by Joye C. Anestis, M.S.
Alcohol and substance abuse/dependence, or addiction, touches almost all of our lives in some ways. In the mental health community, discussions of the treatment of addictions are rife with controversy. But common knowledge of these controversies is minimal - few people outside of the mental health world know that, for example, many problem drinkers can manage their drinking via moderation without entering an inpatient rehab facility (i.e., abstinence is not the only option for many) or that research does not exist to indicate that Alcoholics Anonymous is the most effective self-help treatment available. Our friends at the Cognitive-Behavioral Therapy Center of Western North Carolina have kicked off their new podcast series with a fascinating discussion of the current state of addiction treatment research, with R. Trent Codd, Ed.S., of the Cognitive-Behavioral Therapy Center of Western North Carolina interviewing Dr. Tom Horvath. This resource is designed to provide evidence-based information for both professionals and consumers.
Some of the topics covered in their discussion are:
- The stepped-care approach to addiction treatment. Resources recommended for individuals beginning to investigate treatments include www.moderation.org and www.smartrecovery.org.
- A description of SMART recovery, an alternative to 12-step programs, which combines cognitive-behavioral therapy and motivational enhancement therapy in a self-help format.
- Discussion of the evidence (or lack thereof) behind Alcoholics Anonymous (AA) and other 12-step programs.
- The usefulness of the disease model of addiction
- Medication options available to help those with substance abuse/dependence problems
- Recommendations for family of those struggling with addiction
Several things are worth noting about this particular podcast. One of the overall messages I felt was conveyed throughout the interview was the importance of motivation on the part of the individual struggling with addiction. Copious amounts of research has repeatedly shown that addiction treatments don't work unless the addicted individual is motivated for treatment. In other words, if you don't want to quit, you're not going to quit. Sounds so obvious, right? Unfortunately, many folks are of the mindset that staging an intervention (like those showcased on the TV show "Intervention") and then forcing an individual into an inpatient program is the the only way to go. Such forced treatment fails more times than it works. One of the key components of developing motivation in an addicted individual is to allow them to choose what type of treatment to pursue, and one of the highlights of this interview is the discussion of the several treatment options that are currently available and well-supported by research literature.
Another idea that Horvath mentions that I found to be quite exceptional arises during discussion of several controversial topics in addiction, such as the utility of AA and the disease model of addiction. His take-home message regarding such topics is that, if something is working for you, by all means keep doing it. For example, there is inadequate literature on the efficacy of AA, even though it is often presented as the best and only option available for folks with alcohol problems. But this paucity of literature doesn't mean that it doesn't work for some people, and if it does work, then, as they say, "keep coming back."
Relatedly, viewing addiction as a disease is not supported by what we know about how addiction actually works. For many people, viewing addiction as a disease decreases their motivation because they feel like they are powerless to change. But others find comfort and help in that viewpoint - and again, Horvath notes, if it works for you, stick with it. I think it sometimes gets lost when discussing empirically-supported treatments that occassionally treatments with minimal support do work for some folks. The EST message is never that ESTs are the only things that work, just that they are the only things we can "prove" work for most people with a particular problem.
So, check out the podcast at www.behaviortherapist.com. I'll let you know when the next one appears. For more information on addiction, we recommend the APA Division on Addictions website. Also, peruse our bookstore for more information on empirically-supported addiction treatments:
- Motivational Interviewing, Second Edition: Preparing People for Change
- Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence
- Cognitive Therapy of Substance Abuse
-
Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening.
Joye Anestis is a doctoral candidate in clinical psychology at Florida State University.
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