In this article, we begin the first installment in a new series of articles that will highlight differences between the treatment of addiction treatment and the treatment of other illnesses. This series is mean to enlighten healthcare workers, individuals, and families who are struggling with addiction as well as the public at large about essential differences between addiction care and the treatment of other psychological, medical, and psychiatric diseases. In this first installment, we hope to educate you about these differences as a means of deepening insight into what has been called “the most complex disease of mankind.”
Five characteristics that set addiction care apart from other illnesses are:
- Stopping the behaviors of addiction is the first step, not the final goal.
- Individual therapy alone is only marginally effective in the initial phase of treatment.
- In addiction, “patient-driven care” early in the process of change often produces a negative outcome.
- While undergoing treatment, feeling bad often means you are doing well.
- The most lasting change commonly involves a transformative change or spiritual awakening.
Why is it important to know about these differences? The answer is simple. If you or a family member is entering treatment expecting one type of experience, you might be surprised or even put off by what occurs while in the treatment setting. Patients often tell me, “Treatment was not what I expected.” Addiction care is unusual, especially when compared with traditional medical or psychiatric interventions. All of us have interacted with general medical care and many of us have been to see a psychologist or psychiatrist. When we enter addiction treatment, we look for similarities with what we already know. Our preconceptions may lead to confusion or even distrust. In contrast, if you understand these core differences, you are better prepared for the treatment experience.
Another important reason to discuss these differences is to help patients choose an effective treatment program. For instance, any provider who assures a patient that care will be free of any emotional (or physical) discomfort should be considered with more than a modicum of suspicion. This goes along with the fourth characteristic above—feeling emotionally upset is part and parcel of definitive treatment.
Let us consider the first characteristic listed above. If you go to a physician to treat a bacterial sinus infection, you can expect to take antibiotics for several days. Along your course of treatment, the symptoms of that illness improve. You are less congested, your headache improves, and the fever subsides. If you see a psychologist to help with your grief, you can expect the symptoms of your grief to improve over weeks and months of therapy. The bouts of crying become less frequent, sorrow is replaced with acceptance, and the painful memories grow wistful.
In the treatment of a substance use disorder, the most important signs and symptoms are compulsive and out-of-control substance use. Alcohol, marijuana, opioids, or stimulants have taken over the patient’s life. When entering treatment, the patient might expect that learning a certain set of skills will help him or her gain control over these difficult symptoms of the illness. Instead, the treatment team suggests that interrupting the symptoms is the first step in sustained change. This does not mean that preparing for abstinence is not treatment useful content. However, deep change does not occur until abstinence is acquired. In fact, many treatment providers believe that no sustained improvement will occur until abstinence is ensured.
Physicians, psychologists, and psychotherapists who are unfamiliar with addiction might begin their treatment by focusing on the emotional upheaval and interpersonal distress that surrounds addiction. They hope that decreasing the factors that seem to drive substance use might help a patient decrease or even stop using. Such an approach is well meaning, but flawed. Years of experience have taught us that addiction fans the flames of emotional distress. Such a therapist is placing a dollop of water on a raging fire while the illness itself is quietly feeding the flames with kerosene.
Good care balances compassion for an individual’s distress with a firm contract meant to interrupt substance use. Patients come into addiction treatment thinking that stopping their substance use is the full extent of their care needs. Seasoned addiction providers know different. They know that untangling the Gordian knot of the addiction illness requires a period of sustained abstinence. Once abstinence has been ensured over the short run, a patient can learn the skills necessary for a sustained recovery.
Patients arrive in treatment hoping to stop the unrelenting and often devastating symptoms of addiction. Once they have achieved initial abstinence, many have a “flight into health.” Their substance use is stopped, isn’t everything all better? In truth, short-term abstinence is but a springboard for deeper work. With abstinence, the patient can begin the journey toward recovery, learning skills that sustain abstinence and transform the addict or alcoholic into an individual that can lead a powerful and impactful life.
Stopping the signs and symptoms of addiction are indeed the first step along the path toward recovery. Getting the patient to that path and keeping them on it creates an opportunity for real change. In subsequent installments in this series, we will discuss the four hallmark differences between addiction treatment and other medical and psychological illnesses.