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Caleb Thompson

Professor Hellmers

English 1201 Online

22 March 2019

Updating Addiction Treatment

Drug abuse has been a hot topic in recent years, and for good reason. Drug

overdose deaths have been becoming increasingly more common. According to Jeff

Reilly’s documentary Generation Found, since 2014, drug overdoses are the lead cause

of accidental death for young people in America (Reilly). Going back even further to

statistics gathered on drugabuse.gov, 16,849 deaths from drug overdose occurred in

1999. In 2017, 70,237 people died, a massive jump that has been increasing steadily

over time (drugabuse.gov). Here in Dayton, we have seen the effects of drug abuse first

hand. Some have referred to the city of Dayton and Montgomery County as the

“Overdose Capital”, since we have previously led the nation in drug overdoses. To bring

down overdose deaths, we must start by helping those that are abusing drugs fight their

addictions. Addiction Treatment is an extremely challenging process, and although a lot

of institutions, groups and businesses that are dedicated to treating addicts use similar

treatments, they aren’t effective enough, and that is a big problem. I believe that we

need to focus our efforts on updating and refocusing treatments for addicts, so that

those that are unable to stay clean with the current common practices have a chance to

get sober. This is an important task, because there are people depending on these

treatments to fix their lives.

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To understand addiction treatment, we must go through the process that the

addict goes through. Medical News Today writes that the first step towards recovery is

for a person that’s abusing to admit it has become a problem in their life and is

disrupting their work (Felman). That step is a difficult one for anybody to reach. We as a

species are naturally prideful, and its hard to accept that some things we do are hurting

ourselves, and its even harder to ask for help. Once someone reaches that step and

accepts that they need help, detoxification is the next door to walk through. Withdrawal

from their substance can have several side effects, the most common being nausea,

vomiting, headaches, body pain, and in some cases even delusions. Medical

Professionals can prescribe medications to help with the side effects, but there are also

medications that can help treat the symptoms of addiction, depending on the substance

that the addict is abusing. Ida Walker writes in Addiction Treatment: Escaping the Trap

that in cases of alcohol abuse, doctors may provide naltrexone and nalmefene, which

are “designed to prevent relapse, naltrexone in low-level to moderate drinkers and

nalmefene in heavier drinkers” (Walker.) Another choice of drug is called Di-sulfiram,

which is an example of an aversion treatment. Walker writes that when it interacts with

alcohol, there are multiple unpleasant side effects, including nausea, vomiting and

headaches. In cases of opioid addiction, there are other medications that are used. A

common example is Methadone, known to have success treating heroin addiction. It

suppresses withdrawal symptoms by binding to receptors in the brain, where the opioid

would normally bind, before it can. There are other drugs that provide similar

suppression effects for other forms of drug addiction as well.

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After the individual has completed their detoxification, they then would move on

to the next step of their treatment. That can vary depending on their preferences as well

as recommendations from medical professionals. The most common follow-up to

detoxification is behavioral therapy. Drugabuse.gov explains that behavioral therapy is

designed to help patients change their attitudes and behaviors surrounding drug use,

learn healthy life skills, and continue with other treatments. The patient first must figure

out whether they would want to do outpatient or inpatient treatment. Outpatient

treatment is more common, and provides multiple programs for patients, mostly

involving things like individual/group counseling. One example is cognitive behavioral

therapy, where patients learn to recognize and avoid the situations in which they are

likely to use drugs. For younger adults and adolescents, “multidimensional family

therapy” is recommended. It is designed to address drug abuse patterns and improve

how families function together. Other options include motivational interviewing, as well

as motivation through incentives, which uses positive reinforcement to encourage a

drug free life. Treatment can be intensive at first, such as having multiple outpatient

sessions attended each week. Patients eventually transition to regular outpatient

treatment, meeting less often and for fewer hours at a time. Inpatient therapy is another

option and is usually more effective with those with “severe disorders (including co-

occurring disorders).” One example is what’s known as a therapeutic community, where

a patient would remain at the facility for around 6-12 months. There are also shorter-

term residential treatments, which usually focuses on detoxing, includes “initial intensive

counseling” and prepares individuals for later treatment. This is a common form of a

“rehab facility” and is usually what my initial thought is of an inpatient therapy center.
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Another form of short-term housing is called Recovery Housing, which provides similar

experiences as the shorter-term residential treatments, with the addition of the focus on

transitioning the patient towards independence. Patients receive help with learning how

to manage their money, get a job, and finally finding other support services in their

area”.

After completing their selected therapy format, the individual would then enter the

relapse prevention portion of addiction treatment. Some patients will continue with forms

of treatments, such as cognitive-behavioral therapy. Others will move on and join

support groups, one of the most famous being Alcoholics Anonymous (AA). Walker also

writes that there is also a program called Narcotics Anonymous. She writes that “NA

groups can be found in many locations, but where there are none, individuals with

addictions to drugs and other substances can feel at home at AA meetings.” The addict

will continue with whatever recovery methods they choose and continue to improve

upon their lives. Its also important to note that during the process of addiction treatment,

friends and family play a very intimate role in helping the addict recover. These people

need as many people in their corner as possible, to offer encouragement and support

as they work to change their lives for the better. During recovery, families and friends

can also get help from groups such as Alateen and Al-Anon, whom offer “support for

children and other family members and friends of individuals addicted to substances.”

There are also groups that they can join to talk with others who have endured similar

circumstances and receive advise from them.

As you can see, the addiction process is one that truly lasts a lifetime. It is one of

the most challenging processes a person has to face, and sadly, a lot of people don’t
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make it through treatment. In fact, some never even get close. In their 2017 statistical

report, the Substance Abuse and Mental Health Services Administration (SAMHSA)

estimated that 20.7 million people aged 12 and above needed substance abuse

treatment (2017 NSDUH Annual National Report). Sadly, they also noted that only

around 4 million in that group received any treatment in the past year, which is only

about 19.3%. That is a major problem, as it is hard to stay drug free without receiving

quality help.

As for those that do receive treatment, it isn’t always what it is cracked out to be.

Jane E. Brody of the New York Times wrote in 2013 discussing a 5-year study run at

Columbia University, which focused on the quality and quantity of treatment provided to

addicts. They said that “The vast majority of people in need addiction treatment do not

receive anything that approximates evidence-based care” (Brody). On top of that, only a

small fraction of individuals get treatment that has scientific knowledge backing its use.

Those are outstanding accusations about the quality of addiction treatment being

offered in our country. The Columbia report points to the fact that most treatment

providers aren’t medical professionals, and don’t have the knowledge or credentials that

would allow them to provide more of the evidence-backed options, like medications or

psychosocial therapy sessions. Authors of the report also described the care to be

possibly considered as medical malpractice. Brody also included quotes from

individuals such as Anne M. Fletcher, who wrote a book title Inside Rehab, and said that

most rehab facilities use the same treatments that were used back in 1950. She also

found the low-cost, publicly funded clinics to have had higher-qualified individuals

working in them and had better statistics than high-end residential centers, such as
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those “typically used by celebrities like Britney Spears and Lindsay Lohan.” She also

unearthed a myth regarding addiction, that addicts need to stay at a rehab facility to

recover. Most addicts recover on their own, or by joining self-help groups, and/or by

getting a counselor/therapist individually. She added that individuals with serious abuse

problems need multiple months, maybe years of care, and short-term programs are why

so many people relapse.

Another major problem with regards to substance abuse treatment is that

individuals with substance abuse problems may also be suffering from other major

health issues. Lena Lundgren at Umeå University in Sweden studied the connection

between clients with substance abuse problems and co-occurring mental health

problems. Also, a part of the study was the staff assessing whether clients had any

present mental health symptoms, as well as the clients themselves telling the staff if

they have had problems in the past. Out of the 12,833 individuals that the study

included, 44% of clients had previously used outpatient mental health treatment centers,

and 19% reported that their problems were “significant”. 45% of clients reported that the

were experiencing problems at the time of the study. The staff themselves diagnosed

74.8% with ongoing mental health problems and described 13.9% as “significant”. This

study has unpacked some interesting information, because it brings up another major

problem in the treatment industry. A lot of individuals who suffer from substance abuse

are either unaware or unwilling to share any other medical/mental issues that they are

having.

Keeping in the subject of those who are unaware/denying the need of treatment,

SAMHSA also gathered data on whether individuals perceive that they need treatment
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or not, specifically for those who did not receive treatment, but were assessed as

needing it. Shockingly, out of the 18.2 million who needed treatment but didn’t receive

any, only approximately 1.0 million individuals felt they needed the treatment. 17.1

million (94.3%) felt that they didn’t need the treatment. Out of the ones who felt they

needed treatment, 39.7% felt that they were not ready to stop using their substance.

30.3% said they had no insurance and couldn’t afford treatment. Those are staggeringly

high percentages of people who are unwilling and unable to get treatment. How do we

convince those who aren’t ready for treatment to change their mind?

Fig. 1. This chart shows the total number of individuals that believe they need treatment,

out of those who were determined to need treatment but did not acquire any in a years’

time: 2017 (SAMHSA)

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Fig. 2. This figure outlines the percentages of reasons that individuals, who felt they

needed treatment, had on why they didn’t receive any during the past year: 2017

(SAMHSA)

One of the methods promoted as a US federal policy is known as the referral to

treatment program. Primary care physicians will have their patients who suffer from

substance abuse participate in a “brief intervention” that is designed to convince the

patient to seek treatment. Theresa W. Kim from the Boston University School of

Medicine performed a study on the effectiveness of these brief interventions. 528

individuals were randomly selected to participate in a 15-minute negotiated interview

with health educators, and others were put into a 30-45-minute motivational interview

session with counselors. The study found that the brief intervention did not increase the

likelihood of addiction treatment seeking significantly, and the motivational interview

appeared to have negative effects on it.

As you can see, there are several issues that need tackling in the addiction

treatment field. Most people aren’t getting treatment, some because they don’t want to
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and others because they can’t afford it. Some addicts have underlying health issues that

need to be addressed with their addiction problems. Some current forms of motivation

to seek treatment are not working as intended. These are the reasons that the addiction

treatment method needs to be remodeled a bit.

Now, some would argue that the we need to be focusing more on preventing

drug issues from happening in the first place, which is understandable. There are plenty

of things that can be done to help community’s keep drugs out, and they are worth

investing in. By getting drugs out of our neighborhoods, we could prevent future

generations from facing these issues, but those who are already addicted still need our

help! We can’t turn a blind eye to addicts and focus solely on prevention, we must also

do our best to help them, by changing the methods we use to treat addicts.

To start, it wouldn’t hurt to refocus how therapy sessions are targeted. That’s not

to say the current behavioral therapies are a failure, it’s to say that there needs to be

more targeted therapy. Not necessarily towards individuals, but also to groups of people

as well. For example, individuals in high school who are suffering from substance abuse

are not going to face the same issues as someone who is in their early 30s facing

substance abuse. Targeting a group of individuals to better focus on relatable treatment

is a wonderful concept and has been shown to work. The documentary Generation

Found is centered around Archway Academy, a “recovery high school” in Houston

Texas, which provides an education and a place for consistent treatment and group

therapy for high schoolers in need. There are very few recovery high schools in the US,

and that is something that needs to change. Individualized treatment is also important,

as that is something that has been needed for a long time. As Dr. Mark Willenbring
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described in Jane E. Brody’s article, you can’t treat someone with a chronic illness for

four weeks and then send them to a support group (Brody). They need individualized

treatment because they aren’t necessarily facing the same exact problems as every

other addict. Similarly, there needs to be a major focus on mental health concerns on

addicts as well. Considering how difficult it is for addicts to admit that their substance is

causing problems, it may take even more for them to admit they are suffering from

mental issues. That’s another reason that individualized treatment is necessary. It could

be easier for an addict to talk to their therapists about their issues, instead of their

therapist and a bunch of other people in the room.

The next major problem that needs fixed is getting people into treatment. That

starts with finding new ways to convince addicts to seek treatment. As discussed earlier,

current ways such as brief interventions are not successful enough to justify halting

other forms of persuasion. The first step should be outlying more ways to give attention

to potential treatments. For example, flyers around town, information stands at busy

areas like grocery stores and popular businesses. Getting the word around that there is

affordable, safe treatment has potential to convince individuals to seek help. Another

interesting option is to offer incentives for doing so. Monetary rewards for participating in

treatment sessions could convince people, and it would also be interesting to see if

anyone would participate in a “drug/paraphernalia buyback program.” It would help get

drugs off the street and would be another place to advocate for treatment centers.

Another good way to advocate for treatment is to help families and friends of addicts in

convincing the addict to seek treatment. Interventions can be very crucial in convincing

individuals to get help, and if people were more educated on how to perform them
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successfully, there would be more people deciding to seek treatment. Nobody wants to

let their family and friends down, so I am sure that they would eventually realize that

they are harming themselves and their families.

The most important way to increase the productivity of treatment, is to increase

the quality of treatment! First, there needs to be more affordable, possibly publicly

funded centers available. Those 30% that couldn’t afford treatment don’t deserve to lose

out on fixing their lives due to a bill. It’s ridiculous to think that it’s cheaper for them to

get on drugs and ruin their lives than to get off drugs and save their lives. Also, as the

Jane E. Brody article put it best, those low-cost clinics tend to have better outcomes

than their more expensive counterparts. The more productive a clinic is, the better! We

should be also advocated for those that work in addiction treatment centers to get the

training they need to better understand the recovery process, as it is described

scientifically. We have plenty of knowledge about what works and what doesn’t, so why

don’t we put it to good use?

The last major thing that needs to be changed about the addiction process is how

it is viewed by people. People often have the misrepresentation that getting over an

addiction is as simple as a two-week stint in a rehab clinic, and presto! Addiction is a

lifelong process. Rehab itself can take anywhere from a few months to years, and

relapse can happen at any time in life. It is a major commitment to make, sobriety for

the rest of a lifetime is a permanent commitment. Another mistaken viewpoint people

have is that only one form of addiction therapy is worth the effort. Some people believe

that since a person they knew did well in group therapy, that it is the only worthwhile

treatment option, and that if you fail it you will never be sober. That viewpoint is really
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damaging, as it can cause a lot of emotional pain to the addict. Failing a treatment and

relapsing is hard enough, knowing that you let someone down, and that they may have

lost hope in you is even worse.

I believe that we need to focus our efforts on updating and refocusing treatments

for addicts, so that those that are unable to stay clean with the current common

practices have a chance to get sober. Everyone deserves a chance to better their life,

and it’s up to us as a society to give them that chance. It’s up to them to take that

chance, but we must be willing to push them along. It’s incredibly difficult and brave to

face your demons and overcome them. We should be there to support them when they

do it. This must be done, because these people are depending on these treatments,

and our support to save their lives.

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Works Cited

“2017 NSDUH Annual National Report.” 2017 NSDUH Annual National Report |

CBHSQ, Sept. 2018, www.samhsa.gov/data/report/2017-nsduh-annual-national-

report.

Brody, Jane E. “Effective Addiction Treatment.” The New York Times, The New York

Times, 4 Feb. 2013, well.blogs.nytimes.com/2013/02/04/effective-addiction-

treatment/. 3 March 2019

Felman, Adam. “Addiction Treatment: First Steps, Types, and Medications.” Medical

News Today, MediLexicon International, 1 Nov. 2018,

www.medicalnewstoday.com/articles/323468.php. 3 March 2019

Kim, Theresa W., et al. “Receipt of Addiction Treatment as a Consequence of a Brief

Intervention for Drug Use in Primary Care: A Randomized Trial.” Addiction, vol.

112, no. 5, May 2017, pp. 818–827. EBSCOhost,

sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?direct=

true&db=s3h&AN=122313858&site=eds-live. 3 March 2019

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Lundgren, Lena., et al. “Integrating Addiction and Mental Health Treatment within a

National Addiction Treatment System: Using Multiple Statistical Methods to

Analyze Client and Interviewer Assessment of Co-Occurring Mental Health

Problems.” Nordic Studies on Alcohol and Drugs, no. 1, 2014, p. 59.

EBSCOhost, doi:10.2478/nsad-2014-0005.

“Overdose Death Rates.” National Institute on Drug Abuse. NIDA, Jan. 2019,

www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

“Perceived Need for Substance Use Treatment among People Aged 12 or Older Who

Needed but Did Not Receive Specialty Substance Use Treatment in the Past

Year: 2017”. SAMHSA, Sept. 2018. https://www.samhsa.gov/data/report/2017-

nsduh-annual-national-report. 2 April 2019

“Reasons for Not Receiving Substance Use Treatment in the Past Year among People

Aged 12 or Older Who Felt They Needed Treatment in the Past Year:

Percentages, 2017” SAMHSA, Sept. 2018.

https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report. 2 April

2019

Reilly, Jeff., et al. “Generation Found.” Film, 2016, generationfoundfilm.com/. 3 March

2019

“Treatment Approaches for Drug Addiction.” National Institute on Drug Abuse, Jan.

2019, www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-

addiction. 3 March 2019

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Walker, Ida. “Addiction Treatment: Escaping the Trap.”, 2013. Internet resource. 3

March 2019