Why Drug Treatment Fails
Most people in the 12-Step program recognize insanity as doing the same thing again and again and expecting different results. Yet, this very same insanity is recurring with those who go in and out of treatment and expect different results. During the 34 years that I have been in the addictions field, I have watched treatment costs rise exponentially while the quality has steadily declined. There are critical issues that must be faced if people are ever to get well.
First, the utter-chaos of mental health and addictions therapy and the lack of a coherent diagnostic process is incomprehensible and has led many patients into a no man’s land of confusion and relapse. The addiction training for mental health professionals is inadequate, and vice versa. For years, I’ve witnessed psychotherapists treat patients who were first and foremost (undiagnosed) addicts, and I’ve seen addictions counselors treat addicts who were first and foremost in need of mental health treatment.
When someone suffers from severe depression, schizophrenia, or bipolar disorder, they must have medication. Still, the current norm is to medicate, medicate, medicate – it’s the easier softer way to manage emotions – as if feelings can’t be addressed any other way. It’s time to teach people what they didn’t learn when they were young, how to deal with anger, sadness, fear, and delayed gratification.
Thirty years ago, unless there was a true dual-diagnosis, it was customary to wait a year before prescribing meds. Waiting gave the brain to re-regulate and heal itself. If a patient regressed during therapy, medication could always be added to the treatment plan. Currently, the numbers of people put on an anti-depressant, anti-psychotic, and other forms of medically assisted treatment are staggering. Now, the bar is being lowered even further with the new protocol – insurance mandated medication. Since when does an insurance company have the skill set to dictate treatment with someone they’ve never even met? One of the popular “required” medications is Suboxone, which is the same method used to treat heroin with methadone. Many of these drugs are much harder to stop than the original drug-of-choice—this is crazy.
I’m not opposed to medically assisted treatment when it’s the last option, not the first. It’s certainly a better alternative to homelessness or jail, but often, we give up too quickly because it’s just plain easier than trying harder to reach the addict that seems too far gone.
Most psychiatrists are equally ill-equipped to understand the basic list of unacceptable drug prescriptions for recovering addicts. Not to mention physicians who randomly prescribe pain pills to people in recovery and who are deaf to the dangers and alternative solutions to pain control. How many times do we have to hear that years of sobriety were wiped away with a single prescription for post-surgical narcotics?
Second, treatment centers are not treating addiction as a single entity. The addiction is independent of its source and will plug into anything that masks the hole it is trying to fill. Until we recognize there is only one addiction, the recovering person will most likely stay on the merry-go-round of switching from one thing to another—drugs to alcohol, alcohol to sex, sex to work, cigarettes to food, food to exercise, etc. Until the heart and mind are healed, the addiction remains intact. Abstinence is not recovery.
Third, treatment centers have inadequate aftercare. Sending a patient back into a non-supportive environment after treatment is like sending kids into a candy shop after school and telling them they can’t have any candy. Often the family is unsupportive, “We liked you better before you stopped ____,” and even downright sabotaging, “We can eat candy in front of you, but you can’t have any.” Or my favorite, “No, I’m not going to therapy, Al-Anon or any other stupid thing, you’ve got the problem, not me.”
Old friends who don’t have a clue about the need for abstinence also work against the fragile defense system of the newly recovering person. “Isn’t it fun to watch all of us get high, come on, you can have just one.” A newly sober person must be fully immersed in a support system of meetings, new friends, a sponsor, a sober-coach, a therapist, and anything else that helps them to feel cocooned into a new life for which they feel cared. Most people who claim they don’t like meetings haven’t had the loving arms of sober support around them.
Fourth, when therapists are sicker than the patients to whom they are providing treatment. I know of no program that requires therapists to have therapy. Think about that – the psychologically blind leading the blind. Most therapists are drawn to the field because of their personal childhood issues when they developed a sensitivity to help other people. Psychotherapy is an extremely complicated process that requires an extremely well-trained person with good mental health to navigate the murky waters of transference and counter-transference when the going gets tough. Working through the patient’s resistance, the ability to manage negative feelings and the confidence to know how to engage in carefrontation and conflict are the basic tenets of successful recovery. When a therapist unconsciously colludes with the patient’s agenda rather than being clear-minded and secure in holding firm, the therapist has given way to their own unmanaged unconscious wish to be liked over being effective.
Fifth, treatment is not enough. Trauma work isn’t enough. Going from one meeting to the next isn’t enough. To heal, we not only have to address the underlying drive to use people, places, and things as drugs, but also, we must learn that all addiction is a substitute for love. Unless someone knows what love is and what it is not, and learns how to feed the obsession with love rather than deadly and psychologically debilitating behaviors, the endless search for the next fix will never stop. Not knowing how to love oneself and others explains why people with double and triple decades of sobriety hit a wall and wind up bewildered and hopeless — often depressed and suicidal.
Learning how to love, is no easy matter for those of us who spent our lives in the maze of going from one addiction to the next, but once the code is cracked, freedom reigns. At that point, a person who is full of love will have no desire to substitute love with addiction; it will simply be of no interest. He or she is too busy having fun and fulfilling their life purpose.
When working with addicts, we differentiate each decision as love-based or fear-based. Patients are also taught (like a young child), how to love themselves. How to eat, sleep, communicate, play well with others, and all of the other basics of healthy child-growth development that create the type of human being who holds no interest in toxic substances of relationships.
The relapse rate is staggering. The time has come to put the patient’s future first and foremost. The expedient or financially lucrative systems of treatment under the pressure of insurance mandates must take a more in-depth look at their own dysfunctional systems. Reenacting the family of origin trauma, “You’re here for your parent’s benefit, we’re not here for you,” must be stopped. It’s time to refocus on what’s best for the patient, not the other way around.
No, a therapist or a treatment center cannot be responsible for a patient’s recovery; it is a collaborative effort, recovery like all relationships is a “we” program. But failure to understand that modeling a healthy relationship is fundamental to reprogramming a defective internal template can only lead to repeating the same patterns time and time again. A sober mind is not necessarily a healthy mind.
When a child fails a subject, the teacher or the institution are rarely held accountable for failure to inspire or teach in the ways that maximize learning. We can no longer turn our backs on the reasons that recovering people are failing. We must provide the education and support that will help them overcome whatever is causing the failure. This is not only possible but the only way a person will maintain long-term sobriety from all addiction.
The only meaningful “measurable outcome” is to be able to experience the love of self and others that brings about authentic happiness and success. Until this is achieved, there is more work to do, and it must be through the healthy, functional support system that replaces—rather than reenacts—the old one. Then and only then can we be assured that there’s a loving (symbolic) family to help the patient learn what any healthy parent teaches, “Let’s look at went wrong, how to do it better next time, and to never give up no matter what.”
Dr. Marks, the author of Exit the Maze – One Addiction, One Cause, One Cure, is in private practice in Palm Beach, Florida. For further information visit: www.dronnamarks.com