Why Do So Many Have to be Forced Into Treatment? (And how to make help more attractive and effective.)

Stanton Peele and Zach Rhoads 

There’s benefit to seeking life help in the form of therapy, counseling, coaching and mutual-aid groups. But most of that which is available for addiction doesn’t provide essential benefits. 

The Life Process Program operates as a therapeutic coaching program. It is premised on the belief that—with or without outside help—people have the power to help themselves, if only they can sort out their values and goals, and access their best skills, resources, motivation, and ability to set and to accomplish goals. You have this ability.

(The following is excerpted from Stanton’s forthcoming memoir: A Scientific Life on the Edge: My Lonely Quest to Change How We See Addiction.)

Here is the Rolling Stone headline about Oregon’s “Reform” Measure 110  “Decriminalizing” Drugs:

Drug Decriminalization Goes Into Effect in Oregon

Measure 110 prioritizes drug treatment over police enforcement, using cannabis revenue to open new addiction treatment centers across the state.

Do you notice how integral treatment is in the new law? In the first place, treatment is “prioritized” over police enforcement. But how exactly are the drug users to be treated “identified.” The answer: they are apprehended by police, who funnel them into treatment.

And, then, to handle this new spigot of customers, vast state marijuana revenues are being used to create “new addiction treatment centers across the state.”

Does the US not have enough drug treatment? Au contraire: the US is the world’s leading provider of drug treatment, both public and private, both 12-step and “medicine” based. But it is always expanding. To wit, from the National Institute on Drug Abuse in 2018:

Treatment for drug abuse and addiction is delivered in many different settings using a variety of behavioral and pharmacological approaches. In the United States, more than 14,500 specialized drug treatment facilities provide counseling, behavioral therapy, medication, case management, and other types of services to persons with substance use disorders.

Along with specialized drug treatment facilities, drug abuse and addiction are treated in physicians’ offices and mental health clinics by a variety of providers, including counselors, physicians, psychiatrists, psychologists, nurses, and social workers. Treatment is delivered in outpatient, inpatient, and residential settings. Although specific treatment approaches often are associated with particular treatment settings, a variety of therapeutic interventions or services can be included in any given setting.

Because drug abuse and addiction are major public health problems, a large portion of drug treatment is funded by local, State, and Federal governments. Private and employer-subsidized health plans also may provide coverage for treatment of addiction and its medical consequences. . . .The recent passage of parity for insurance coverage of mental health and substance abuse problems will hopefully improve this state of affairs. Health Care Reform also stands to increase the demand for drug abuse treatment services and presents an opportunity to study how innovations in service delivery, organization, and financing can improve access to and use of them.

We are left then to wonder why the US is at the very top of the world list in drug deaths and disability, including amphetamines, cocaine, and opioids, as outlined in the 2019 World Happiness Report:

Recent data of the Institute of Health Metrics and Evaluation (IHME) show that the US has among the world’s highest rates of substance abuse. The estimates for 2017 are shown in Table 1, comparing the US, Europe, and Global rates of disease burden for various categories of substance abuse. The measures are the Disability-Adjusted Life Years (DALYs) per 100,000 (100K) population. For example, the US lost 1,703.3 DALYs per 100K population from all forms of drug use, the second-highest rate of drug-use disease burden in the world. The US rate compares with 340.5 DALYs per 100K in Europe, roughly one-fifth of the US rate.

Among all 196 countries, the US ranks 2nd overall in DALYs lost to all drug use disorders; 1st in DALYs from cocaine use; 3rd in DALYs from opioid addiction; and 2nd in DALYs from amphetamine use. (my emphasis)

In fact, drug treatment locales are associated with drug deaths. Consider the very epicenter of drug treatment in the US: Delray Beach, Florida (as described in the New York Times in 2017):

In a nation awash in opioids, there are few, if any, places where this kind of scene plays out more often than this artsy beach town of 15 square miles. Here, heroin overdoses long ago elbowed out car crashes and routine health issues as the most common medical emergencies. Last year, Delray paramedics responded to 748 overdose calls; 65 ended in fatalities. In all, Palm Beach County dealt with 5,000 overdose calls.

Unlike other places in the United States that have been clobbered by the opioid crisis, most of the young people who overdose in Delray Beach are not from here. They are visitors, mostly from the Northeast and Midwest, and they come for opioid addiction treatment and recovery help to a town that has long been hailed as a lifeline for substance abusers. But what many of these addicts find here today is a crippled and dangerous system, fueled in the past three years by insurance fraud, abuse, minimal oversight and lax laws. The result in Palm Beach County has been the rapid proliferation of troubled treatment centers, labs and group homes where unknowing addicts, exploited for insurance money, fall deeper into addiction. (my emphasis)

Thus, as the US has increased addiction treatment nationwide, the 12-month period ending in September 2020 (half before the pandemic, half after) witnessed a new record 87,000 drug deaths, an increase of 20,000 from 2018, and a 400 percent annual increase in drug deaths since the end of the 1990s.

Unfortunately, I saw this coming, as I announced in a featured debate at the 1996 Drug Policy Reform Conference:

The most popular version of drug reform is that we should shift funds from our massive drug interdiction and law enforcement efforts to the treatment of people with drug problems (of course, treatment for drug abuse is already a massive enterprise in the US; SAMHSA, 1997). The failures of current punitive approaches are so obvious, and the value of treatment is so unquestioned, that a wide range of those involved in substance abuse policy and treatment endorse this shift.

There is also a large industry engaged in propagandizing on behalf of this position. On the Internet (www.health.org/csat/) and through other media, “Treatment Works! Month” is celebrated annually. “Designed by SAMHSA (Substance Abuse and Mental Health Services Administration)/CSAT (Center for Substance Abuse Treatment) with the cooperation of the National Association of Alcoholism and Drug Abuse Counselors (NAADAC), these promotional materials will help educate people throughout your state, county, city or community about the true value of treatment and the fact that it really works.”

Why, indeed, are drug, alcohol, and addiction treatment so unpopular that it is necessary to constantly propagandize about the value of drug treatment, while forcing so many people into it?

The five reasons drug, alcohol, and addiction treatment are so unpopular, and such failures, that people won’t willingly enter it

  1. Treatment is presented as being in opposition to people’s desires, which are assumed to be negative, leading them to harm themselves.
  2. Treatment denigrates people’s belief in themselves, in their skills, past successes, and current relationships and options.
  3. Treatment detracts from people’s sense of their own agency, of their ability to control and to improve their lives.
  4. Treatment is imposed on people, rather than seen as a collaboration of wills and efforts.
  5. People are chastised, punished, and belittled for expressing their beliefs about who they are and their own value.

People will not change under these conditions, or indeed willingly submit to such treatment, which puts them at war with themselves, their desires, and their own positive impulses.

 

In fact, we believe that people will always seek what they believe, and find, is best for them if given the choice and the opportunity to do so. Only when help is offered in this vein can people accept and benefit from it.

Exercise in self help

YOU have this ability. 

How about being your own best helper? No one knows YOU better.

Set some time aside to answer these questions for yourself, then answer them in the comment section if you’re feeling brave 🙂

  1. What have you wanted to accomplish but not succeeded at? (Pick one difficult and one easier goal.)
  2. Do you think you can really accomplish these goals?
  3. What has stopped you in the past?
  4. What could you do differently? 
  5. What is an entirely new way to make sure you succeed? (Think outside the box—even bordering on “crazy talk”.)

 

Don’t you see now how much you can accomplish and change?

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