Rethinking substance abuse/addiction treatment programs
For many years I have been aware that treatment programs for those dealing with addiction are successful long term for a relatively low percentage of people. My suspicion is that they are most successful for those whose addiction begins in their late twenties or older. This may be because many of these individuals already have a history of making decisions based on core values. Obeying the prompting of core values may be the only reward they needed prior to addiction. In other words, they have a history of facing life on life’s terms head on. These individuals are often able to use such programs as the 12 programs to refrain from any compulsive urge to again use addictive behavior to face tough life issues. These individuals are also more likely to have a healthy support system in place.
Some of the individuals I see fit the above description. While continued recovery cannot be taken for granted many are very successful in reclaiming themselves and a healthy, physical, emotional, financial, and spiritual life.
The individuals who are most likely to relapse are those who began their addictive behavior (may not have started with food, alcohol or other drugs) relatively early in life. It is also likely that they score high on the ACE – number of traumas – and may have had parents who themselves were struggling with addiction or other issues. This group includes those who may have had a heathy family setting but never felt as if they belonged in that family. This could have been because of a mental illness, an undiagnosed or poorly treated learning disability or some other condition. They may report that they were always uncomfortable in their own skin. This group may not have a strong sense of core values or experience in accessing and making decisions based on those core values.
I often listen to the podcast Hidden Brain the host of which is Shankar Vedantam. This morning I listened to a rebroadcast of a 2018 episode entitled “When things click” This episode deals with a review of teaching methods based on the principles of operant conditioning. One of the guests is a frisbee coach, a surgeon and a surgical teacher. For both frisbee teachers and new surgeons the only reward system he uses is the sound of a clicker. The actual reward is the satisfaction of a job well done. He never uses negative reinforcement or punishment. It is also significant that he “breaks the skills down into tiny, incremental steps.”
I thought about the skills and steps necessary for recovering addicts .to make healthy decisions. These include:
- Daily hygiene
- Daily healthy nutrition.
- Daily home maintenance.
- Daily calling sponsor and sharing successes and concerns.
- Daily journaling which involves practicing the HOW of the program – honestly, open mindedness and willingness.
- Reaching out to one’s healthy support system before one decides to date/hook up or make other potentially unhealthy decisions.
- Job interviewing
- Expectations of employers.
- Care of children or other family members
- Budgeting time, energy, and money.
- Daily physical exercise/centering.
The coach surgeon, Dr. Levy, using the clicker, suggests that “All the usual interference from the teacher – ‘great job,’ ‘well done,’ ‘no wrong is removed. “This is why I use the clicker,’ says Dr. Levy. “It is baggage-free.”
Most of the professionals working in addiction treatment programs are licensed counselors, social workers, psychologists or physicians. There are also para-professionals who are frequently individuals who themselves are in recovery. They are almost always kind, loving, touchy feely people who are quick to give praise and sometimes quick to be critical. When someone relapses, they are frequently removed from the treatment program for a period of time or for good. It is interesting to question whether the frequent use of praise and criticism (overt and covert) is sometimes counterproductive. It may also be important to ask if enough time and effort is spent breaking down the needed skill sets into small, teachable units of behavior. For example, should more time be spent teaching the use of the phone to call and talk to the sponsor and other healthy support people. Do we need to teach the steps of journaling? Should we be using a less baggage free clicker system?
Obviously love and respect is important components of any healing program. Yet these are not sufficient.
Do we need to rethink the central role of group and individual cognitive based therapy? They may be important components but not the central ones.
As social scientists it is imperative that we continue to step back and question how we are approaching treatment and whether or not we are using an optimal healing approach. I believe that we can be more skilled employees of those seeking recovery from active addiction.
Written February 7, 2020
Jimmy F Pickett
coachpickett.org
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