If no one treatment for alcohol or other drug use disorders has been found to be effective for everyone, do the available formal treatments for these disorders have any value?
I posed this question to my online chemical dependency class this week. The issue pertaining to this question is not whether or not formal treatments actually work and have value. For students who have taken my classes, they hear me repeat one of the tenets of my therapeutic approach is since treatment is not mathematics or physics, there are no absolutes when working with human beings.
As practitioners we sometimes fall into the trap that a specific methodology or approach is the only way. This is not uncommon in all areas of practice but it is especially true in the treatment of chemical dependency disorders. We want to feel that what we do is working and that, in and of itself is fine. The problem is when we buy into a treatment approach as the only way because we have found it to be successful. What happens (and it will happen) when we encounter clients who do not fit into a specific method we are in love with? This is not a joke. In the 1980s when the family of origin approach took hold, there was tremendous pressure to utilize what was seen as the answer. It’s a good approach and I might utilize some aspects in my practice but I don’t identify myself as being allied to any one specific method because people are not supposed to fit my method. I’m supposed to adapt to their needs. The tremendous success of twelve step programs has spawned a somewhat nasty side effect of a minimizing of the benefit of concurrent psychotherapy as an adjunct to twelve-step recovery programs. It is incumbent upon us to be open-minded when we help our clients work through substance abuse disorders. Not every user/abuser must do 90 meetings in 90 days. Not every addiction is primary; some are secondary. Here’s a treatment plan that I have found to be successful:
1. I refer every client to a twelve step program
2. I see them in individual and/or group therapy with other users
3. I respect my client’s right to follow their own path to recovery
Do not misunderstand. If I am working with a full-blown addict/alcoholic who is resisting AA or NA, I do not tell them, “That’s fine, you don’t need it.” I still push them in that direction and that’s where the individual/group therapy comes in. By the same token, when I have a client who has attended AA/NA for a period of time and starts to express doubts about themselves because they feel that they don’t need to go to a meeting everyday, I don’t give them the message, “You will never achieve serenity if you stop going to AA/NA.”
We listen, look, evaluate and stay on top of it. That’s how you increase the likelihood of success.