We Can’t Ignore the Elephant
Much of the focus and headlines have been on the opioid epidemic and more recently on the increasing rates of overdose deaths rates from methamphetamines as stimulants are once again gaining momentum in use and increasing addiction rates. Recent studies on the detrimental effects of alcohol have brought into question, what are safe levels of drinking? Vaping (inhaling/ exhaling some type of aerosol using e-cigarettes and similar devices) is increasing among youth with 1.3 million high school students started vaping in 2018.
Marijuana is the most commonly used “illicit” drug in the USA (an estimated 22+ million users in the last month). A political movement (with economic implications) has re-branded marijuana and cannabis as increasing numbers of states have decriminalized or have legalized (10 states as of this writing) its use for medical and/or recreational use. Perceptions are changing. A 2013 Fox poll found that that 85% of Americans support medical marijuana when prescribed by a physician.
I have created two workshops in collaboration with the Gottman Institute, a one-day training for therapists (Couples and Addiction Recovery Training), and a two-day workshop for couples in recovery from addiction (Roadmap for the Journey). I often receive email requests from couples asking if I know anybody in their area that works with addiction and recovery issues. Almost always, I apologize that don’t know of anybody in their area. To be honest, it has been a challenge to get therapists to attend the training. I have some ideas why.
Don’t Ask Don’t Tell?
Helping professionals often feel overcome with anxiety or fear in addressing, much less managing, addiction issues with their individual or couple clients. It is understandable, addiction is very daunting and overwhelming. Unfortunately, for many professionals misinformation, bias, and stigma associated with addictive disorders seems to get in the way of learning more to help more. These are the same struggles the lay public have. So the professionals may very well avoid facing the thing that feels most uncomfortable, and either refer or treat the client(s) for some other complaint.
At some level it may boil down to thinking “I’m not somebody who works with these issues”. Or perhaps it’s more like, “I am not somebody who wants to work with these issues”.
In reflecting on my own development as a therapist over the years, I can relate to the concerns and discomfort many therapists feel about treating addiction. It wasn’t until I received post-graduate training in addiction, some five years into my practice, that I learned that addiction is treatable and preventable. Having specialized in addiction now for over 30 years, I struggle with the conclusion that while tremendous advances in the science of addiction and treatment have led to a remarkable area of growth in treatment knowledge, the therapy field has not kept up with those advances to access what we now know.
There Really is Hope
Therapists and counselors have the tools to assess problematic and non-problematic substance use. Couple therapists can help couples to have conversations about existing concerns with substance use, or compulsive, dis-regulated behaviors. We can help couples and families talk about the impact of addiction and of recovery and help those couples and families integrate recovery into family life. Having a healthy relationship is one of the single biggest predictors for long-term recovery.
If you are a health care or mental health professional, think about the last time you received any training in addiction. Explore what your beliefs and attitudes are about addictions, and people with addictions. Most with problematic substance use are not addicted, but they still need help and education. About 70% of those diagnosed with alcohol use disorder, will not meet that criteria in four years. Approximately 7% – 9% fall in the severe symptom range and meet the criteria for the disease concept of addiction, defined in the context of structural and functional changes in the brain that is well documented in the research. A little information goes a long way in helping people.
Taking the Next Steps
Is it time to get more information, training? Some places to start are The National Institute on Drug Abuse (https://www.drugabuse.gov/), and The National Institute on Alcohol Abuse and Alcoholism (https://www.niaaa.nih.gov/).
We desperately need to destigmatize addiction in both the lay and professional communities. If you are a professional in thr helping professions consider what it could mean to identify with; “I am someone who can learn about and work with addiction and problematic use”. That shift in thinking can make all the difference in the world; it did for me at least.