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Tuesday
Aug022011

It takes a village to treat addiction: whatever works!

Very frequently I am asked, "What is your take on addiction treatment?" This is what think.

The disease of addiction is bigger and overwhelmingly stronger than many of us - patients and treatment providers alike. At the end of untreated addiction, there is deterioration in all areas of life, and subsequently, death. Every addict has a mistress in their addiction. And she is a very cold hearted mistress. The addict will do anything to be with her: steal from anyone; lie or betray anyone; even loved ones and themselves. Addiction is a life-long chronic condition that is lethal if untreated. It needs to be treated with respect ...  and by all means necessary.

The majority of my patients do well in an individually-based and customized treatment environment. I meet every client in that moment exactly where they are. What I like about this approach is that in my office, I can provide complete confidentiality. I am sad to say, but confidentiality can not be guaranteed in group settings - someone always "squeals." Privacy is very important for all my patients. Unfortunatelyl, "addict" is still a dirty word in the English language. For that same reason, I ask all my clients to consider the consequences of using insurance in paying for addiction treatment: what are the long term effects of having "addiction" on your medical record?

Very often, my clients have symptoms of depression and anxiety that either pre-date their addiction, or were developed as a result of it. Over the years, I developed very strong professional relationships with psychiatrists in the Bay area, and I can provide each client with a high quality referral for medical evaluation. Not every one needs it, but it is good to have this option available. A word of caution: from my experience, it is important to actually go and see a specialist for psychiatric medications evaluation: either a psychiatrist or Board Certified Addictionologist. Symptoms of addiction can be very complex to manage, and I have seen too many mistakes made by regular physicians resulting in grave consequences.

Addiction treatment also takes time. Over 90% of all clients entering twenty-eight day programs relapse, often shortly after release. Why? Because they were taken out of the world for four weeks, kept safe, taught addiction basics, and then let out to that same world that they could not deal in the first place. From my fourteen years of treating addiction, the long-term outpatient treatment model works better. In this approach, clients are learning new tools for the world where they need to use them. Success rate for this treatment model - a combination of individualized therapeutic services ( individual, couple's, family therapy) and medication - is closer to 70%.

Of course, there are clients who respond well to external structure of 12-step meetings and group settings to stay clean. If that is what works for them, then I definitely recommend that they should do just that.

It takes a village to treat addiction. Whatever works!