“The opposite of addiction is not sobriety. The opposite of addiction is connection.”
Johann Hari, Chasing the Scream
Ideas about how to treat addiction are so widespread that it seems almost impossible to imagine alternatives. Endless films, TV shows, and news coverage have led us to believe that if someone is addicted to drugs, the only solution is for them to stop, cold turkey.
However, treatment needs to move beyond just sobriety. Here’s why:
1. When abstinence is the only option, people fall through the cracks.
Contrary to popular belief, AA and Twelve-Step treatments are not actually evidence-based approaches to addiction treatment. A 2006 review of studies going back to the 1960s found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.” And yet, at least 80% of all rehabs rely on these treatments as the foundation for their centers, with sobriety as their ultimate goal.
Though these methods work for some, they do not work for all.
Also, because many people do not want to define as an addict or are not in a place where they want to commit to a lifetime of sobriety, they opt not to seek help at all. In fact, currently only 1 in 10 people dealing with addiction receive treatment. And of those who did not seek help, 25% say it’s because they are not ready to stop using. It’s critical for multiple options to exist so that more people get the help they need.
2. Drugs and alcohol are not the cause of addiction. They are the symptom.
The idea that drugs are addictive in and of themselves, because of their chemical compositions or effects, is a myth. Surprisingly, only 10-20% of those who try even the most stigmatized drugs like heroin, crack, and methamphetamine become addicted.
Instead, addiction most often occurs as response to pain that a person is experiencing. Addictive behaviors are a coping mechanism to deal with complex and dynamic personal and societal factors. At least two thirds of addicted people have suffered at least one extremely traumatic experience during childhood--and the higher the exposure to trauma, the greater the risk. To overcome addiction, It’s important to address these underlying causes.
3. When people steer the course of their own treatment, outcomes last.
When you know someone dealing with an addiction, it’s a common desire to want to use a little bit of “tough love,” lay down the law, and tell them to just stop already. Unfortunately, that’s not how behavior change works.
Addiction often arises for people in response feeling a lack of control over their life circumstances. Treatment that is confrontational or imposes a particular outcome sometimes just reinforces this feeling of lack of control. A person might comply with sobriety in the short-term, but find that it doesn’t stick. In fact, we know that most traditional programs, particularly ones that advertise a “guarantee of success” toward a singular outcome of sobriety, see high rates of sobriety at the program’s completion, but questionable rates of long-term success. And in reviewing over four decades of research, Bill Miller and Bill White found that not a single study supported the confrontational approach as better than kinder and less harmful treatments.
By contrast, when people have a say the course of their treatment, it is more effective. Treatment where clients drive the outcomes, where clinicians incorporate formal, real time feedback from clients, has better retention and outcomes. In this approach, people have a stake in their healing and are often clearer about what they want and value. The result is deeper and more sustainable change.
4. When you meet people where they are, you reduce harm.
Renegotiating relationships to substances takes time and, more often than not, involves making mistakes. Yet, many rehab programs view relapses as a sign of failure or even as grounds to kick someone out of treatment, rather than as a part of the natural course of recovery.
By contrast, research on non-judgmental harm reduction approaches, like needle exchanges and health interventions, show reduced infection and overdose. These approaches do not prolong addiction. In fact, numerous doctors, clinicians, and community practitioners who practice harm reduction say their clients would not have started their recovery journey if not for these methods.
Harm reduction approaches lead with the sentiment that a person’s life is valuable, no matter what. When people see that others value them, they start to value themselves.
5. Renegotiating substance use on a person’s own terms allows them to go deeper and open up possibilities.
Solely encouraging someone to shift their behavior just scratches the surface. Addressing the symptom without treating the pain that informs it does not address the cycle of addiction.
When the conversation becomes less about taking away a person’s escape from pain and more about addressing the pain that drives these behaviors, the possibilities for effective treatment multiply. What are a person’s fears, dreams, and desires? What gives them meaning in life and how can they reconnect with their sense of inner purpose?
Shifting treatment towards an individualized approach tackles the underlying driving forces of addiction and allows for deeper and more sustainable change in a person’s life.
No one size fits all solution
Sobriety should not be the only solution. This doesn’t mean that quitting is a bad idea. In fact, abstinence may be the best solution for you if drugs and alcohol are extremely triggering or repeatedly stand in the way of what you desire. If this is the case, sobriety is absolutely worth it.
The important thing is to understand that recovery looks different for every person. There is no one-size-fits-all solution to addiction, just as there’s no one-size-fits-all solution to anxiety or depression.
Effective treatment should lead instead with respect, meeting a person where they are and respecting where they want to go. Another way is possible.
Alexander, Bruce K., M.D. The Globalization of Addiction. Oxford: Oxford University Press, 2008.
The Business of Recovery, Film directed by Adam Finberg, Greg Horvath Productions, 2015.
Ferri M, et al. “Alcoholics Anonymous and other 12-step programmes for alcohol dependence.” Cochrane Database of Systematic Reviews, No 3, 2006
Fletcher, Anne. Inside Rehab. New York: Penguin, 2013.
Glaser, Gabrielle. “The Irrationality of Alcoholics Anonymous,” The Atlantic, April 2015.
Hari, Johann. Chasing the Scream: The First and Last Days of the War On Drugs. First U.S. edition. New York, New York: Bloomsbury, 2015.
L. Khoury et al. “Substance Use, Childhood Traumatic Experience, and Posttraumatic Stress Disorder in an Urban Civilian Population,” Depression and Anxiety 27, No 12, 2010: 1077-86.
Lee, Stephanie. "BEYOND DRUGS: The Universal Experience of Addiction." Dr. Gabor Mate, April 5, 2017.
Miller, Scott et al. “Using Formal Client Feedback to Improve Retention and Outcome: Making Ongoing, Real-time Assessment Feasible,” Journal of Brief Therapy, Vol 5, No 1, 2006.
Substance Abuse and Mental Health Services Administration (SAMHSA), “The NHSDUH Report: Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings,” September 4, 2014.
Szalavitz, Maia. “Genetics: No More Addictive Personality,” Nature 522, no. 7577, June 24, 2015.
Szalavitz, Maia. Unbroken Brain. New York: St. Martin’s Press, 2016: 224-242
White, W. & Miller, W. "The use of confrontation in addiction treatment: History, science and time for change." Counselor, 8(4), 2007: 12-30.
Evo Health and Wellness is an outpatient addiction treatment program that respects where you are and where you want to go. Clients set goals that work for them, whether they include complete abstinence or moderation. Evo sees success as lasting change in the client’s life, including physical health, movement towards personal goals, and their sense of connection and purpose. Evo’s program integrates psychotherapy, psychiatry, life coaching, and somatic therapy. Learn more about Evo’s program.