How can we continue with our current addiction treatment model?
Our current standard of care involves a system that was developed over sixty years ago. The typical treatment program begins with waiting for the substance user to “hit bottom” and be ready to get help. The substance user is then admitted to a treatment facility for 30 days (give or take), usually after detox. The client is taught about the 12 steps, the family is included for a “Family Weekend”, the client is instructed to attend 12 step meetings after discharge, and the therapeutic relationship is generally severed at that time. This plan was somewhat effective with middle-aged alcoholics, but that is not the case today. Waiting for a teen or young adult, with a serious drug problem, to “hit bottom and become willing” is essentially murder. Opioids, especially the extremely powerful ones such as fentanyl, are killing people at an alarming rate, we don’t have time to wait for these folks to seek help. We should seek them out wherever we can find them, meet them where they are (physically, emotionally and spiritually).
The rinse and recycle program of the typical treatment center is not adequate. Seventy percent of persons entering treatment today have been there before. Ten percent have been in five or more times. If a surgeon had to repeat surgery on seventy percent of his patients, he would be considered totally incompetent, yet the system deems this acceptable for treating addiction. In fact they are okay with people coming back again and again, if they have funding. The system is broken!
There is reason to believe that the use of peer support recovery coaches holds promise as a new model to address this disease. I believe that when we identify a person with the disease of addiction (whether they present for help, are identified by friends or loved ones, enter the criminal justice system, etc.), we should have a recovery coach begin the process of drawing them out, instilling hope, and encouraging recovery. They can then help direct the person to the appropriate resources (in-patient or out-patient treatment, 12 step recovery, medication assisted treatment, individual or family counselling, or whatever other paths are identified. They can then rally the family in a way that is appropriately supportive of the substance user. We might involve a family recovery coach, or maybe a counsellor, to be a part of the recovery team. That team should continue with the client for at least a year of solid remission of the disease, and possibly for as long as five years. The recovery programs for pilots and physicians are very effective, and I believe this is due to the long term follow-up that is an integral part of these programs.
The key factors that are predictive of success in recovery are what I call the Four H’s…Housing, Healthcare, Hope and Helpers. Housing means safe housing in a safe environment. When we take someone out of a terribly unhealthy situation and get their disease into remission, and then return them to the same horrible environment, how can we be shocked when they have a recurrence? Even if the home itself is safe and loving, they are still back in with the same “playmates and playgrounds.” These temptations can be overwhelming and trigger a return to using. The brain, in early recovery, is still very susceptible to triggers and cues related to previous use. It takes several months for the neurochemical changes caused by chronic drug use to return to normal. Healthcare includes addressing physical, emotional, mental, and spiritual health. This is a multifaceted disease that effects all of these areas. Hope refers to the opportunity to return to a healthy, happy, productive life. This may include being reunited with family, getting custody of children back, resuming ones work life, or returning to school. We all want to be happy in life and that is a strong motivator for recovery! Helpers includes the recovery team. This may include family, peer recovery coach, family recovery coach, counselor, or even a sponsor (if the person is a member of a 12 step group or similar organization). The recovery team may help the person get into treatment, identify and join a mutual assistance group, apply for jobs or school, and similar opportunities. I believe that these are the keys to success.
It is time for a total paradigm shift, if we are to save lives. It is up to us to make history!
~~ E.V. Archambeau, MD