Substance abuse treatment (SAT) can be problematic for several reasons. But, I think there is a fundamental reason behind all SAT: There is an underlying misunderstanding of the mechanics of, not only substance abuse, but also of Addiction in general that impede any real ways to both define and measure SAT and recovery.
To illustrate what I see as the core issue, I provide a quote from a book called “The Sober Truth” that was written by a medical doctor named Lance Dodes. He writes, “A treatment for alcoholism may be called successful in an individual no longer drinks in a way that is harmful in his or her life.” While this quote and measure of success is consistent with the idea that substance use progresses from use to abuse until it develops into Addiction and that progression is measured in adverse consequences. However, the measure of success only addresses one variable: Use of alcohol. And to me, that’s the issue that I continue to run into time and time again: Treatment success is measured and perceived in direct relation to the substance of abuse.
That this measure, both according to Dr. Dodes and to the general public is limited and demonstrates that the substance is the focal point of treatment. But, it should be neither the only measure nor the most important measure of treatment success. Really, a comprehensive treatment program should address all areas of human life such that success can become an aggregate measurement of holistic health.
For example, if someone is abusing alcohol to the point of adverse impact, then it’s a safe bet that the person has a poor diet and may be at risk for other physical health ailments such as cirrhosis and/or diabetes. Therefore, not only should the alcohol use be addressed, but also, both a nutrition and exercise program are also warranted. If so, then there are several variables that can be measured for positive growth such as: blood sugar, hemoglobin, and BMI, for starters.
Also, because I have found that substance abuse can be a symptom of psycho-emotional issues, emotional causes such as depression and/or anxiety levels must also be accounted for within an overall treatment program. If a person reduces his or her alcohol use without addressing the underlying psycho-emotional causes then the risk is that the person may become overwhelmed by the experience of un-numbed emotions.
To further illustrate the point, a recent study (the study is here: RecoveryIndicatorsStudy) that tried to measure recovery showed twenty-eight (28) recovery indicators. While reduction of using alcohol and/or illegal street drugs were on the list, several other indicators were also on the list such as:
- Participation in education, training or work
- Taking care of appearance
- Treating others with respect/consideration
- Taking care of physical health
- Having a good daily routine
What these and all other “recovery indicators” demonstrate is that, because recovery is multidimensional, Addiction is mulit-layered and cannot be understood solely in terms of the target of the Addiction. SAT MUST be approached holistically; that is, if someone is to achieve recovery, then that person must address all aspects of his life and health.
I do not see substance abuse (or Addiction) as “behavioral issues” as Dr. Dodes and others do. Rather, I see Addiction for what it is: A disease with a course of progression and defined treatment options. Looking at the problem of substance abuse and Addiction too narrowly misses gains in treatment that may not appear directly related to the substance of abuse. I do hope to change this myopic focus on substances so that real SAT can occur and be measured. We should all remember that there is a lot more to humanity besides what it ingests.