Changing the Focus of Substance Abuse Treatment

This is part 2 of two responses to the New York Times article about Dr. Carl Hart’s research at Columbia University.  You can read Part 1 here and the the original NY Times article here.

Some of the work of Carl Hart, an experimental psychologist at Columbia University, was described in the NY Times recently, and adds to our understanding of motivation in addiction, while challenging one of the myths of addiction.  Many people believe (and it’s often supported by treatment providers) that you can have little impact on a substance users choices, because their brain is wired to choose drugs or alcohol over anything else (“uncontrollability”, the defining characteristic of addiction for many).  The message attached to this myth is “you can’t do anything to help them until they bottom out and have no other choice to make but to change”.  In fact, Dr. Hart’s work appears to support what years of other solid research has found (again and again): if you give people access to alternative resources and behaviors, many will choose these things over substances (in Harts experimental lab work it was the finding that people chose small amounts of money over their drug of choice when given a choice). The foundation of the treatment we use at CMC is the Community Reinforcement Approach (CRA) which is an evidence based treatment (means it’s been studied and proven to be effective). The main objective of CRA is to reduce or eliminate substance use by strengthening “community”. The goal of this treatment model is to identify things (people/relationship, resources, activities) in a person’s environment that reinforce positive behavior and change, then increase attention to those variables and provide access to them.  By building up alternative reinforcers you are establishing alternatives that can compete with what the person gets from their substance use, and ultimately replace substance use as a behavior.