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Showing posts with label addiction. Show all posts
Showing posts with label addiction. Show all posts

Saturday, December 8, 2018

Veterans, Addiction, Mental Health Consumers and Vocational Rehabilitation, Part I

Helping veterans with challenges 
find work again is necessary
By JIM PURCELL

It's a big equation for a veteran, being a mental health consumer, addicted and needing vocational rehabilitation. 

   As a peer support specialist, I worked with this population for abot two years. It was an honor, a privilege and the hardest job I ever had. As I speak about this, I am doing so using my experiences in the field as a guide.

Sobriety and Compliance
   To begin with, if anyone who suffers from addiction is actively using mind and/or mood altering subtances then they are not a good candidate for voc rehab. Anyone who is a mental health consumer and is not fully compliant with their medication is also not a good candidate for voc rehab. A veteran must be in recovery, about a year, and medically compliant (a year would be a good amount of time), before they can really get down to the work of vocational rehabilitation. In my experience, prematurely working on vocational rehabilitation leads to a bad outcome for the client.

   Veterans have access to many programs that might assist them with vocational rehabilitation. However, without a willing, medically stable client and with addiction being in remission, the work of vocational rehab is so futile, so often that it makes little sense to try.

   Finding a job is stressful. Preparing for job interviews is stressful. Beginning a new job is stressful. Without a sound program of recovery then these stressors may well lead to a client becoming , compromised in one of these areas. Of course, anyone can fall prey to mental health disorders and addiction at any time. Adding stress to very early recovery, though, is a recipe for disaster.

Dealing with Court, Drivers Licenses, 
Finances and Credit, Etc.
   The work of helping a veteran return to the workforce actually begin with meeting them where they are. Someone cannot get and/or keep a job when they do not have adequate housing; are not able to have access to food or medical attention; have a drivers license or extremely reliable transportation; have the adequate training or experience in a given field; and/or have open warrants by the police.

   Helping a veteran find his way to work restoration is not something that any one individual can do. That effort begins with the client. A man or woman must be sober, medically comliant and interested in moving forward with work, or with school. But, it can be a long road until the task at hand becomes diagnostic testing, interview preparation and creating a resume.

   Many of my clients had pending charges or were on probation or parole. Well, if someone has not violated parole or probation then that is great. If someone has pending charges, outstanding warrants, has violated parole or probation and is pending court on any of these then they need a lawyer. There are organizations that help veterans with legal help. However, pro bono lawyers volunteer for such on an isolated basis and may not be available in every area.

   Having a driver's license or reliable transportation is a must for any job seeking client. If a client lives in the suburbs or in a rural area, a driver's license is absolutely necessary. If a client lives in an urban area then buses or subways are an effect transportation tool.
Using resources available to vets from the VA can really help

   It is straightforward, if a client has a suspended license then it needs to be reinstated. This means that fines have to be paid up, surcharges have to get paid and, perhaps, a client will have to take the driving test and/or a road test. This is precisely why a client must be sober and dedicated. Putting an addict behind the wheel again isn't a good idea for anyone.

   There is also the issue of credit. Many companies today check credit reports before they give an applicant a job. Consequently, if someone is well behind in their bills then they need to deal with that. If the situation requires assistance then referring a client to a financial counselor may be a good idea. If it is worse than that then maybe referring a client to a bankruptcy attorney is the right thing to do. No one wants to go bankrupt, but sometimes it is necessary. Getting a client in front of an attorney that specializes in bankruptcy can be important. Finding an attorney who will do it pro bono is easier to find if a client is a veteran, but that is no guarantee there is one in someone's local area.

   When a client suffers from addiction, when they are non-compliant with their meds and they are mental health consumers, then bad things can happen. The wreckage of past deeds can haunt a client, and spoil their plans for the future -- unless they are dealt with in a forthright manner by a client. This is also why a year's 'cooling off' period is important. A year of sobriety, of being medically compliant makes a statement about a client wanting to help themselves.

Next week: Part II - Housing and Supportive Employment



Tuesday, October 25, 2016

The Challenge of Addiction Treatment Today


 What help really works for hard core drug abusers? 

By DAVID KERR

Maia Szalavitz[1] is a thoughtful, respected and long-time writer in the field of addiction and I support most of her 8 points as listed below and seen in her article in the Huffington Post; “The Rehab Industry Needs to Clean Up Its Act. Here's How.” Here’s the link:
CLICK HERE


Though I disagree (in blue below) with some of her points, she presents a concise summary of what she sees needing to change in our field and she knows from her own personal history using heroin and cocaine.  Here is part of what she has to say:

“I have covered addiction as a journalist for nearly three decades, and also have my own history of heroin and cocaine addiction, and of receiving treatment. With the input of longtime leaders in and critics of the field, here are my views on what needs to change.
1. Remove 12-step-related content from treatment — or at least, stop charging for it
2. Ensure access to maintenance treatment for opioid addiction
3. Fight corruption and unethical practices
4. End the reliance on criminal justice system referrals
5. End humiliation and confrontation
6. De-emphasize residential treatment
7. Create truly independent accrediting bodies that are consumer-friendly—and national standards of care
8. Expand harm reduction”

I have a problem with three of her eight points but she missed a major point as described below.  Also I would add to her eighth point: “Expand all treatment.”
I disagree with her points #1, #4 and #6.

 #1.  The AA 12 step approach is a marvelous group process where recovering substance abusers are accepted by their peers, finding a mentor and/or coach who guides the new candidate for years through the process of recovery.  Why would we want to end a process that has clearly helped many addicts for years and years?

#4.  I don’t think that treatment programs in New Jersey, for example, rely on criminal justice referrals.  Rather they see the desperate need of those addicts caught in the criminal justice system who need treatment rather than incarceration.  According to the Human Rights Watchreport, 10-17-16, “ every 25 seconds someone in America is arrested for possessing drugs for personal use.”

To make matters worse, many of those failing to meet bail requirements are incarcerated since treatment beds are usually full with a waiting list.

What’s the alternative?  Recovery help and treatment must be available to all people in all cultures.  Should we just bypass the treatment of addicts whose disease causes illegal drug use and associated crime?  In New Jersey, residential treatment programs have contracts with Corrections and Parole and they are showing positive results over years with the legally supervised treatment and follow up support of hard core criminal addicts.  Many studies have shown that this treatment enhances the likelihood of continued recovery with fewer relapses over time.  It makes no sense to arrest and incarcerate but provide no treatment to some addicts just because of their background and previous record while offering treatment for the same crime to others with little or no criminal record.  Many of these “others” are those who are part of the growing heroin epidemic in the suburbs.  Punish some and help others based on their skin color, criminal background and/or lack of bail money?  Not the right direction.

#6. Residential treatment is part of the continuum of help for many if not most hard core addicts.  Very, few of the thousands of addicts I’ve known could ever begin to put their life back together without removing themselves from the temptations of “the streets” and their neighborhood i.e. “the hood”. 

Here is an alternative model for Treatment and Recovery, call it the
Long Term Continuing Care Recovery Model

Help and caring for hardcore long-term addicts must be long-term (years.)  Also, the life supporting connections between treatment and the community neighborhoods to which recovering addicts re-enter after treatment, must be strengthened. 

The full recovery model of help for hard core criminal addicts often looks like this:  The detoxification phase followed by the residential phase followed by the reentry phase {followed sometimes by the out-patient phase} and then the most critical, the follow up coaching phase.  These are all part of the essential many year recovery continuum of care for hard core addicts.  I emphasize the word “caring” in this continuum. 

One of the most effective ways to measure quality in a program is to notice the level of concern and caring shown by all staff, not just counselors.  Assuring a caring staff must be the first step to assuring a quality staff and a quality program.  The best measure of a caring staff often comes from comments by the residents.[2]

The reentry phase of this continuum can be very challenging and it is not always the recovering person’s fault.  If we think of the cause of addiction as much from an addiction seeking culture as from a disease, we can begin to understand how difficult it can be to help people who must return after treatment to their home environment that is loaded with temptation.  Yes I know and believe the studies supported by Nora Volkow, NIDA, demonstrating that addiction is a brain disease.[3]  However, I attribute the present day growing problem of heroin addiction in the suburbs more from copy-cat and cultural behavior rather than so many people suddenly developing a “disease.”  AA talks about changing “people, places and things,” to stay clean and sober but this is often not possible in a drug seeking culture and as a result, addiction spreads.  Today, if you want to help and coach an addict towards recovery sometimes your most formidable enemy is our present day growing feeling that “heroin is ok.”  Some are saying under their breath; “yeah right, now that white people are using heroin, it’s ok;” and this has a ring of truth to it.

Peer support is often critical for hardcore criminal addict recovery
I founded a TC in Newark in 1968 called Integrity House. I retired from this work in March, 2012.  The TC concept has come a long way since the early 1960's.  We recognize the impact of the recovering peer, clean and sober for years, as a role model for change in our residential and out-patient programs.  We recognize the need for changing our system of care from long-term residential help to long-term support and coaching so that self-realization and the new drug free lifestyle has a chance to become internalized and practiced over years.  I have not found much long-term recovery success for hard core criminal "lifestyle addicts" without years of interaction with positive peers, and without support and coaching[4].

That said, most hardcore criminal addicts that I have worked with need to start and become part of a culture of safe, clean and sober living in a residential setting.  Each participant has a role in helping him/herself and others while learning, practicing and finally internalizing a new positive and ethical lifestyle. In my experience, the Therapeutic Community is the most effective tool, demonstrating a positive culture of right living for many months in treatment and for years thereafter following the long-term recovery continuum model.  

I have found that they must give help to others to get the full measure of help for themselves. 
A properly functioning TC must be sensitive to others needs and wants and what will help and what will hurt.  I've found that those addicts I have worked with over the years need a combination of understanding, love and straight honest talk and finally the role modeling of others like them, clean and sober for many years.  What I didn't expect to find, as I began to know them in the mid-1960’s, was a deep understanding of their own motives and behavior to help themselves as well as their strong need for help and guidance from others in long-term recovery. Finally I have found that they must give help to others to get the full measure of help for themselves.  Addicts in recovery for years make some of the best counselors I’ve ever met and this is with or without a degree! 

Let’s not mandate a degree since the bi-product may be to eliminate the recovering peer from our system of treatment.[5]
My experience supports the idea that a durable recovery is best insured by a counselor and/or peer who can feel a deep understanding and sincere sense of love and caring for others.  I have seen that recovering addicts who attain a degree are seen as role models to others in recovery!  On the other hand, I have found that the most effective people to inspire change are often former addict role models with a strong history of recovery, with or without a degree.

Growing addiction in the mainstream society is setting a bad example for our children
It is difficult today to help someone in a residential or outpatient treatment program to pursue a lasting recovery, when they leave treatment to return to our present drug consuming culture.  Addiction today is part of our culture whether it be from middle class in more affluent suburbs or ghetto pockets in the inner-city. If we want to make a serious impact on this personal and cultural malaise, we have to look at our own addictive behaviors and negative role modeling!  It's what we as parents do that is having a noticeable impact on the behavior of our children.  Growing addiction in mainstream society is setting a bad example for our children.  As a result, many have fallen into the deep hole that takes “adolescent recreational use and abuse” down the path of lifetime addiction.

Let's work together and with the media to develop more effective prevention plans that will be part of our culture and that will help our children grow up healthy.  These plans must start with changing our own habits and negative role modeling and personal substance abuse that will be mimicked by our children!

 [1] Maia Szalavitz is a columnist for The Influence. She has written for Time, The New York Times, Scientific American Mind, the Washington Post and many other publications.
[2] Be careful though not to base staff evaluations on resident comments!
 [4] While I never used drugs, I lived with active addicts in Newark while starting Integrity House and learned much from what they said and how they lived.
[5] Most addicts in recovery owe fines and are just beginning a stable life in the workforce.  They will not be able to afford to pay for a degree for years if not decades!

Tuesday, January 27, 2015

The Key Factor in Addiction Recovery

Positive Lifestyle Change
The Key Factor in Addiction Recovery

By David H. Kerr                  January 22, 2015


What is addiction? 
Is it a disease?  Is it a sickness?  Is it a mental health problem? Is it a moral failing?  Is it a crime? Is it a harmful lifestyle?  Is it something else?  The debate roars on but today I would rather call addiction a harmful lifestyle. Addiction is a lifestyle choice that harms self and others, no debate about that. 

How can people recover from addiction?
The National Institute on Drug Abuse classifies addiction as a medical disorder: Considering that, here’s what they say about how to recover from addiction:

How Can People Recover Once They’re Addicted? – NIDA’s points

1)     As with any other medical disorder that impairs the function of vital organs, repair and recovery of the addicted brain depends on targeted and effective treatments that must address the complexity of the disease. We continue to gain new insights into ways to optimize treatments to counteract addiction’s powerful disruptive effects on brain and behavior because we now know that with prolonged abstinence, our brains can recover at least some of their former functioning, enabling people to regain control of their lives.
2)     That said, the chronic nature of the disease means that relapsing to drug abuse is not only possible but likely, with relapse rates similar to those for other well-characterized chronic medical illnesses such as diabetes, hypertension, and asthma. For all these diseases, including drug abuse, treatment involves changing deeply embedded behaviors, so lapses should not be considered failure but rather indicate that treatment needs to be reinstated or adjusted, or that alternate treatment is needed. But addicted individuals also need to do their part. Even though they are dealing with a compromised brain that affects decision-making and judgment, people with drug abuse or addiction must also take responsibility to get treatment and actively participate in it.”

To help an addict, I have found it more practical to see addiction as an acquired harmful lifestyle with possible genetic origins rather than or as well as a sickness or disease.  Changing the addiction lifestyle is a major factor leading to lasting recovery!  It usually involves finding new friends who are positive and changing our interests and where we work and “play.”  As they say in AA, changing “people, places and things” is required for recovery[1].

Mankind has always been curious, always seeking quick ways to feel happier and/or ways to be quickly removed from intolerable physical or mental stress and pain.  Many substances now legal or illegal, fill that need.  This is where the trouble can begin and for some, at an early age and then lasting a lifetime.  Media advertisements for opioid pain killers plus word of mouth descriptions of the good feelings associated with taking these legal medications and illegal drugs, especially heroin, fuel the curiosity and soon comes the statement, “I want to try this just once!”  Often this “once” leads to years of addiction to the pain killers and then for some, to heroin!  Situations like war can cause rampant drug abuse and addiction so that many of our veterans are returning physically addicted or detoxifying on the plane ride home.

The same positive lifestyle changing goals we use for addicts in long term recovery often work for returning war veterans.  Those returning soldiers who want to stay clean and sober here in the states, often have to break ties with veteran friends who choose to continue to use drugs upon returning to the states.  They must avoid the places that are known hangouts for addicts and substance abusers as well.  They must avoid the kind of idleness that often is the open door for the addiction lifestyle to enter.  They must move forward and/or relearn a new positive healthy lifestylethat will promote their feeling of self-worth, a critical ingredient to staying clean and sober for any length of time.

Finally, you’ll be interested and perhaps surprised to know that the vast majority of addicts whom I have met, know this!  While this knowledge is essential, it is only the first step towards building that new and durable drug free lifestyle.  Doing what they know they should have been doing for years, is the key to building the bridge to lasting recovery.  How do you get an addict to start doing and stay doing what he/she already knows is right?  Now there’s the key question.  The technical answer to this is “you don’t.” 

Remember, the addict doesn’t need a “counselor” he[2] needs a coach since the addict is his own counselor!  The addict must go through the process of healing himself.  He must do it but he can’t do it alone.  He needs someone by his side to remind him of his “good” and his strengths so that he can begin the process of restoring his faith in himself.  He may need to enter a drug free residential program that is long-term focusing on lifestyle change rather than on medically oriented treatment.

Author Johann Hari in his new book, “Chasing the Scream” offers his point of view about addiction.  Although not agreeing with all of them, I find that his ideas are more consistent with my experiences and understanding of the addicts I have met since 1965.  The title of Hari’s article below is: “The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think.”  Hari traveled across the country interviewing addicts and compiling a picture of their lives and addiction itself.  Here are eighteen points from his thinking and understanding that are well worth a look:

1)      “But what I learned on the road is that almost everything we have been told about addiction is wrong - and there is a very different story waiting for us, if only we are ready to hear it.”
2)     Hari even reviewed the studies of rats, designed to predict the reason for addiction.  In an experiment with rats giving them a choice of good or drugged water, “the rats with good lives didn't like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did.”
3)     In a comparison with soldiers who went to war and became addicted: “But in fact, some 95 percent of the addicted soldiers - according to the same study - simply stopped (when they returned to the states). Very few had rehab. They shifted from a terrifying cage (as per the rat experiment above) back to a pleasant one, so they didn't want the drug any more.”
4)     “Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It's not you. It's your cage.”
5)     “In the hospital around you, there will be plenty of people also given heroin for long periods, for pain relief. The heroin you will get from the doctor will have a much high purity and potency than the heroin being used by street-addicts, who have to buy from criminals who adulterate it. So if the old theory of addiction is right - it's the drugs that cause it; they make your body need them - then it's obvious what should happen. Loads of people should leave the hospital and try to score smack on the streets, to meet their habit. But here's the strange thing. It virtually never happens. The Canadian doctor Gabor Mate was the first to explain to me, medical users just stop, despite months of use. The same drug, used for the same length of time, turns street-users into desperate addicts - and leaves medical patients unaffected.”
6)     “The drug is the same, but the environment is different.”
7)      “But in fact, some 95 percent of the addicted soldiers - according to the same study - simply stopped. Very few had rehab. They shifted from a terrifying cage back to a pleasant one, so they didn't want the drug any more.
8)     Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain.  In fact, he argues, addiction is an adaptation. It's not you. It's your cage.”
9)     “He says we should stop talking about 'addiction' altogether, and instead call it 'bonding'. A heroin addict has bonded with heroin because she couldn't bond as fully with anything else.
10)  So the opposite of addiction is not sobriety. It is human connection.”
11)   “You can have all the addiction, and none of the chemical hooks. I went to a Gamblers' Anonymous meeting in Las Vegas (with the permission of everyone present, who knew I was there to observe) and they were as plainly addicted as the cocaine and heroin addicts I have known in my life. Yet there are no chemical hooks on a craps table.”
12)  “But the Office of the Surgeon General has found that just 17.7 percent of cigarette smokers are able to stop using nicotine patches. That's not nothing. If the chemicals drive 17.7 percent of addiction, as this shows, that's still millions of life ruined globally. But what it reveals again is that the story we have been taught about The Cause of Addiction lying with chemical hooks is, in fact, real, but only a minor part of a much bigger picture.”
13)  “There is an alternative. You can build a system that is designed to help drug addicts to reconnect with the world - and so leave behind their addictions.”
14)  “The results of all this are now in. An independent study by the British Journal of Criminology found that since total decriminalization, addiction has fallen, and injecting drug use is down by 50 percent.”
15)  “The rise of addiction is a symptom of a deeper sickness in the way we live - constantly directing our gaze towards the next shiny object we should buy, rather than the human beings all around us.”
16)  “The writer George Monbiot has called this "the age of loneliness."We have created human societies where it is easier for people to become cut off from all human connections than ever before. Bruce Alexander - the creator of Rat Park - told me that for too long, we have talked exclusively about individual recovery from addiction. We need now to talk about social recovery - how we all recover, together, from the sickness of isolation that is sinking on us like a thick fog.”
17)   “Loving an addict is really hard. When I looked at the addicts I love, it was always tempting to follow the tough love advice doled out by reality shows like Intervention - tell the addict to shape up, or cut them off. Their message is that an addict who won't stop should be shunned. It's the logic of the drug war, imported into our private lives. But in fact, I learned, that will only deepen their addiction - and you may lose them all together. I came home determined to tie the addicts in my life closer to me than ever - to let them know I love them unconditionally, whether they stop, or whether they can't.”
18)  “When I returned from my long journey, I looked at my ex-boyfriend, in withdrawal, trembling on my spare bed, and I thought about him differently. For a century now, we have been singing war songs about addicts. It occurred to me as I wiped his brow - we should have been singing love songs to them all along.”

Summary

As we work to help addicts relate to and feel their own self-worth let’s be sure to understand that a critical part of this is for the addict in recovery to choose and practice a new drug free lifestyle!

Tuesday, November 4, 2014

Changing Lifestyles and Addiction

By David Kerr

The following quotes are taken from an article written by Kenneth Anderson[1] who criticizes: “The Training Manual for US Addiction Counselors.” Here’s the link:
http://www.substance.com/the-training-manual-for-us-addiction-counselors-is-full-of-myths/12204/
 
The federal “Training Manual” mentioned above says that addiction’s “chronic and relapse nature” is recognized as a part of the “disorder.”:  The Manual goes on to say that “Recovery from addictive illness necessitates sobriety and abstinence, relapse prevention programs and continuing supportive intervention for those who become dependent on mood-altering chemicals.”
 
I agree with this statement from the federal “Training Manual” since it describes a large percentage of hard core heroin addicts with whom I have worked over the last several decades.  However, according to Anderson, this statement is false.  He says that
 
“ the NESARC research tells us that most people who recover from alcohol dependence do so by cutting back on their drinking; less than half recover via abstinence (as outlined here by the National Institute on Alcohol Abuse and Alcoholism). Not only is a return to moderate use after a period of addictive use common among people who drink alcohol, the same phenomenon can be seen with “harder” drugs—even with heroin.”
 
Here is another quote where Anderson is trying to make the case for remission without treatment:
 
NESARC also shows that the lifetime rates of treatment utilization (including AA) for any Drug Use Disorder are 8.1% for Abuse and 37.9% for Dependence. Lifetime treatment utilization (including AA) for Prescription Drug Use Disorders, by drug category, is: tranquilizers, 38.6%; stimulants, 28.6%; sedatives, 35.7%; and opioids, 31.9%. Compare that to lifetime remission rates for these disorders: tranquilizers, 98.3%; stimulants, 99.0%; sedatives, 98.7%; and opioids. 96.1%. The lifetime remission rates for illicit Drug Use Disorders are: 97.2% for cannabis and 99.2% for cocaine. Lifetime treatment utilization rates for these two drugs apparently have yet to be researched, however.”
 
My challenge to Mr. Anderson, even if I agreed with all he has said, should we eliminate drug treatment programs for those hard core addicts whose life is clearly in a shambles due to their accelerating heroin addiction?”  I have worked with these hard core addicts for decades and abstinence from all mind altering and addictive drugs is absolutely the only way to go if your goal is a durable recovery lifestyle over years.
 
Anderson’s argument of “abstinence vs cutting back” may be the wrong one.  Chronic heroin addicts, abusing drugs for many years (10 years or more) have developed a new drug oriented lifestyle just as people moving into a new neighborhood will, over the years, reflect the lifestyle (behavior and attitudes) of that of the surrounding community.  It’s hard to live totally independent of those who we call our friends and neighbors.  We have a need to belong, to one degree or another, with our surrounding environment and culture.
 
So it’s not so much about abstinence or cutting back as it is about an entire lifestyle change.  This may mean new friends, possibly a different place to live, new positive values, ethics and often a fundamental change in beliefs that include a core of spirituality and faith.  I have seen few long term heroin addicts maintain a job and a family while continuing their addiction.  Maybe there are a few who can do this but I would strongly recommend against it.  Also addicts can’t just stop doing drugs without learning to put another activity in its place.  This new activity can’t be alcohol or the use of another drug.  Addicts receiving methadone maintenance treatment must be very careful about the concurrent use of alcohol.  Those who violate the rules and use alcohol as well have not changed their lifestyle and are likely to relapse, stopping legal methadone to resume heroin use.  In a way this is comparable to the present movement from prescription opiate pain killers to heroin abuse and addiction.
 
Finally, after working directly with addicts since 1965 it would never occur to me that the three reasons people do not want to go to treatment are, as stated by Mr. Anderson, the following.
 
“As a former consumer of substance abuse treatment and as a person who works with active substance users, I believe that the primary reasons people do not want to go to substance abuse treatment are: (1) they will be disrespected as individuals, (2) abstinence will be forced upon them whether they choose it or not, and (3) spirituality will also be forced upon them. This is a basically accurate description of most of the alcohol and drug treatment currently available, particularly for poor people.”
 
In fact, this is not an accurate description of why most people don’t want treatment.  The way I see it, addicts don’t want treatment because they prefer to “get high.”  In fact, for many addicts, the only reason they finally do go to treatment is because, thankfully, they are forced by a judge or their probation or parole officer!
 
In spite of my disagreements, Anderson’s article below is well worth a read! Here are some points he makes in his article below:
 
“Research tells us that treatment has some benefit for some people. Indeed, former users report that it saves lives. But research doesn’t tell us who is most likely to benefit—and therefore where the resources should be spent. Are the substance users who have the most severe problems the ones who are most likely to benefit from treatment? Such questions require answers.”
 
Anderson goes on to quote from federal data that:
Only 11.8% of people with an Alcohol Use Disorder in 2012 received treatment.”

********************************************************
Addendum
Here is a blog from Kenneth Anderson worth a reading:
 
Addiction Treatment: Who Gets It and Who Needs It?
 
Popular notions about who receives treatment are largely wrong. But what about the conventional wisdom that we should devote more resources to treatment to increase access? Let's look at the data.

Only 11.8% of people with an Alcohol Use Disorder in 2012 received treatment.
Who goes to rehab? Ask the person on the street and you’re likely to be told, on the one hand, celebrities, who spend a month or two at luxury residential rehabs, and, on the other hand, former heroin addicts, who line up every morning at methadone clinics. These popularized notions present an interesting (the very rich and the very poor) but grossly inaccurate picture. The reality, of course, is that problematic substance use cuts across all demographic lines. And so does addiction treatment. Sort of.
 
We know that factors such as socio-economic status and race influence whether a person gets treatment or gets sent to prison, for example; these factors also influence the type of treatment available. But it may come as a surprise that the drug of choice plays a significant role in determining who receives treatment.
If we look at the data from the large epidemiological studies that have been done nationwide, we can learn more about that—and also about who recovers from problematic substance use on their own, without rehab. This kind of recovery, which falls into the category of natural recovery (also known as spontaneous remission), is common—so common, in fact, that it calls into question the general view that everyone with problematic substance use needs rehab.
Data from the Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Survey on Drug Use and Health (NSDUH) shows that there are large variations in who goes to rehab (private, public and related facilities) based on their drug of choice. This is true both for those with a Substance Use Disorder (SUD) and for all nonmedical substance users, including recreational users. 
Figure 1 (seen in the attached full blog) shows the percentages of people with SUDs who utilized “specialty treatment[1]” for addiction in 2012.
Figure 2 gives the percentages of all nonmedical users of a substance who utilized such facilities that year.
“Specialty treatment” for an SUD is defined by SAMHSA as treatment received at any of the following: hospitals (inpatient only), drug or alcohol rehabilitation facilities (inpatient or outpatient) or mental health centers. It does not include treatment at an emergency room, a private doctor’s office, a self-help group such as AA or NA, a prison or jail or a hospital as an outpatient.
We can see from these two graphs that there are significant disparities between who utilized treatment and who did not. The most provocative statistics shows that six out of 10 people with a Heroin Use Disorder were likely to get treatment, compared to six out of 100 people with an Alcohol Use Disorder. In other words, people with problematic heroin use, who constitute less than 2% of all Americans with an SUD, were about 10 times more likely to use rehab treatment than those with an alcohol or marijuana use problem, who comprise over 80% of Americans with SUDs (see Figure 3). Indeed, these alcohol and marijuana disorders are the least likely of all SUDs to be treated.
 

Figure 4 shows what percentage of users of each substance are recreational users vs. substance abusers vs. substance dependent (the “abuse” percentage was calculated by subtracting the number with “dependence” from the number with “abuse and dependence” in the NSDUH data). As we can see, the vast majority of users of each substance are recreational, or non problematic, users—with the notable exception of heroin: Fully two out of three people who use heroin are dependent on the drug. It is important to note, however, that other surveys, including the Epidemiological Catchment Area Survey (ECA), have found much lower rates of Heroin Use Disorder among users. Although the ECA statistics cover the late 1980s, and therefore offer only a historical comparison, the finding of this large study—44% vs. 65%—is more representative of what the majority of research had found.

So far we have looked at which substance users go to rehab. Now let’s look at how well rehab works. Do those who go to specialty treatment[2] for addiction fare better than those who get no treatment at all and kick on their own?
 
To explore this question, we turn from 12-month data to lifetime data. According to the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which included some 43,000 people and was conducted between 2001 and 2005, only 11.8% of people with an Alcohol Use Disorder ever received specialty treatment. If AA attendance is included as a form of help seeking, that percentage only increases to 14.6%. However, in spite of this, the NESARC data also shows that the lifetime recovery rate for Alcohol Dependence is over 90%.
 
NESARC also shows that the lifetime rates of treatment utilization (including AA) for any Drug Use Disorder are 8.1% for Abuse and 37.9% for Dependence. Lifetime treatment utilization (including AA) for Prescription Drug Use Disorders, by drug category, is: tranquilizers, 38.6%; stimulants, 28.6%; sedatives, 35.7%; and opioids, 31.9%. Compare that to lifetime remission rates for these disorders: tranquilizers, 98.3%; stimulants, 99.0%; sedatives, 98.7%; and opioids. 96.1%. The lifetime remission rates for illicit Drug Use Disorders are: 97.2% for cannabis and 99.2% for cocaine. Lifetime treatment utilization rates for these two drugs apparently have yet to be researched, however.
 
It is worth noting that nicotine is the hardest of all drugs to kick, with a lifetime remission rate of 83.7%. Yet there are no residential rehabs for cigarette smokers. Although research suggests that smokers who get some form of treatment have higher success rates than those who do not, it also tell us that only about one fifth of smokers get any sort of treatment: Therefore, as with other substances, the majority who kick their nicotine addiction do so without treatment.
 
What these comparisons of substance use data suggest is that even though the majority of people with problematic use never get rehab treatment or go to AA, the success rate in kicking abuse and/or dependence is very high.
 
Now, the half-life of an addiction is the amount of time it takes for half of the people who have that addiction to recover from it. NESARC shows that the half-life of Prescription Drug Use Disorders is: stimulants, four years; sedatives, tranquilizers and opioids, five years. The half life for other Substance Dependencies are: cocaine, five years; cannabis, six years; alcohol, 14 years; nicotine, 26 years. It would be of great interest if future researchers using the NESARC data would crunch the numbers to answer the question for us: Does treatment do anything to shorten the half-life of a substance abuse career? Or do those who get no treatment do as well as, or even better than, those who do get treatment? Such an analysis would go a long way toward answering questions about treatment’s effectiveness. The answer lies in the raw data collected by NESARC—all we need is a researcher to tease it out.
 
As for the rates of spontaneous remission of Heroin Dependence, the NESARC numbers have not been published yet. A number of studies, such as Lee Robins’ classic study of Vietnam veterans in the early 1970s, have shown that natural recovery from heroin addiction is common, but because these are not naturalistic epidemiological studies, we have no truly accurate estimates of remission rates. (Robbins’ findings, which are generally viewed as extraordinary, showed a relapse rate of 5% after one year and 12% after three years.)
 
One question of great interest that remains to be answered is: How effective is treatment when compared to the rate of spontaneous remission? And what types of treatment are effective? The NESARC study has amassed a huge amount of data that can be used to address this question, but unfortunately no researcher has (yet) crunched the numbers.
Another fascinating fact we find in the NSDUH data is that 84% of the people the government thinks should have treatment do not want treatment, as illustrated in Figure 5.

The government’s criteria for those who should get treatment involves three categories: individuals who met DSM IV criteria for “Substance Abuse,” those who met the criteria for “Substance Dependence” and everyone who received treatment regardless of DSM criteria. Although both the federal government and the addiction treatment industry use these statistics when calling for increased access to treatment—in order to meet this perceived “need”—the vast majority of people with an SUD do not in fact feel this need. And as we see, the data back them up—a fact that is not as widely known as it should be.
 
The conventional wisdom says that this glaring gap between the perceived need for treatment and the felt need for treatment is a sign that we need to do a better job of persuading substance users to enter treatment. Two of the main reasons typically given for why substance users do not want or do not get treatment are: lack of resources and psychological denial. The Affordable Care Act increases access to mental health and addiction services; public awareness campaigns, media attention and entertainment such as Dr. Drew Pinsky’s franchise, have both reinforced the concept of denial and promoted the act of overcoming it.
It is important to ask whether this enormous—and growing—financial and cultural investment in addiction treatment is wise or wasteful. Research tells us that treatment has some benefit for some people. Indeed, former users report that it saves lives. But research doesn’t tell us who is most likely to benefit—and therefore where the resources should be spent. Are the substance users who have the most severe problems the ones who are most likely to benefit from treatment? Such questions require answers.
 
As a former consumer of substance abuse treatment and as a person who works with active substance users, I believe that the primary reasons people do not want to go to substance abuse treatment are: (1) they will be disrespected as individuals, (2) abstinence will be forced upon them whether they choose it or not, and (3) spirituality will also be forced upon them. This is a basically accurate description of most of the alcohol and drug treatment currently available, particularly for poor people.
 
A new treatment paradigm that meets people “where they are at,” encouraging them to pursue goals they choose for themselves, would attract rather than repel people who need help. Patt Denning, Jeannie Little and Andrew Tatarsky have done pioneering work on developing such a paradigm; they report many successes with clients who have been resistant to traditional forms of treatment. My own experience tells me that this paradigm should become the standard of care. At the very least, advocates of the current treatment paradigm would do well to expand specialty treatment to include this approach.

[1] The term “specialty treatment” in this article just means licensed drug treatment.
 

[1] Kenneth Anderson is the founder of HAMS Harm Reduction for Alcohol and the author of How to Change Your Drinking: A Harm Reduction Guide to Alcohol. He has a master’s degree in Mental Health and Substance Abuse Counseling from the New School for Social Research and has worked in the field of harm reduction since 2002, including “in the trenches” doing needle exchange in Minneapolis. He served as online director for Moderation Management and as director of development at the Lower East Side Harm Reduction Center. He hosts a harm reduction podcast and writes a blog for Psychology Today called Overcoming Addiction. His last piece for Substance.com was“The Training Manual for US Addiction Counselors Is Full of Myths.”