Adi Jaffe Ph.D.

All About Addiction


Moderation in Addiction Treatment, A Change Is Gonna Come

People don't seek treatment because they hate the options out there

Posted Aug 10, 2013

Not that long ago the mere mention that responsible drinking was an option for people who have struggled with alcohol or drugs was a non-starter. It could get you thrown out of parties, yelled at, and even endanger your well-being (or at least your career). It didn't seem to matter that research supported the notion that for some people, moderate drinking was a relevant goal (See here, here, and here for some examples).

It seems the tide is turning, if even just a bit.

Since I've set up my new outpatient treatment center (Alternatives Addiction Treatment) along with Dr. Marc Kern less than seven months ago even I have been surprised at the response. You see, I always believed that moderate drinking is possible after addiction, partly because of my own experience as a moderate drinker and partly because I've been looking at research for more than a decade and the numbers suggests it is actually pretty common. I just didn't realize that so many other people were just waiting for an opportunity to join the movement.

Different ideas don't always have a place

When Dr. Kern and I opened Alternatives we didn't know how long it would be before we would get a single call. The addiction treatment industry is competitive, especially in the Los Angeles area. We had developed what we thought was a great program, but no one knew about us and we didn't have money for serious promotion. But we did have his 30 years of experience treating people using moderation as a goal and my 11 years of research experience. And we believed in what we were doing.

Sometimes abstinence is the only reasonable goal. Sometimes it's not.

I've been writing about the problem of offering only abstinence, and 12-step-based abstinence at that, when it comes to substance abuse problems. I've been lauded and shunned, often for the exact same piece of writing, but have continued on believing that an alternative approach was needed. There is a small number of providers that has been providing non 12-step addiction treatment for a while, but essentially every single one offers abstinence only treatment (see here for exceptions). The research I had been doing, including research on addiction treatment barriers (read - why people don't go into treatment) suggested that more was needed.

Looking at drinking problems differently isn't always easy

The need for more options became obvious to me when presenting my most recent research at a UCLA research group. The study looked at the attitudes and behaviors of people looking for addiction treatment over a six-month period after they began looking. I was trying to replicate and extend the findings of Cunnigham and colleagues (including the Sobbells) from 1993 that showed that cost, shame, lack of information and not wanting to quit were the main barriers to people getting help.

The results I was presenting at UCLA that day indicated that indeed, when people start looking for treatment, all four of these factors were important. However, within one-month of looking for treatment stigma had been significantly reduced for all those seeking treatment regardless of whether they found it or not. What was left behind was cost, logistical issues, and the lack of a desire to quit. The first two likely make sense to anyone reading this, but the third is the kind of "barrier" that often gets a round of laughter. Indeed, even when giving a talk summarizing this research at UCLA I got the following question from a post-doctoral student:

"Wouldn't you need to assess people's motivation for treatment? It seems pretty clear that those who 'don't want to quit' aren't ready yet or are in denial."

This is such a common sentiment and it is simply wrong. In fact, every single one of our research participants came to us looking for help on their own, so it would be pretty difficult to say that they didn't want help. Instead, it seems they didn't want the only help most addiction treatment centers are willing to provide--quitting for life regardless of their problem severity.

And that's where the problem lies. For more than a century we have been assuming that the reason behind the incredibly low enrollment, not to mention success, rates for addiction treatment have to do with clients' "denial," "lack of motivation," and "lack of readiness." But what if the truth is that we've simply been offering them the wrong set of treatment options? What if it is all our fault?

For the moment, I'm going with the premise that it is and that more people will try treatment, allowing many more to be successful, if we simply change our entire approach towards them. It sounds pretty straightforward to me, but in the meantime I'll keep filtering my inbox for death threats.

© 2013 Adi Jaffe, All Rights Reserved

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