Expectations for Treatment Often Clash
Expectations are High
Many people, including drug users themselves, have mistaken beliefs about drug addiction and recovery from addiction. Two of the most pervasive myths are that a person can get off drugs alone and that most addicts can become permanently drug-free. These ideas stem in part from notions that continued drug use is voluntary and that a person's inability to overcome addiction stems solely from character flaws or a lack of willpower.
Society has differing standards of success in treating chronic conditions or nicotine or alcohol addictions than for treating addiction to opiates and injection drugs.
The highly addictive nature of nicotine and the difficulties associated with quitting smoking cigarettes are well understood and accepted. Quitting smoking often requires repeated attempts and the help of therapeutic aids, changing from nicotine patches and gum to antidepressants, hypnotism and acupuncture. Only 3 to 7 percent of those who try to quit on their own each year succeed. Yet little stigma is attached to a relapse to smoking. Rather, smokers are urged to try again to quit.
The public also has a more evolved understanding of alcoholism as a disease and more realistic expectations about the success of treatment. The potential for relapse after treatment for alcoholism is generally recognized and accepted. In contrast, societal reactions when a person relapses on opiates or injection drug use are usually highly negative.
Similarly, society understands that chronic conditions, such as diabetes or high blood pressure, cannot be "cured" but only treated and controlled over many years to reduce potentially severe consequences. In contrast, if is widely believed that it should be possible to permanently cure a person of addiction to injection or other drugs. If a "cure" doesn't happen, then treatment is seen as useless and not deserving of societal investment or support.
Reality Does Not Often Meet Expectations
Numerous studies have shown that it is very hard for opiate and injection drug users (IDUs) and others addicted to drugs like cocaine to quit on their own. Research has also shown that relapse to drug use is common and that it is difficult for opiate drug users and those addicted to other drugs to attain a permanent drug-free state, even after treatment. Many people with addiction problems also have mental health disorders, which makes recovery even more difficult.
Research Provides Some Explanations
A more sophisticated understanding of addiction has emerged in the last two decades and this is helping to clarify the disconnect between expectations and reality:
- Addiction is a brain disease. Long-term drug use causes profound changes in brain structure and function that result in uncontrollable compulsive drug craving, seeking and use.
- Addiction is a multifaceted disease. It is the quintessential "bio-behavioral disorder" with profound effects on a person's physical, emotional and mental health, as well as his or her family, colleagues, neighbors and community.
- Addiction is a treatable chronic disease. The changes in brain function and structure that occur with drug use persist long after drug use is stopped. "Cure" is therefore not necessarily an attainable or appropriate goal.
However, substance abuse treatment can successfully address the multiple facets of addiction.
What Are Some Realistic Expectations For Substance Abuse
Research has shown that comprehensive and sustained substance abuse treatment can help individuals reduce or stop using illegal or dangerous drugs, thereby greatly improving their functioning in the family, at work and in society, and is as effective as the treatments for other chronic conditions, including diabetes and asthma.
Research has also demonstrated that a variety of effective approaches to substance abuse treatment exist that can help people achieve long-term control. This control allows people to reach important goals, including reduced drug use, reduced criminal activity, gainful employment, and more stable life situations.
Unrealistic vs. Realistic Expectations: Changing the words we use
|eliminate drug use||reduce or stop drug use|
|cured||treated and controlled|
|on my own||with help|
|forever||one day at a time|
|one-shot treatment||ongoing process|
|relapse is unacceptable||relapse happens|
Extensive experience has revealed a number of issues that are key to successful substance abuse treatment:
- Treatment should be readily available to individuals who need it.
- Individuals need to be engaged in treatment for an adequate length of time. For example, participation in outpatient or residential programs for less than 90 days is of limited or no effectiveness. Patients should receive a minimum of 12 months of treatment in a series of settings.
- Treatment for many chronic conditions involves daily decisions about issues such as diet, exercise or medication. Similarly, "recovery" from drug addiction is a dynamic process that requires a person to decide to "stay sober one day at a time." Recovery is a long-term effort, often requiring multiple episodes of treatment.
- Addiction often occurs simultaneously with other physical or mental health problems. The treatment plan must take those into consideration.
- Addiction is often called a "family disease." All members of a family with an addicted member should seek treatment in the form of education/counseling.
- Treatment programs work better if they are tailored to the person's characteristics and needs. No single type of treatment is appropriate for everyone, however the 12-step community has the highest success rate for continued sobriety/clean time.
- Treatment must be reassessed periodically so it can be adjusted as needed.
The information on this page is taken, in part, from the CDC publication, "What Can We Expect From Substance Abuse Treatment," February, 2002.