Writing in the NIDA journal Addiction Science and Clinical Practice, Alexandre B. Laudet challenges us to look at what it means if we do accept the premise that addiction is a chronic condition by suggesting that is this indeed the case we must assess success (or recovery)differently. Noting that previous assessment of treatment success has narrowly focused on abstinence from substances, Laudet proposes that "quality of life" must be considered in determining how much treatment has really helped an individual with a chronic condition.

This makes complete sense to me. In other words, it is hard to defend the idea that a miserable recovering person, regardless of how long he or she has been abstinent, represents a fully successful treatment outcome--or an individual who returns to criminal or abusive behavior, even if not using substances. The question, of course, is how to measure the construct "quality of life," and if it is solely from the perspective of the individual patient/client/addicted person, or if some external source has a say in this assessment.

On balance, however, the idea of adding a quality of life measure to the assessment of treatment outcome is another step in the right direction, it seems to me, of truly looking at substance use disorders as the chronic conditions they are, and not as the black-and-white, right-and-wrong conditions the so-called moral model has often dictated.

Be well.... 
 

In 25 years as a counselor and 12 or so teaching college students, as well as being an interested observer of how American culture views addiction, treatment, and recovery, I am struck by what seems to be one of the biggest misconceptions that people have about treatment, namely that an individual must "want" help in order to be helped.

My reaction to this perceived truism is a resounding"no!" The reality is that the desire to recover, the motivation to change, if you will, is most often something that develops during the course of counseling or treatment. Yes, ultimately the individual client or patient does need to want to change, to recover, but this desire is frequently very low or even non-existent at the commencement of treatment or counseling. All that is really required at the front end is some willingness to show up or participate--the professionals can take it from there.

Imagine if it were true that for treatment to be successful the individual must really want help. Here is a somewhat-over-the-top depiction of what an initial counseling exchange would look like:

Counselor: How can I help you today?


Client: Well, my drug use is really causing me a problem, so I called your treatment center for help, I know I need treatment, I cannot stop on my own, and I think you are the folks to help me, regardless of how much it might cost or how much work (or school) I might miss.

I am not sure many of us who do this work have ever heard quite that sentence--and part of me wonders what we would do if we did.  A much more common exchange would be something like:

Counselor: What brings you here today?

Client: I don't know. My family thinks I have a drug problem because I just got fired from my job for testing positive on a drug test, but it was just marijuana, which should be legal anyway, and I could stop any time I want. It's no big deal, and I don't need to be in this place with all these drug addicts, that's for sure.


That gives us somewhere to start. In reality, it is very common for the desire to recover to be something that grows gradually during the course of treatment. In the language of motivational interviewing, clients frequently come to treatment in the precontemplation or contemplation stages, rather than in the action stage.

Just a thought--thanks for letting me share with you.

Musing on the resignation of University of Richmond football coach Latrell Scott...

News reports today informed us that University of Richmond football coach Latrell Scott resigned after being arrested early this morning for a DUI outside Richmond, reportedly his second in the past 5-10 years. It is natural, I think, for us to think that he did the right thing in resigning, that a football coach at a major university should set a better example for his players, or that someone in the public eye should not put himself (or herself) in such a situation--all defensible positions.

Another thought hit me, however, understanding that I do not know Coach Scott or all of the details of this incident. A second DUI raises a major red flag for the possibility of a substance use disorder (abuse or dependence). What would the reaction have been if Coach Scott had immediately requested a leave of absence to seek treatment for this problem? Would he have been permitted to step aside for a period of time while attending an inpatient or residential treatment program--or given the time he might need to go to outpatient treatment?

Yes, it is about setting an example--but I am not sure that stepping down was the right example to set.

How about this: "Coach Scott announced today that he was seeking an evaluation of issues relating to his use of substances, and that he would follow the recommendations produced by this evaluation. In his absence, his associate head coach will assume responsibility for the day-to-day operations of the team.  Coach Scott indicated that he is committed to receiving the help that he needs and that he looks forward to returning to the team at the appropriate time." Could this have been an alternative ending--or beginning--to the story?

Would we not have done that if he had previously had cancer and his cancer returned? Was not Pat Summitt applauded for her courage in adddressing her early onset dementia--and for contining to coach?

It just seems to me that even though we give lip service to the idea of the disease concept of addiction, when we are presented with opportunities to really operationalize this, as Coach Scott's situation may have offered, we respond with the same old moral model response, in this case resignation (or the termination that may have resulted any way) rather than assessment or treatment. Your thoughts?

Support for college students in recovery from addiction is a personal passion of mine--and so I was gratified and encouraged to see that students in New York City will soon have access to recovery housing (see the link below). It only makes sense to provide resources to those students who are facing the sometimes daunting challenge of maintaining their sobriety in the "belly of the beast," if you will. Understanding that not all college students choose to partake in alcohol or other drugs, it is certainly a difficult environment in which to be an abstainer. If we as a society can identify and implement pro-recovery elements, such as recovery housing, perhaps this challenge can become less daunting. I applaud the steps described below--let's hope other plac

http://www.drugfree.org/join-together/addiction/new-york-recovery-residence-hall-is-the-latest-in-a-small-but-growing-group?utm_source=Join+Together+Weekly&utm_campaign=3f1f2282a1-JT+Weekly+News%3A+Recovery+Schools%3A+Giving...&utm_medium=email

SAMHSA issues new definition of recovery....what do you think?

Working Definition of Recovery

Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.

Clearly, a definition has to be broad to be inclusive. The above is certainly that, but does it far enough or provide enough speficity?

Recovering Athletes in 2011?

Happy New Year! Will 2011 be the year that recovering athletes come forward and tell their stories of hope and recovery? Let's hope so. It seems almost a weekly occurrence: the news story of the celebrity athlete pulled over for DUI, arrested for drug possession, or charged in a domestic dispute where alcohol or other drugs are clearly involved.

What is missing are the uplifting stories of athletes who have received treatment, addressed their issues, and made the changes necessary to recover. As Gus Gerard's story from my previous post illustrates, athletes can and do recover-- but this is not necessarily news.

Watch this spot for more stories like Gus's in 2011. The athletes out there who have courageously dealt with their issues can be role models and examples for thousands of others who are dealing with addiction.

Think of these names:

Cris Carter (NFL/ESPN)
David Thompson (ABA/NBA)
John Lucas (NBA)
Dock Ellis (MLB)
Gerry Cooney (Boxing)
Pat Day (Jockey)

No news is good news; all of these athletes have reportedly been clean and sober for years. Maybe this is the year that athletes in recovery will be recognized--and step up to provide counsel, wisdom, and encouragement for those in need of help....