There’s this statistic that’s always bothered me since I learned of it back in graduate school: Of all the people who experience symptoms of addiction (also known as substance use disorder) in any given year, only 10 percent receive any kind of help—including peer support groups. It’s so stubborn that it has not meaningfully changed in the years since I became aware of it.
However, when you keep in mind that the vast majority of people experiencing substance use issues have problems that fall along the mild-to-moderate end of the spectrum, the reasons behind this become clearer. We could greatly improve access to quality treatment and help many more people if therapists felt more confident working with addiction. Thankfully, there are plenty of reasons why we should.
The sad truth is that modern addiction treatment has not meaningfully changed since its inception around the late 1940s. Back then, people here in Minnesota had created the first replicable model for treating “alcoholism,” later dubbed “the Minnesota Model.” People with drinking problems were expected to leave their families, jobs, mortgages, and other responsibilities for an entire month, followed by the recommendation to return home and attend regular 12-step meetings in their community.
This was a revelation for many, and countless people have found a pathway to healing thanks to this model. But here we are, well into the 21st century, when our knowledge and understanding of addiction have improved exponentially. And yet, the options available have not similarly changed, leading most people to believe that leaving life for a month or more of rehab is their only option—so, of course, people avoid it or refuse to go until their problems get much worse.
Don’t just take my word for it: We now have loads of evidence that therapy is an effective option for treating addiction. The proof of the various “evidence-based practices” was developed using 1:1 psychotherapy with masters-level or higher therapists. Massive trials conducted in the 1990s and early 2000s (Project MATCH and COMBINE, respectively) offered people with problematic drinking manualized psychotherapy and showed addiction therapy was effective. Since then, additional models have been developed, nearly all of which used individual therapy to show effectiveness.
To be sure, sometimes people find that therapy alone is insufficient. Medications can help a lot, and I will be sure to highlight these in a future blog post. But when we’ve exhausted our options in therapy and psychiatry, a higher level of care might be required. In this case, I help my clients select a program that appeals to them and make the referral. The best part, though, is that we get to pick up where we left off and continue our work together once they finish rehab.
I have found that there are a huge number of people out there who would much prefer to start addressing their problematic substance use with a therapist. Many of these folks are very high-functioning adults—lawyers, health care professionals, entrepreneurs, parents, and others—who have gotten into a cycle of drinking or drug use that is starting to impact their relationships, hobbies, or otherwise bring down the quality of their lives. At first, they are the only ones who are aware of the issue: They might start setting limits but go over them or make several unsuccessful attempts to quit or cut back. And yet, they are getting their jobs done, showing up for their kids or spouses, and generally keeping up appearances.
For these people, going away to rehab for a month or more is not at all attractive. What’s more, it is probably not even indicated, and they might not meet the criteria for that level of care even if they wanted rehab. Seeing a therapist regularly, on the other hand, is doable and infinitely more attractive. It’s also usually a fraction of the cost.
Exactly how we work with substance use issues is also important, and we will talk more about this moving forward. Perhaps the most important thing to keep in mind is that the most widely cited reason for not wanting treatment boils down to one thing: People are not yet ready to embrace total abstinence.
In therapy, this is not an issue. We can work with people as they try out strategies, help them plan for upcoming events and high-risk situations, and work on goals of reduced use or consumption. To do so, we must check our own biases about drinking or drug use and refrain from imposing an abstinence-only viewpoint in service of helping our clients find what works for them.
In my experience, people are hungry for alternatives to traditional rehab and eager to find an individualized approach with a therapist who is willing to take the time to get to know them. People drink and use drugs for a variety of reasons, and their substance use is often meeting some kind of need. Exploring these reasons and developing approaches to address this is engaging, rewarding, and deeply interesting work. The approaches are very familiar to most therapists, and if you are treating depression, anxiety, trauma, or ADHD, then you likely have the skills required to start addressing substance use issues as well.
Addiction is a complex but highly treatable phenomenon that responds well to therapy. Despite how pervasive it is, few people receive help when they need it. Therapists and other mental health professionals could help reduce the treatment gap by offering treatment for addictions in their current practice. This blog will provide concrete strategies to inspire therapists to become more confident about this, and it will hopefully inspire more people to seek out therapists before their use gets too severe. As someone who has been doing this work for the last 10 years, I can say with confidence that it is extremely rewarding, highly in demand, and deeply appreciated. I can’t wait to hear what you think.
The Untapped Potential of Therapy in Addiction Treatment
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29.11.2023
There’s this statistic that’s always bothered me since I learned of it back in graduate school: Of all the people who experience symptoms of addiction (also known as substance use disorder) in any given year, only 10 percent receive any kind of help—including peer support groups. It’s so stubborn that it has not meaningfully changed in the years since I became aware of it.
However, when you keep in mind that the vast majority of people experiencing substance use issues have problems that fall along the mild-to-moderate end of the spectrum, the reasons behind this become clearer. We could greatly improve access to quality treatment and help many more people if therapists felt more confident working with addiction. Thankfully, there are plenty of reasons why we should.
The sad truth is that modern addiction treatment has not meaningfully changed since its inception around the late 1940s. Back then, people here in Minnesota had created the first replicable model for treating “alcoholism,” later dubbed “the Minnesota Model.” People with drinking problems were expected to leave their families, jobs, mortgages, and other responsibilities for an entire month, followed by the recommendation to return home and attend regular 12-step meetings in their community.
This was a revelation for many, and countless people have found a pathway to healing thanks to this model. But here we are, well into the 21st century, when our knowledge and understanding........
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