; asthma inhalers keep many of us breathing well. MATs reduce harm to the individuals who are struggling, their families, and even broader communities. With regular, controlled, and safe dosages, a person becomes more stabilized and functional. Stability and functionality are hallmarks of recovery.
While much of the focus on drugs and overdoses has been on opioids, methamphetamine deserves as much attention. At present, there are no effective medications for this type of addiction. However, a form of treatment called Contingency Management (CM) is proving itself effective. CM works by offering rewards for a negative drug test. The rewards may be affirmations (“Great job!”) or small monetary ones (winning a $5 gift card). The rewards may increase the longer one is able to have negative test results. While some worry that it is “rewarding bad behavior,” part of the reason CM may work is that people begin to see themselves as being capable of making changes. They start to cultivate a sense of self-worth, which is often a very early casualty of addiction.
The context in which one lives and is trying to be sober matters enormously.
If a person’s choice of drugs has been a matter of opportunity and accessibility, so too may their choice of treatment options. Some people will have access to first-rate medical care; they may have insurance that will pay for in-patient treatment with medical staff to manage withdrawal. Some may need and want the nearly cloistered nature of in-patient while others want to figure out how to become sober in the place where they live and work. One is not objectively better than the other; the measure of goodness is whether it works for a particular person.
Some people may want to become sober in the company of others who have lived the same struggles. There are various self- and mutual-help groups that do this. If there is any slight glimmer from the pandemic, it is that many mutual-help programs have a more robust online presence. This includes Alcoholics Anonymous, Women for Sobriety, Rational Recovery, SMART Recovery, Moderation Management, and LifeRing, which offer online meetings.
Some people may prefer to do this work privately on their own, while others may do so in the privacy of a supportive family and friend network. Others may seek help from a psychologist, social worker, licensed alcohol and drug counselor, or religious person. Each of these is a wonderful place to start. Access and opportunity may be the first consideration, but they need not be the only or the last.
People who have been in recovery—even or especially those with long-term sobriety—may find themselves needing to recommit to their sobriety. For some, this will be redoubling their efforts with a method that has been tried and true for them. Others will need and want something new or different. Since we as people are constantly changing, our needs in recovery will change as well. There are more options now than even 20 years ago, but we must continue to multiply these options.
