We currently live in a country where the attitude and swirl around substance use issues is very intense. Our country has long stigmatized the problem of addiction and most people develop their ideas about the struggle based on TV shows and anecdotal stories they hear in school, at work, and in the press. The recent increase in opioid related overdose deaths has brought even more stigmatized opinions and misinformation into the forefront. Unfortunately, when substance users and their families contemplate asking for help they have faced the shame that comes along with stigma and inadequate treatment options. We as a country, have to do better.
There are many, many ways to get help. Getting help can include seeking professional treatment, talking to a friend or family member, finding self-help meetings, and talking to a doctor about medication options.
If you seek treatment from the professional treatment world, be aware that there are a wide range of options and different philosophies about how to treat the problem of addiction. Some professionals (e.g., therapists, medical doctors, counselors) and programs adhere strictly to the disease model and prescribe attendance to 12-step meetings and complete abstinence from all substances in order to address a substance use problem. Other providers are more willing to work with a range of motivational states and goals and utilize a variety of treatment approaches. And still others use a combination of these approaches. Some providers do individual therapy, some only do groups. Some support medication-assisted therapies, others discourage it. And the list goes on …
The reality is that while there are lots of different approaches, there are some approaches that have been shown in clinical research studies to be very effective and these are called Evidence-Based Therapies, or EBT’s and include treatment such as Cognitive-Behavioral Therapy, Motivational Interviewing, Medication-Assisted Treatments and Dialectical-Behavioral Therapy. Unfortunately, depending on where you live, and what financial resources or health insurance you have, it can be hard to find people who offer the most effective treatments.
Given the range or options out there, here are some things to consider as you seek support for yourself or a loved one. Letting yourself consider these points will prepare you for the often arduous task of finding help that you actually find helpful! And keep in mind, the fact is, different things work for different people (often at different times!) so it is important to do your best to find the option that feels like the best fit for you.
While it may seem commonsensical, it is important to like the person you decide to work with and not feel judged or scolded by them. It has not been uncommon in the addiction treatment world for providers to be punitive and authoritarian in tone and approach. This is not helpful and it is important that you find someone you are comfortable with and feel understood by. One of the most important underlying elements in research on EBT’s for substance use disorders is the role of empathy and compassion in treatment. Study after study find these variables in a clinician to be a predictor of positive outcome. Being in recovery is not a predictor of clinician effectiveness. Being a hard-ass and able to confront addiction is not a predictor of clinician effectiveness (in fact, confrontation has been found to be predictive of relapse!). Being able to actually listen to your client and appreciate where they are coming from is predictive of successful outcomes. The enormous power this has in helping people cannot be overstated and it’s important that you find a provider who you feel has these skills and qualities.
As you look at treatment programs, look at the level of training of the clinicians. Substance use problems are often very complex as they involve environmental/social, psychological, physical/medical variables. It is important that the treatment provider you work with is trained to address or be able to at least identify issues that you face in all of these areas. When seeking treatment, be fully aware that many programs are staffed by employees who are ill-equipped to work with all of these issues. Programs who are genuinely utilizing EBT’s provide their clinical staff with lots of training and supervision, by supervisors trained in the approaches they are using. Good therapy is hard to do and it’s hard to keep doing it right. A good treatment provider can tell you about the last training they did and tell you how they are supervised or supported in their work. Don’t be afraid to ask. Give yourself permission to ask about years of experience, level of training, rate of staff-turnover (which reflects health of the overall system) and supervision protocols of the treatment team.
Ask whether the program you are considering is supportive of Medication Assisted Treatments (MAT’s) like buprenorphine and naltrexone/Vivitrol for opiates, Antabuse and Naltrexone for alcohol, Chantix and Nicotine Replacement medications for nicotine dependence. The incredible number of opioid overdoses in this country is in large part the result of the traditional treatment system having been slow to adopt the use of MAT’s like buprenorphine, because they believe “a drug, is a drug, is a drug.” The reality is that some drugs save lives and we should be using them. So if the provider you are interviewing has overly strong opinions against the use of medications to address substance use problems, consider going elsewhere. Odds are that person has not read up on the latest evidence of their effectiveness.
Insist on a thorough evaluation by someone qualified to assess the emotional, physical and environmental issues that you face in addition to your substance use. One size does not fit all and too many people with substance use disorders have been pigeonholed into programs that are ill-equipped to help them (e.g., “your an addict, you need to go to a meeting and get a sponsor”). The provider doing the assessment should want to spend time with you and anyone in your life who knows you and has the potential to support you. They should also ask to have contact with any other providers you have worked with along the way. The more information they have about you, the more likely they will be to build a treatment plan that works. If you ever hear a provider say, “you suffer from terminal uniqueness” … let yourself get up and leave and find someone else who will actually try to understand and work with your uniqueness.
Finally, consider the role of trauma. Many, many substance users have trauma histories and suffer accordingly. Sometimes that trauma results in diagnosable Post-Traumatic Stress Disorder (PTSD). Other times it manifests itself in chronic difficulties in functioning in relationships and work/school and overall poor emotional and physical health. There are a variety of therapies that address the effects of trauma effectively and if you are someone who has had trauma, you should consider seeking out a provider who has these skills.
Seeking help can be a difficult process to say the least. And substances users and their families face a flawed system in a country with deep stigmatized views on addiction. It’s time we all start demanding better, and knowing what to ask for of the professional treatment world is a great first step.