Should Addiction Treatment be One Size Fits All?

Should Addiction Treatment be One Size Fits All?


Should addiction treatment essentially be a one size fits all approach? Or should it be custom tailored to the individual?

Huffington Post says “Because addiction is a chronic brain illness that must be managed for a lifetime, finding multiple pathways to recovery is essential for long-term sobriety.”

In other words, the new thinking is that we should be finding multiple avenues for treatment, and giving people more options.

This is in stark contrast to the thinking of the old days, in which the 12 step model of AA was pretty much the only game in town. This is because historically, dealing with addiction and alcoholism were very difficult problems, and the medical community simply did not know how to approach it. So AA was really the first major solution that came along, and much of the treatment system has evolved around that development.

But more and more medical professionals are realizing that there are options. The Tribune Democrat says that “Dr. Rachel Levine, stressed individualized drug addiction treatments, as opposed to using a one-size-fits-all approach.” They are finding that some people respond to different treatments differently, and therefore we might think twice before funneling everyone into the exact same program.

Consider, for a moment, how very different two recovery stories can look in long term sobriety. You could interview one recovering alcoholic who has ten years sober and they work as a therapist now and sponsor people in AA. They are heavily involve in going to AA meetings on a regular basis, and they study out of the big book with people and have sponsorship groups on a weekly basis.

Take another recovering alcoholic who is basically using personal growth and physical fitness as their recovery solution. They, too, have over ten years sober and their life is all about positive change and reaching out to help others. But they do not necessarily attend 12 step meetings, nor do they formally sponsor anyone in recovery.

But the second example, the fitness person, they might reach out to people in unique ways to try to “give back.” They might be a big brother or a big sister, or they might work in the field of substance abuse therapy, or maybe they do online meetings. There are many different ways to reach out and help others, and you do not necessarily have to go the traditional AA path of meetings and sponsorship.

In terms of medical advancement, the entire industry of addiction and recovery is way behind most other branches of medicine. This is because we got such a late start compared to most other areas of medicine. So we have a lot of catching up to do, and there are many experiments and data left to be collected. As of now, we are a long way from having “solved” the problem of addiction and alcoholism.

Age seems to be a dividing line, because younger people seem to respond to treatment quite differently than their older peers. For example, if you take a group of kids who are age 12 to 16 and put them in rehab and daily meetings together, what do you think happens? Unfortunately, the stronger peers do not “lift up” the lower peers–instead, the corrupt kids tend to further corrupt the more innocent kids in the group. In other words, the traditional model that is used in adult treatment seems to fall apart when it is applied to young teens. It just doesn’t work because of the influence of peer pressure.

That said, we are learning more all the time about how to produce the best treatment outcomes. Another interesting example has to do with length of treatment. It used to be believed that the longer an alcoholic or addict was in treatment, the better off they were. And this is still certainly true, but only up to a certain point. After 90 days or so in long term treatment settings, the success rate seems to take a nose dive, perhaps due to complacency factors. But this is something that was only learned after we were able to collect mountains of data over the years and decades and spot various trends.

The future may be driven by research and new pharmaceuticals. Many drug companies are attempting to develop the “cure” for alcoholism, for opiate addiction, for any and all addictions out there. Everyone wants a piece of this market and everyone is hoping to develop the killer app–the medicine that actually works as a real “cure” for addiction. So far, many new medications have popped up, but none of them really function as a total cure. They only limit and reduce cravings, but they do not seem to eliminate them entirely.

Very few treatment centers offer a choice to the consumer when you enter their facility when it comes to treatment methods. Most of them are either religious based or 12 step based, and you have to take what you are given. Of course not everyone does well when they are forced to use a recovery method against their will, and therefore it is nice to have some options.

There was a study done called project Match in which people were paired up with their preferred method of recovery, and this was the measured against the method of just forcing people into a standard solution. The data was not really statistically significant, meaning that there was a slight edge when people got to choose their own solution, but it was not by much, and not enough to really call it a success.

It may be the case, ultimately, that addiction and alcoholism are just really difficult problems to address no matter what we do, no matter how much new research is done, and no matter how many new medications are developed. Obviously medical science is going to keep trying, but I wouldn’t hold my breath in terms of a radical cure coming out anytime soon. The truth is that the one critical factor for success in recovery is the level of willingness that the individual has, and that level of willingness is always going to be based on their own level of denial. Either they are stuck in denial or they have hit bottom and are ready to do “whatever it takes.”

Whatever it takes can turn out to be any given program or solution that you put in front of them. The addict or alcoholic that is desperate enough to embrace any solution you hand them is the addict or alcoholic who is desperate enough to really “get” recovery this time around. If they are not desperate enough to do anything and everything to get clean then they probably aren’t at the point of surrender that is necessary for success.

Perhaps what we really need is a program that gets the alcoholic or addict to see through their own denial. Then we can actually help people move closer to recovery, regardless of which treatment program or methods may be offered to them.