What's Wrong With Addiction Treatment in America?
1. "He's been through treatment program after treatment program. None of them worked! And we still don't really feel he's had a good evaluation or any continuity of treatment."
This has been a very consistent experience reported by families of someone with an addictive disorder. There is a profound sense of being out there alone, in sharp contrast to having a relative with colon cancer. There is a great sense of fragmentation of care, as well as inconsistent opinions and recommendations. Because "programs" are arbitrarily time-limited, they have no ongoing responsibility of the care of their patients, unlike other medical specialities. How would you like it if your oncologist only saw you for 8 weeks, and then treatment ended? And once "the program" has ended, there is no care, no one to help you manage an out-of-control situation. And it's worse when "the program" is in a distant location. What is learned in an artificial, low-stress environment and now access to alcohol or drugs does not translate well when you get back home. The stacks of bills, the crying baby, the leaking roof, and the liquor store around the corner make it pretty difficult. Addiction is best treated like other disorders, with people living in their own communities, learning how to stay sober there, with everything that's going on.
2. "I (or my loved one) is in (or about to begin) a treatment program for drug X. But they don't seem to have the kind of treatments you talk about. Where can I get that kind of treatment?"
Many people I talk to are trying to figure out what type of treatment or treatment facility is going to be best for their particular problem. And they don't know where to get reliable information. Much of the information, practices and pronouncements are not supported by scientific studies, but that doesn't stop treatment programs from asserting them anyway. So the marketplace is confusing, not unlike walking through a market with each vendor hawking her wares. Testimonials and outrageous claims abound! Literally fantastic outcomes are assured! That's right! Step right up and submit your payment now! You won't be sorry! We promised 100% success if you do exactly as we tell you and you really want to succeed!
(So if you fail... well...it's your fault. Sorry.)
We need an ethic of professionalism in addiction treatment that at least reduces that type of selling of services. We need to embrace an ethic of adhering to scientific findings, and changing our beliefs when the facts change. We need to foster the humility to care, even though our treatments are only partially effective, and in some cases totally ineffective. We can't abandon our patients because we cannot change the course of their illness. Do you really think they want to die? They don't! But they and we are helpless in the face of their brain dysregulation. As is true with so many human ailments: cancer, heart disease, stroke, diabetes, depression, arthritis, multiple sclerosis. As our understanding of these diseases advances, through scientific research, our tools for preventing and treating them will improve. But it will cost a lot and take a long time. But our only hope is to support it. Research on addictions and their treatment.