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Addiction Treatment is Changing

Five trends are driving a slow, but ultimately cataclysmic shift in addiction treatment.

  • Addiction isn’t about drugs. Of course, as the author (with Archie Brodsky) of Love and Addiction in 1975, I have been tracking this development for some time. In 2013, the American Psychiatric Association recognized what it called “behavioral addictions” by identifying one – gambling – and suggesting another, Internet games. Of course, this will not end our finding new areas of addiction.

    Takeaway: Addiction is not a chemical biproduct of drug use, but is an extreme type of experience an individual forms with a particular involvement.
  • Most people recover on their own. Virtually all of addiction treatment – certainly, disease-based treatment a la Alcoholics Anonymous and the American Board of Addiction Medicine – is predicated on the downward spiral the course of addiction supposedly follows. It doesn’t usually. Addicted people recognize, albeit sometimes haltingly and sub-rosa, the penalties and pain their addictions cause themselves and others. More often than not, this recognition breaks through and causes them to quit when they feel able to.

    Takeaway: Treatment isn’t about rescuing people, but rather enhancing their existing motivation, values, resources and skills that allow them to change.
  • Traditional treatments (i.e. Alcoholics Anonymous and the 12-steps) are ineffective. Americans are split over two contradictory perceptions – that most addicts relapse after treatment and that rehab is not particularly effective, and claims that the 12-steps are the ultimate in effective treatment. AA and the 12-steps are not effective, and Lance Dodes (and myself) are leading a popular uprising against the idea that it is.

    Takeaway: We all know that 12-step groups and treatment are not able to reverse the incidence and prevalence of addiction, and that we need to move beyond them.
  • Neuroscience is not the answer. While we are enraptured by the promise of neuroscience, as Sally Satel and Scott Lilienfeld make clear in Brainwashed, it will not solve our major mental health and, most certainly, our addiction problems. This is due to the uncertainty of neuroscience findings, the inexact relationship between the biological substrata and human experience and behavior, and the need for treatment to impact people’s actual experience and lives.

    Takeaway: Focusing on anticipated neuroscientific breakthroughs detracts from real ways to address addiction at the individual and societal levels.
  • Ultimately, the remedies for addiction are built on inner personal efficacy. As my book with Ilse Thompson, Recover! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program, makes clear, there is no solution for addiction that doesn’t rely on the person’s sense of efficacy. Even to quit drinking or drug use in Alcoholics or Narcotics Anonymous is a statement of personal efficacy. However, their powerlessness message is not the best route to achieve this goal. Instead, as Ilse and I make clear, treatment and policy must pursue self-empowerment built on mindful self-control and self-acceptance/self-love.

    Takeaway: Our infantilizing, disempowering methods for attacking addiction are counterproductive, and we must do an about-face towards empowerment models. Taken together, these five insights (which can hardly be gainsaid) point addiction treatment in an entirely new direction from that we have been pursuing for decades and that many still wrongfully and self-defeatingly defend and promote.

Stanton Peele is the author of Recover! Stop Thinking Like an Addict with The PERFECT Program, along with Ilse Thompson.