A Collaborative Approach to Addiction Treatment
Natural recovery should be seen as the primary process of addiction recovery. Treatment needs to be seen as an adjunct to natural recovery, not as the essential element of recovery. In physical health, the self-healing capacity of the body is ultimately the source of healing. A physician can intervene, but the body heals. As the 16th century French surgeon Ambroise Pare remarked, “I dressed, and God healed.” When the body is too ill to heal, no physician’s work can be effective. Although surgery today is a highly successful enterprise, we might fail to consider that many patients are refused surgery because the surgeon decides they are not well enough to benefit from it.
In psychological health, the capacity to benefit from an intervention appears to be based on the mind’s willingness to accept the intervention. How the client understands (or makes sense of) the world needs to fit well enough with the intervention provided. A priest’s prayers, a shaman’s incantations, or a medical doctor’s advice will have different effects on different individuals, very much connected with how the individual values each healer. This article being written during the 2008 election cycle, we might also consider that what a lifelong Republican hears from a Democratic candidate often “does not make any sense” (even though the same ideas are persuasive to Democrats), and vice versa.
Treatment should involve the universal human processes of seeking to maximize pleasure and minimize loss/pain. From a motivational interviewing perspective “denial” is an interaction that occurs between a client and a professional in a specific context, and not an internal characteristic of the client. Anyone (in the right context) would welcome an objective assessment of the pros and cons of their addictive behavior, if they are in any doubt about that assessment. When the assessment begins with the question “what do you like about this addictive behavior?” there is explicit acknowledgement of the addiction as an adaptive effort that has been, at least at one time, beneficial. When an individual perceives that the beneficial aspects of the addiction have been understood, there is an increased willingness to consider the costs of addictive behavior. No one likes to be criticized based on a one-sided view of his or her behavior. As the founder of cognitive therapy, Aaron Beck, might suggest, when the client states “I’m depressed because I’m a failure as a person” the professional needs to begin not by attempting to change this perspective, but by examining why it might be true.
If there is objective evidence that addictive costs exceed benefits, and the individual agrees, there may still be other issues the individual is concerned about. When and how do I actually change this behavior? Will I have any choice in this? What side effects will there be and how do I cope with them?
How then can treatment promote natural recovery by using interventions that fit with the client’s perspectives on the world (and beyond), engage his/her desires to maximize pleasure and minimize pain, and deal with concerns about how change will unfold, while also including what is known about addiction treatment? The ideal approach to addiction treatment would
1) have available a very broad range of evidence-based treatments, including ones which involve each of the probable underlying mechanisms of change.
2) not include treatments that do not work (e.g., confrontation)
3) keep evolving as the scientific literature evolves, and, at the client’s discretion, include interventions that are not (yet) fully supported but have no potential for harm
4) give clients full control over their treatment, including setting, length, intensity, specific providers involved, and treatment format
5) acknowledge that treatment is only a small part of the recovery process