A discussion of whether addiction is a condition that really
needs an intensive treatment regime for recovery. Looks at some of the history and current
evidence before reaching a conclusion.
Today most people take for
granted that addiction is a condition that requires medical attention. However,
it is only relatively recently that addiction has been treated by the medical
profession at all. A hundred years ago addiction was not a term that many
people would have recognized and, even if they had recognized it, they would
not they would not have considered it to require medical attention. Indeed, it
wasn't until the 1950s that the major medical bodies in the USA decided to make
addiction treatment widely available and even later, in the 1960s, before
psychiatrists started to address it. Prior to this time, addiction was
considered to be criminal justice or moral problem, the answer being punishment
or sermons. Recovery from addiction problems in those times tended to something
people achieved by themselves or with the aid of friends and relations, doctors
were rarely if ever consulted. Currently, while recognition of addiction as a
medical problem has brought benefits, for example, treatment rather than
punishment, many believe the pendulum has swung too far with any risky behavior
now regarded as an addiction and requiring medical attention. Indeed many ask
if we are medicalising issues that should be more appropriately dealt with in
other ways? Certainly many including well-respected researchers think that this
is exactly the case.
In the 1970s and 80s a couple of researchers carried
out some interesting studies. They found that some people recovered from addiction
problems, alcohol and heroin addiction, without ever going to treatment,
medical or otherwise. At the time, the medical profession recognized that this
was a possibility but they also considered that it was extremely rare. Research
over the last decade has dispelled that myth consistently finding that between
70 and 85% of people who recover from addiction problems do so without the aid
of treatment, including AA and NA. Other research found that even for people
who have actually gone to treatment, when they are asked to name the most
important influences on their recovery, it is rare for them to list treatment.
So what are the implications of this research does this
mean that we should close treatment that we no longer need it? No of course
not, there will always be some people who need treatment. What it means is that
medical treatment should not be seen as the first and only option for addiction
problems. Some commentators suggest that we should be looking at what they call
stepped care, basically that inpatient treatment would be the final option, not
the first and that the less intensive options would be tried first.
For example, if someone were to go their doctor with a
drinking problem, the doctor's first reaction should not be that here was
someone who needs to be in treatment, go to AA and be abstinent for the rest of
their life. Instead the doctor should be looking at various other measures that
are much less intensive and or extreme. Not everyone with a drinking problem is
an alcoholic, and not everyone with a drinking problem needs to abstain from
alcohol forever. Many alcohol problems are transient, that is they may be the
behavior of youth, which later disappears when the person is faced with
marriage and responsibility. Other ‘problems’ are reactions to life
circumstances, eg bereavement or job loss. When we again look at the research
we find is that people are reluctant to attend doctors or treatment agencies
with an alcohol problem. The reason they give is that they will be branded an
alcoholic, have the shame and stigma of being an alcoholic and never be able to
drink again in the lives. Given these reasons it is hardly surprising that
people do not attend for treatment of drinking problems until they are
desperate or hit rock bottom.
There are two rather worrisome side-effects from
treating alcohol problems in the way described above. The first of these is
that because people are reluctant to go to treatment because of stigma, etc it
means that people delay addressing their alcohol problem until it is so severe
they have no choice or they have reached rock bottom. Perhaps with a less
medicalised system people would perhaps seek treatment earlier and suffer less
damage as a consequence. However, the second side-effect is perhaps even more
worrying. Because this attitude to addiction problems, breeds dependence on the
doctor or a medical system for a solution to their dependence on substances or
other behaviors. Similar things have been written about 12 step groups, that
people become dependent upon the group or the organisation. Thus they are
transferring dependence from one thing to another.
If we are going to reduce the incidence and effects of
addiction then, rather than have a system that substitutes one dependence for
another, what we really need is a system that allows people to be free of
dependence, of any kind. This is not a radical new idea, if anything it is a
trip into a time past where we dealt with the problems in the community rather
than expected the doctor to cure them all. However, in order to do this, we
need to have a system that teaches people life skills. For example, how to
solve their problems, how to set goals for the future and perhaps the most
basic skill of all, how to communicate with each other. Maybe if people had
more of these skills, they would be less likely to develop addiction problems
in the first place. If they did develop addiction problems, they will be less
likely to be severe. If the addiction problems were severe, they would be more
likely to find a solution. Thus perhaps the solution lies in empowering people
to ‘treat’ themselves rather than creating more addiction specialists.
evidence before reaching a conclusion.
Today most people take for
granted that addiction is a condition that requires medical attention. However,
it is only relatively recently that addiction has been treated by the medical
profession at all. A hundred years ago addiction was not a term that many
people would have recognized and, even if they had recognized it, they would
not they would not have considered it to require medical attention. Indeed, it
wasn't until the 1950s that the major medical bodies in the USA decided to make
addiction treatment widely available and even later, in the 1960s, before
psychiatrists started to address it. Prior to this time, addiction was
considered to be criminal justice or moral problem, the answer being punishment
or sermons. Recovery from addiction problems in those times tended to something
people achieved by themselves or with the aid of friends and relations, doctors
were rarely if ever consulted. Currently, while recognition of addiction as a
medical problem has brought benefits, for example, treatment rather than
punishment, many believe the pendulum has swung too far with any risky behavior
now regarded as an addiction and requiring medical attention. Indeed many ask
if we are medicalising issues that should be more appropriately dealt with in
other ways? Certainly many including well-respected researchers think that this
is exactly the case.
In the 1970s and 80s a couple of researchers carried
out some interesting studies. They found that some people recovered from addiction
problems, alcohol and heroin addiction, without ever going to treatment,
medical or otherwise. At the time, the medical profession recognized that this
was a possibility but they also considered that it was extremely rare. Research
over the last decade has dispelled that myth consistently finding that between
70 and 85% of people who recover from addiction problems do so without the aid
of treatment, including AA and NA. Other research found that even for people
who have actually gone to treatment, when they are asked to name the most
important influences on their recovery, it is rare for them to list treatment.
So what are the implications of this research does this
mean that we should close treatment that we no longer need it? No of course
not, there will always be some people who need treatment. What it means is that
medical treatment should not be seen as the first and only option for addiction
problems. Some commentators suggest that we should be looking at what they call
stepped care, basically that inpatient treatment would be the final option, not
the first and that the less intensive options would be tried first.
For example, if someone were to go their doctor with a
drinking problem, the doctor's first reaction should not be that here was
someone who needs to be in treatment, go to AA and be abstinent for the rest of
their life. Instead the doctor should be looking at various other measures that
are much less intensive and or extreme. Not everyone with a drinking problem is
an alcoholic, and not everyone with a drinking problem needs to abstain from
alcohol forever. Many alcohol problems are transient, that is they may be the
behavior of youth, which later disappears when the person is faced with
marriage and responsibility. Other ‘problems’ are reactions to life
circumstances, eg bereavement or job loss. When we again look at the research
we find is that people are reluctant to attend doctors or treatment agencies
with an alcohol problem. The reason they give is that they will be branded an
alcoholic, have the shame and stigma of being an alcoholic and never be able to
drink again in the lives. Given these reasons it is hardly surprising that
people do not attend for treatment of drinking problems until they are
desperate or hit rock bottom.
There are two rather worrisome side-effects from
treating alcohol problems in the way described above. The first of these is
that because people are reluctant to go to treatment because of stigma, etc it
means that people delay addressing their alcohol problem until it is so severe
they have no choice or they have reached rock bottom. Perhaps with a less
medicalised system people would perhaps seek treatment earlier and suffer less
damage as a consequence. However, the second side-effect is perhaps even more
worrying. Because this attitude to addiction problems, breeds dependence on the
doctor or a medical system for a solution to their dependence on substances or
other behaviors. Similar things have been written about 12 step groups, that
people become dependent upon the group or the organisation. Thus they are
transferring dependence from one thing to another.
If we are going to reduce the incidence and effects of
addiction then, rather than have a system that substitutes one dependence for
another, what we really need is a system that allows people to be free of
dependence, of any kind. This is not a radical new idea, if anything it is a
trip into a time past where we dealt with the problems in the community rather
than expected the doctor to cure them all. However, in order to do this, we
need to have a system that teaches people life skills. For example, how to
solve their problems, how to set goals for the future and perhaps the most
basic skill of all, how to communicate with each other. Maybe if people had
more of these skills, they would be less likely to develop addiction problems
in the first place. If they did develop addiction problems, they will be less
likely to be severe. If the addiction problems were severe, they would be more
likely to find a solution. Thus perhaps the solution lies in empowering people
to ‘treat’ themselves rather than creating more addiction specialists.
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