Many treatment centers follow A.A.'s 12-Step (or similar) model, including education about the signs and symptoms of addiction, evaluation for medication, counseling, exercise, meditation, family education, and aftercare. Treatment can be outpatient or inpatient and may range from thirty days up to a year or two. It is estimated that 40 to 60 percent of people who receive treatment will relapse. Treatment has become so inadequate, I stopped referring to them.
Some treatment centers are staffed with a team having varying amounts of training and differing views. On far too many occasions, staff have undermined progress or treatment plans with referrals, creating another "dysfunctional family" scenario: When a referring therapist sends a patient to treatment, a collaborative effort should be made to ensure the patient's safety and continuing treatment after discharge. This means having a sustainable support system in place prior to discharge, and a few hours of aftercare and one therapy session a week won't cut it.
Some facilities have inadequate staffing (psychiatrists, licensed experienced psychotherapists) and overstep the limits of their capabilities. Most addiction counselors and treatment centers view addiction as the insanity of doing the same thing again and again and expecting different results, but that is precisely what they are doing when they offer the patient the same failed treatment plan, again and again, then expect different results. This presents a huge financial burden on patients and insurance companies, but even worse, it deepens the patient's probability of failure and a sense of hopelessness. It's one thing to go to a few meetings and relapse, but it's emotionally devastating to spend a month or more of your life and, in many cases, invest upward of tens of thousands of dollars in treatment at a facility and fail. Also, since A.A., outpatient, and inpatient programs can't accurately track how many people stay sober and how many people relapse, there's not much data to support that residential treatment is any better than outside help. If a patient can't stay sober in outpatient treatment, I'm all for residential, but if residential didn't work the first time, Plan B should be different than Plan Alike long-term detox or daily therapy combined with a sober-living facility if necessary.
One key reason for the immense relapse rate is that treatment centers tend to ignore that addicts usually don't remain pigeonholed in one addictive pattern. To cease one addictive behavior isn't like swatting a mosquito and abolishing all insects once and for all. It's more like the Whac-A-Mole game. You smash down your addiction to alcohol, and next thing you know, you've become addicted to caffeine or cigarettesa maze is a maze is a maze.
It's not unusual for a person in treatment to smoke like a chimney, drink ten cups of coffee a day, or dive into love or sex addiction while being treated for alcoholism or drug abuseright at the facility. Treatment generally focuses on one specific behavior and fails to recognize that all addictive behaviors exist for one reasonto seemingly get rid of unwanted feelings or obtain a more positive state of mind. This approach comes from a reluctance to separate the addict from all of their vices at once.
"First things first" is the standard. Best that the addict not feel overwhelmed. But what I've found both in my practice and my personal experience is that no one can get completely well unless they first become unhinged then put back together, and there is no better place to do this than in treatment. Perhaps the real issue is the fear that no one would sign up.
But consider this: Becoming unhinged doesn't mean just falling apart. It means disconnecting from the addictive pattern itself and all of its manifestations. To do this, we must remove all the false comforts of substitute addiction and go right to the source. Healing from within is the only way to true freedom. More on this to come.
I recommend treatment only when it's in the patient's best interest to be removed from an unsafe environment or other methods of abstinence have failed. I carefully recommend a facility that is local so the patient has a support system on departure and one that will collaborate on and follow through with the patient's aftercare plan.
Behavior Modification
I'm not going to bother reviewing all of the different types of behavior modification programs that have failed (such as "controlled drinking"). Typically, controlled use is measured intake. The patient keeps a chart of agreed-upon usage and is positively reinforced (intrinsically or otherwise) by sticking to that agreement.
Another method of controlled drinking is aversion therapy, pairing a negative stimulus with the addiction of choice. For example, patients are shown pictures of a skull and crossbones next to a bottle of alcohol or given a mild electric shock every time they see a drink. Of course, every addict has already experienced enough shock, and it hasn't stopped them from drinking; it's only created a greater need to continue self-medicating.
I've worked with thousands of people who were addicted, and I've never seen anyone control their addiction for very long. The fact that they've lost control is what defines their addicted status. If a gambler could bet five dollars and walk away, she'd have accomplished that on her own. If a porn addict could control himself, he would have stopped before he got fired for using porn at work. Attempting to control any uncontrollable behavior is like teaching the mouse to have a little bite of the cheese, leave it, and make its way out of the maze.
The two most commonly used and effective methods for behavior modification are cognitive therapy and 12-Step programs.
Cognitive Therapy: Cognitive therapy helps people change their thoughts and regulate their feelings so they can change the behavior that is triggered by those thoughts and feelings.
Rational-emotive therapy, developed by Dr. Albert Ellis, and other cognitive therapies are commonly used to treat addiction by teaching patients how to recognize that their unpleasant thoughts produce unpleasant feelings. By reorganizing the irrational beliefs and replacing it with more rational thoughts, feelings would improve and thus remove the need to self-medicate. Cognitive therapy is an effective way to help people become more rational and be better thinkers, but it does not heal the wounds underneath the addiction, so it does not provide a cure. "If a bad feeling activates my addiction, I can rethink my way into a better feeling, and I won't want to act out," says the patient.
While cognitive therapy is a good adjunct tool for abstinence, it is not the end-all treatment. When a person attempts to cover an unhealed wound with cognitive-behavioral techniques, it is like putting pink frosting on a mud pie. The unhealed wound festers, and the addictive behavior either resumes in its original form or shapeshifts into a new "drug" of choice, and the person becomes sucked back into the maze. Cognitive therapy is a good first step at stopping an addiction if followed by the necessary steps to heal the underlying wound.
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