Summary

The article calls for a transformation in addiction treatment methodologies, emphasizing professional standards over personal experience and advocating for a more nuanced, individualized approach to substance use disorders.

Abstract

The author expresses frustration over recent debates in the addiction treatment field, particularly the rivalry between 12-step abstinence-only models and harm reduction or alternative models. They argue for a shift in the conversation around addiction, suggesting that the term "relapse" should be used more accurately and that not all substance use disorders are severe. The author urges professionals to tailor their approach to the individual rather than expecting individuals to fit a one-size-fits-all treatment model. They also highlight the importance of recognizing the diversity in how substance use disorder manifests and the need for an individualized approach, even in severe cases. The article criticizes the imposition of personal recovery experiences on professional practice and stresses the importance of evidence-based treatment. It also points out the limited nature of current knowledge on addiction, suggesting that future research will significantly alter treatment practices. The author warns that addiction treatment professionals risk becoming obsolete if they do not adapt to new research and changing times.

Opinions

Professionals should consider all treatment options and not be biased by their personal recovery experiences.
The term "relapse" should be reserved for a return to full symptoms meeting the criteria for substance use disorder severe.
Recovery from substance use disorders is not an all-or-nothing scenario; it requires a nuanced medical assessment.
Substance use disorder should be treated with varying approaches depending on its severity, not automatically assumed to be severe.
Medicine, including behavioral health and substance use disorders, requires an individualized approach, as there is no one-size-fits-all solution.
Healthcare providers should not rely solely on what has worked for them personally in their professional practice.
The field of addiction treatment is still developing, and future research will likely change treatment practices significantly.
Professionals in the field must remain open-minded and adaptable to avoid becoming outdated in their methods.

Addiction Treatment Must Surely Change Lest It Surely Die…

Professional standards over personal experience.

I’ve been frustrated with some recent interactions on the professional front. I made the mistake of getting baited into the debate surrounding addiction treatment and recovery services.

You know…the “our program is better than your recovery program” battle? More accurately, the debate between 12 step abstinence only models and harm reduction/other alternative models.

I got pulled into the fray. I have zero self control. I have strong opinions. I believe professionals have an ethical obligation to explore all treatment options. I also believe that, too often, professionals blur the lines between their personal recovery and their professional work. So I jumped in.

Now I might as well run with it…

An open letter to professionals working in “addiction treatment/recovery” field. Addressing some common areas of concern:

1) Regarding the term “relapse”: We all need to work hard to change the conversation surrounding substance use disorders. We know that people who progress into the most severe stage of this disorder do outrageous, dangerous, unacceptable things along the way.

That’s why it gets so intense and everyone flips out if someone “relapses”. First off, it’s not a relapse unless the person returns to full symptoms and the criteria are met for substance use disorder severe.

We need to react as medical professionals and assess the situation. Recovery is not a zero sum game. It’s not win or lose. You are not in the recovery club or out of the recovery club. If you are a healthcare provider then act like one.

This catastrophic mentality hurts everyone. It hurts families as well; by creating hysteria.

Furthermore …

2) Substance use disorder is classified as mild / moderate / severe. Stop treating everyone as severe when they show up for help. Stop waiting until it progresses to severe. Get in game earlier.

Adjust your approach to the individual. Not the individual to your approach.

3) Along those same lines, take an individualized approach even if the disorder is severe.

The disorder, like all other disorders, will manifest itself differently in different people. The entire world of medicine knows that behavioral health (which includes SUD) epitomizes “intuitive healthcare”.

There is no right or wrong because there is no precision. It’s not a broken leg where you can point to the problem and the precise solution.

It’s a “judgement” call. Stop acting as if you know what works for everyone. No one knows what works for everyone. The best we can do is guide and encourage. YOU DON’T KNOW.

4) You are a professional…WHO CARES WHAT WORKED FOR YOU…

You are in the role of a healthcare provider. Not the chairman of your home group. I hope my doctor doesn’t just pray over me because it “worked for him”…

5) There is more we DON’T know about addiction than we do know. Relatively speaking, the research related to substance use disorder is limited. The attention and focus is new. There will be breakthroughs in the future.

The way we handle this disorder will be completely different within 10 years.

In terms of your own professional self interest…. open your mind.

You will be out of business if you keep on this path. Times are changing.

As they say in the rooms of recovery ….”change or die”.