WHY TREATMENT FAILS
More often than not, treatment has become just another extension in the maze of addiction. After thirty years of working in the field of addiction as a therapist, educator, consultant, and (former) co-owner of an outpatient treatment program, I have been repeatedly disheartened by the all-too-often relapse rate for those people who struggle to recover from addiction. The current models for treating addiction do not work. The reason is that the most utilized treatment strategies focus on stopping the addiction (the symptom), not healing the cause, create a temporary dependency on the facility, and then fail to develop an adequate plan for continued abstinence after discharge. Thanks for your tens of thousands of dollars and now just go to some twelve-step meetings with a room full of strangers and when you relapse time and time again, we'll keep charging you for the same program or a different version of the same program for even more money or a longer stay"
Abstinence will stop the behavior but not the addiction. In fact, all willful attempts to stop or reduce the addictive behavior only intensify the obsession. Studies have shown that for heavy drinkers, parts of the brain that can help control a drinking habit are damaged, which makes the pursuit of moderation not just a matter of will but a physical impossibility.
Please note that any reference I make to treatment for substances applies to all flavors of addiction because they are all expressions of the same disease, which I will explain later. The treatment models are pretty much the same alsoyou give up the thing to which you are addicted. There are exceptions. Obviously, for food, you would abstain from the foods you are addicted tousually wheat and sugarand learn to eat healthily. For sex, you would abstain from harmful sexual behaviors and replace those with healthy sexual intimacy. I'd also like to note that even though not all compulsive behaviors have to be medically detoxed, all do have components of emotional and physical withdrawalthe jonesing effect that shows up across any manifestation of addictionand is always painful.
The medical community has three ways they use medications to treat addictions: detox, psychiatric medications, and harm reduction.
Detox: Hospitals, mental health facilities, and detox centers are available for detoxification from excessive amounts of alcohol or drugs. "Getting clean" is the first step of the recovery process, though not every patient intends to stop using; some just want to "dry out." Detox typically occurs in a confined setting; however, some outpatient clinics will detox patients if they have a proper caregiver at home to administer meds and watch the patient carefully. One of the disadvantages of this approach is that the recovering person does not connect with other people in detox or treatment and remains isolated, thus being less likely to attend recovery meetings and make new friends.
There are several medications prescribed for detoxification. Benzodiazepines (sedatives) and anticonvulsants are administered to reduce withdrawal symptoms and the chance of seizures. Benzodiazepines can cause severe depression, psychosis, and suicidal ideology, and can be deadly when mixed with alcohol. Naltrexone blocks the euphoric effect of opiates and reduces cravings during withdrawal. Suboxone and methadone are used to treat withdrawal from opioids, but both are highly addictive. All detox drugs are prescribed on a temporary basis to help the addict wean off the drug to which they are addicted.
One problem with detox is that many programs do not provide the therapy necessary for long-term remission. Many patients use detox centers to medically withdraw then start drinking or drugging again. A physician at a local hospital recently referred a patient to me who had detoxed five times within a few months. When I met with the patient, it was clear she had no intention of doing the work necessary to stay sober, especially since she was able to use the hospital as her legal drug dealer. When she couldn't stop drinking, the patient would get detoxed on massive doses of benzodiazepines then go on to stay sober for a week or two and repeat the patterns all over again. She simply used the detox medication to get high while she wasn't drinking.
I believe that detox centers could expand to address all manifestations of addiction. Since withdrawal from any addictive behavior has the same symptoms of anger, irritability, depression, and craving, a one- or two-week stay in a facility could ease the withdrawal. Temporary emotional support, safety, and self-care could stabilize a person, reduce chances of relapse, and prepare the person for intensive outpatient therapy and adequate support upon dischargesomething that is currently lacking.
Prevention: Antabuse is a medication that is given to alcoholics after they are detoxed to prevent relapse. The patient is responsible for taking a pill that when mixed with alcohol causes nausea, dizziness, chest pain, and other unpleasant effects. It only works if taken daily, and once alcoholics decide to drink, they set the pill aside.
Psychiatric Medications: Some medications are necessary if a person has a secondary mood or mental disorder such as anxiety, depression, personality disorder, or psychotic disorder. On the other hand, someone in emotional or physical withdrawal might exhibit all of the symptoms of mental illness, but given some time for the brain to regulate, these symptoms often subside. It is my opinion that in the past twenty years, the trend has been to prematurely render a dual diagnosis because many insurance companies will provide additional benefits for mental disorders.
Antidepressants: In the 1980s and early 1990s, unless a patient was severely impaired, it was customary to wait a year before prescribing antidepressant medication. At that time, depression was classified under two categories. Reactive depression was due to an environmental stress such as loss of a loved one and was typically treated with therapy. The other type was a neurochemical imbalance, which was treated with medication. If the environmentally induced stress was severe, such as the unexpected loss of a spouse or a child or being the victim of a violent crime, short-term medication was sometimes prescribed to stabilize the patient enough for them to benefit from therapy.
In 1980, when the third revision of the Diagnostic and Statistical Manual was released, there was an attempt to "re-medicalize" American psychiatry. The DSM-III elected to put all depressive and manic conditions under the category of "mood disorders," and this kicked off a slow shift toward prescribing more medication for these types of diagnoses. Now under the classification of mood disorders, depression due to environmental stress is regularly treated with medication, and in many cases, it is prescribed as an alternative to therapy. At the very least, a person should be given the opportunity to grieve a loss or process trauma before medicating the pain with an antidepressant.
These patients are prescribed serotonin reuptake inhibitors (SSRIs), which reduce symptoms by increasing serotonin levels in the brain. The most common drugs are Celexa, Lexapro, Paxil, Prozac, and Zoloft. These medications are not mood altering, but as I mentioned earlier, many patients who remain on these types of medications for a long period of time, then want to stop, go through a different kind of hell wrought with the symptoms of withdrawal experienced by any addict.
One patient, Jill, struggled with an eating disorder and depression and had been on an antidepressant medication for ten years. At the time, she was not happy in her marriage, her husband traveled, and she often was left alone at home with their two children. When her husband was home, he showed little interest in her, and she used food to soothe herself. Her medical doctor told her she was suffering from "clinical depression" and prescribed an antidepressant. (Jill should have been referred to a psychotherapist first.) Two of the side effects of the medication were weight gain and decreased sexual interest including the inability to have orgasms. During her therapy, we discussed getting to the bottom of her pain, so she could heal the feelings underneath her depression. She felt that the medication had made her emotionally numb, and she wanted to go off of it, so she could "get herself back." Under her physician's care, she was slowly weaned off the medication over a six-month period during which Jill suffered bouts of severe anxiety, clamminess, insomnia, nightmares, obsessive thoughts, and morbid feelings in the morning, all symptoms she'd never experienced before taking antidepressants. It took over a year for Jill to begin to feel back to her old self, and she often said had she known about the side effects, she never would have started the medication.
Anti-Anxiety Medications: Anxiety can be treated with some of the same SSRIs as depression, but sometimes anxiety is treated with a benzodiazepine, such as Valium, Xanax, or Ativan, all mood-altering substances. Like other sedative drugs, they create a sense of calm or euphoria, and for someone prone to addiction, they aren't much different than drinking or drugging away the anxiety. Again, the anxiety should be treated with psychotherapy prior to medication whenever possible.
Antipsychotic drugs: While it is critical that someone who genuinely suffers from a dual diagnosis be provided the necessary medication, I do feel this should not be made in haste. A psychiatrist can order blood work to determine a true chemical imbalance, and if warranted, this should be done at regular intervals to adjust the medication as necessary. Most antipsychotic drugs are not addictive.
A person who genuinely suffers a dual diagnosis (an addiction paired with a mental disorder) will need to be on medication to stabilize their mental disorder before they can benefit from addiction treatment. Secondary disorders are treated with medicine that is not mood-altering but will regulate the chemical imbalance in the brain. Someone who has a mental disorder will need to be informed that it is critical they stay on the medication.
Medication has an important place in treating addiction and mental illness. It is miraculous that a person suffering from schizophrenia, bipolar disorder, or suicidal ideation can be given a non-mood-altering pill and be asymptomatic. Further, there is little chance of these people staying sober when they are suffering from psychosis (visual and auditory hallucinations, delusional thinking) without being stabilized first. My only concern is that often a patient is prematurely diagnosed with anxiety or depression, or even substance-induced psychosis, and once again, rather than helping a person work through what's causing their symptoms, the symptoms are medicated, which only keeps the person stuck in their pain rather than healing it.
In any case, after detox, psychiatrists and physicians should never prescribe mood-altering drugs. The addict is prone to take any mood-altering medication offered, so prescribing it only expands the addict's repertoire of drugs. To an addict, a drug is a drug is a drug, and once the substance is in the brain, the cycle resumes wherever it left off. More cheese, please.
Harm Reduction: Medically assisted treatment (MAT) is offered when a person fails at numerous attempts in treatment. Patients are prescribed drugs from which they are supposed to be titrated, along with counseling and attendance at recovery meetings. Methadone, Suboxone, and naltrexone are prescribed for opiate addiction. Women who are opiate addicts and pregnant are administered methadone to prevent mother and fetal withdrawal and buprenorphine to reduce cravings for all opioids including morphine and heroin. Chantix is prescribed for smoking cessation and nicotine replacement therapy (NRT) is administered as an alternative to smoking. Naltrexone, which reduces the euphoric effects of alcohol, is also given to alcoholics so they can drink without craving more.
I'm not sure why giving up on a program of abstinence is a good idea. There is the assumption that it's just too hard for the addict to stop rather than looking more carefully at the relapse triggers and responses. Giving additional dangerous drugs to people so they can better manage their drug use seems to be just another way to keep people addicted. Many MAT patients do not seek counseling or recovery meetings and are not weaned off of the drugs, another shortcoming of this program.
This harm-reduction method is based on the notion that addicts should be given drugs to reduce the negative consequences of using. Rather than trying to force abstinence or wean the addict, the drug abuser is provided the substances needed to prevent illicit drug use, overdose, the spread of infectious diseases, and other harmful outcomes. Methadone is prescribed for heroin and other opiate addicts, and needle facilities are provided as well.
It is highly unlikely that many people under the harm reduction model voluntarily would seek help to stop an addiction. People in these programs are unlikely to recover because they are being given the subliminal message that they should give up trying to stop.
Another grave concern I have about MAT has come about recently. Several new patients have come to see me and reported that even though they'd been in A.A. and maintained sobriety for a long time, they are now smoking pot. They have reported they were effortlessly prescribed a license to receive medical marijuana and have surrendered their recovery to relapse on pot. One patient who was thinking about smoking it told me it was a "gray area," and he received clarification when I told him it was not a gray area; it's black and white. You're either sober or you're not.
The form of marijuana that was legally approved for genuine medical conditions such as pain control and reducing nausea from chemotherapy is supposed to have minimal amounts of THC, so that it is not mood-altering. The dozens of people I've spoken with who are on today's brand of "medical marijuana" say, "It's the best pot I've ever had."
Lots of people in A.A. are now smoking pot under the illusion they are sober. All of the people who have come to see me are in the throes of an emotional crash. They have suffered numerous consequences including having traumatized their children who had been proud of their parent's sobriety. It's clear to see that none of these people had been cured of their addiction in the first place or they would not have taken such risks.
My big beef with medically assisted treatment is that it's becoming compulsory, mandated by insurance companies that, for example, won't pay for treatment of drug addiction unless a patient is put on Suboxone - another addictive drug. In some instances, employees of MAT facilities are going out into the community and recruiting potential patients, including the homeless, so they can pull more people into their programs and get more government funding. My belief is that MAT should be given as a last resort.
While it is important to respect a person's right to do what they want with their bodies, I'm not sure why providing legal drugs to a drug addict is considered treatment and not enabling. Giving drugs to addicts is just another way of lowering the bar and helping them use drugs rather than helping them to recover. Yes, it's certainly better for a person to be legally administered a controlled substance if it helps them lead a relatively functional life rather than winding up in jail, being homeless, or contracting a disease. Drug addiction treatment is much less expensive than its alternatives, such as incarcerating addicted persons, and treatment doesn't isolate the person from their family. I also agree that it is good to eliminate all criminal elements of drug addiction, but if that's the route we're going to take, why not legalize all drugs, tax them, and use the funds for education and prevention? We could start with teaching parents to lead by example and teach their children it is never a good idea to poison their precious, lovable bodies and developing brains with deadly substances.
Treatment Centers/Rehab - Up until the mid-1900s, people suffering from alcoholism or drug addiction were sent to asylums, but once released from the hospital, patients usually relapsed. Over the past thirty years, treatment centers have become the go-to place for people who need help for an addiction. And treatment centers are big business often purchased by venture capitalists whose knowledge of addiction could be put on a pinhead. Even worse, they think a crash-course on addiction is enough of an understanding to qualify for ownership and competency. I have repeatedly been shocked by the owners of facilities who think they know what they do not know. Very few of these people seek consultation and when they do, the consultants are operating under archaic norms and mores for treatment.
There are treatment centers for every possible addictionmost substances, food, gambling, sex, and codependency. Market Watch reported that there are more than 14,000 treatment centers in the United States, pulling in annual revenue of $35 billion. Patients may go to treatment voluntarily, through a court order, or as a result of a family intervention.
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.
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.
SMART Recovery is also a cognitive-based treatment to manage thoughts and feelings, but it also addresses motivation, urges to use, and a balanced life. The group meetings are held once or twice weekly, have a trained group facilitator, and are free of charge. A downside of SMART Recovery is that one or two weekly meetings are not enough for people whose addiction is constantly gnawing at them.
12-Step Programs: The original 12-Step program of Alcoholics Anonymous was founded in 1935 when a few people, having gone through every imaginable attempt at sobriety, became able to maintain abstinence through a behavioral and spiritual program that involved the admission of powerlessness, willingness to be abstinent, righting their wrongs, and finding a connection to a "higher power." A.A. views alcoholism as a mental obsession, physical addiction, and spiritual void. From my observations, the "willingness to ask a higher power to remove the obsession" to partake of the addiction has been extremely successful for those who follow this suggestion.
Since the first A.A. meeting, 12-Step meetings have popped up worldwide for every addiction imaginable. Attended by millions, meetings are ubiquitouslive or onlineand cost nothing. In my opinion, the 12-Step program, when followed, is more effective for obtaining abstinence than any other form of treatment. Recent research has concluded that spiritual- and religious-based interventions are more effective at reducing or eliminating substance use and equally as effective as other programs on broader measures of wellness and function.
A.A. reports a 50 percent success rate, with about 25 percent of the successes occurring after numerous attempts, though many of these folks may continue to go on and off the wagon.
The 12 Steps are an excellent way to stop a behavior and develop a solid support system, but the program falls short when it comes to addressing the trauma that underlies most addictive behavior. When asked to do a moral inventory and find "your own role" in painful relationships, it is not likely to uncover or address the original wound that led to the whole mess in the first place. The 12-Step programs do recommend "outside help" for people who suffer emotional or mental disorders. In my opinion, that would be almost every addict.
Children are not the cause of their own abuse or neglect. Glossing over the pain only drives the memory of trauma deeper into the unconscious mind. Consequently, people either suffer chronic relapses, or they stay sober but become addicted to something else, and/or remain miserable.
There are many types of professionals who offer outpatient psychotherapy; each one has benefits as well as limitations.
Psychiatrists are medical doctors who specialize in psychiatry and who tend to treat most psychiatric disorders with medication. Unlike the founders of psychotherapy, Sigmund Freud and his followers, most psychiatrists today do not offer psychotherapy. When treating addiction, psychiatrists write prescriptions to help patients reduce the withdrawal effects or substitute one drug for a less addictive one, or they prescribe Antabuse, which causes violent nausea when mixed with alcohol. A psychiatrist also will screen for a psychiatric diagnosis other than the addiction. I carefully select the psychiatrist with whom I work, so that we can collaborate on treatment. I will cover this in greater detail later on.
Psychologists have doctorate degrees in psychology, and counselors have master's degrees in mental health, psychology, or a related field such as social work. None is specifically trained in addictions, nor can they prescribe medication. I have seen numerous patients who were substance abusers and went for years to a psychologist and mental health counselor who knew little to nothing about the symptoms of addiction, so it was never addressed.
Addiction counselors usually have either two-year or four-year degrees in addictions and are either certified or licensed in that field. The complexities of sorting out pathology from addiction is not a simple matter. Addiction counselors are trained to diagnose and counsel people on how to stay sober. They are not trained to diagnose or treat personality disorders: narcissism or borderline, antisocial, or paranoid personalities. Nor are they trained to treat mental illness such as schizophrenia, manic-depression, major depressive disorders, or psychosis, all of which require that the patient be on medication to be able to perform life's daily tasks and functions.
Addiction counselors are not trained to discern the difference between an organic psychosis and a drug-induced psychosis. Research has indicated a link between young pot users and schizophrenic-like symptoms. For example, I have treated several young men who were diagnosed with schizophrenia, but who were in fact addicted to marijuana, and when they stopped using, the schizophrenic symptoms stopped. This misdiagnosis is common, and these types of situations require a psychiatrist's evaluation to be sure.
As one example, John was brought to therapy by his uncle because he was "acting strange." John had been talking about aliens and was writing nonsensical things in his notebook. He also thought he was a unique species of human who could breathe underneath the water. All of these are schizophrenic-like symptoms, but John had had no prior episodes of psychosis.
However, John had used large quantities of both marijuana and hallucinogens. He reported, and his uncle confirmed, that he had been in A.A. for six months, and yet he was psychotic. John's symptoms were inexplicable, and I referred him to the psychiatrist with whom I consult and who is a highly skilled diagnostician. He was unsure whether John's psychosis was organic or the result of drug use, but he prescribed him the appropriate medication, so John could be stabilized. After six months, John was weaned off the medication to see if his symptoms would return. When they did not, we were able to draw the conclusion that his symptoms were most likely due to his prior drug use. To be on the safe side, John continued to meet with the psychiatrist every few months.
Psychoanalysts are either licensed in psychiatry, psychology, or mental health and are required to complete several years of postgraduate education, supervision, and personal psychoanalysis. Treatment is targeted at addressing the underlying causes of emotional disorders, and psychoanalysts must go through their own personal psychoanalysis before certificationat least three or more sessions per week for usually a minimum of four years. I'd like to point out that psychoanalysts are the only licensed professionals who are required to have had therapy prior to certification. This means that many counselors could be unhealthier than the people they are treating.
I've often worked with people who, prior to seeing me, were in psychoanalysis for years, who drank and used drugs (or were otherwise addicted) on their way through the process with the other analysts. They might have connected the dots of the precipitating factors of their addiction, but they were still actively using and too numb or shut down to grieve, and they remained unhealed and addicted. This goes to show once again how even psychotherapists who have undergone their own analysis do not always see addiction when it is right in front of them.
Confused? Welcome to my world. I haven't even introduced the other types of licensed or certified addiction professionals: nurse practitioners, psychiatric nurses, educational psychologists, certified life coaches, guidance counselors, hypnotherapists, sponsors, all with varying degrees of education and training in addiction diagnosis and treatment. All are well-meaning and all have their own opinions that, in many cases, are freely offered to the same patient. With all the conflicting advice and variations in diagnosis, it is no wonder that people struggling with addiction are in a maze. I ran around in the maze a long time before I was able to put it all together. I've made it a life-long study and I've been able to advise patients and treatment centers alike on how to exit the maze.
The time has come to stop this insanity. Addiction can be stopped and it doesn't need to be a life-long struggle. Ineffective treatment strategies can be replaced with a system that will work. Further, we can eradicate addiction by preventing it in the first place all outlined in the book, Exit the Maze - One Addiction, One Cause, One Cure. It's time to get off the band-wagon of a cookie-cutter approach that does not work, and it's time to raise the bar rather than promoting ineffective treatment, just another hallway in the addiction maze.