Do we really need to continue with the Make the Addict Suffer Model?
Or is there a better way?
I have been trying to make sense of non-sense. I have a rambling theory….about 18% to 20% of people with SUD are also narcissists and sociopaths. A much higher percentage than the general population.
Perhaps this lead to the common punishing tactics used in treating this issue.
Narcissists and sociopaths will only respond to clear consequences and “tough” boundaries. You don’t LOVE a narcissist into Recovery. You paint him or her into a corner and they have no choice.
So the hard-ass stuff works on this group. BUT, stating the obvious, the overwhelming majority ARE NOT narcissists and sociopaths.
This group will actually be harmed by the hard-ass approach.
They Love You!
The media also LOVES THE NARCISSISTIC story line. Reality TV is not designed for a supportive, invitational, and ongoing recovery story.
Instead they want the drama, the confrontation, the badass story.
That culminates with someone storming out of the intervention but changing their mind just in time to fly off to rehab at the beach….. so this story line is reinforced to the general public.
Confrontation vs. Support
We tailor our interventions to the lowest common denominator. The narcissist needs to be confronted. But the majority with SUD need supported care.
And I understand why…. the punishing orientation is the only way to do treatment under our current reimbursement system.
Individualized approach to treatment is very hard to pull off when you have to pigeon hole people into groups. Group that meet 3x a week for 3 hours at a clip.
Or run a residential program for 50 plus people. You need people to “fall in line”. Or it’s chaos and mayhem.
Social Following Theory
Social following theory is the foundation of all group process and certainly the foundation for the residential experience.
You can’t have “social following” if you encourage individualism.
Social following requires group think. (This is why you will be put back into the remedial re-education group if you do not adequately “surrender”….).
This model allows for 10% of the folks in need to roll through the structure of treatment and for the reimbursement to follow.
Interestingly… the “confrontational, one size fits all, my way or the highway model”drives many potential patients away from services.
More “Hard Realities”
The tough love stuff runs many people off.
The language around treatment and recovery runs many off.
If a person in need tries some groups and they can’t fit in the box they don’t come back.
We tell people to go back out and “have more pain” then “come back when you want it”.
Sometimes we say this in subtle ways. Sometimes overt ways.
ALL OF THIS IS VERY CONVENIENT FOR THE PAYER. THE INSURANCE COMPANY. THEY DON’T HAVE TO CUT A CHECK IF THE PERSON DOES NOT SHOW UP. So 90% no show works very well for their bottom line.
Make the Addict Suffer
By the way. The “make the addict suffer” approach will also resonate with many families because they are so frustrated and angry with the person’s behavior.
And because they are uneducated on the details of addiction and recovery. And of course it resonates with the “law and order” elements of society.)
It’s a perfectly designed system that has evolved over the decades. The system will always produce the exact results it was designed to produce.
Favor Greenville – Innovation Saves Lives
FAVOR GREENVILLE has started a program in the hospital where we are working with those who “never surrendered”. Those who hit bottom and have just scraped along the bottom for decades.
They “just wouldn’t do what they were supposed to do”.
And after years and years of misuse they are now laying in a hospital bed.
Inpatient, for a wide variety of medical conditions the direct result of use. Alcohol mostly.
But other things as well. The costs are staggering. The hope has been beaten out of them. The healthcare system doesn’t know what to do.
Do you just let them die? Is that what we should do?
After all they “Didn’t want it”….. “They’re not willing” – Right?
The Installment Pain Plan
These are people with families. And with dreams. Human beings cut down way too early.
This is the result of “wait until they hit bottom” system we have built. Society should have been working on an alternative answer 20 years ago when many of these folks started their journey in and out of the hospital.
Their options should not have been limited to “groups and rehab” and “if you want it” recovery.
There are millions of people in America written off like this.
Slowly killing themselves on the installment plan. Because “they didn’t want it bad enough”…..
There is a Moral Imperative
And if you are sick enough to not care about the people. If you lack the humanity to see this as a moral issue then consider the financial implications of taking care of these people as they deal with these devastating conditions.
👊👊👊The system will always produce the exact results it was designed to produce.
But I hope you can clearly see.
It’s a system that desperately needs disrupted. There is a moral imperative to disrupt the system.
6 PRINCIPLES THAT WILL TRANSFORM THE RECOVERY WORLD
“Cartel–an arrangement between parties to promote a mutual interest or goal… “
I believe it will take a RADICAL reshuffling of the current treatment approach & public policy to make a dent in this crisis. I say this because all our efforts, so far, have fallen short as indicated by the astronomical increase in over-dose deaths. If it’s a disease the primary indicator of successful care would be keeping people alive. Right?
All that we have done to this point has been predicated on our pre-existing approach/philosophy. All our money and resources have been funneled through our pre-existing system of care.
It’s going to take a massive shake to transform and usher in change. Our institutions will double down on current practices. Because that is what institutions do. They exist to sustain themselves. It’s a sociological fact.
The change could come via the free market. If treatment providers saw the wisdom of a new business model. However, that would only happen if current business dried up. “If it’s not broke don’t fix it”…. seems to be the prevailing philosophy. And I don’t see it drying up soon. Too deep a problem. Too much demand. Plus 70% repeat business makes the model self-sustaining.
The solution will come via “outsiders” AND NON-CONFORMISTS. Independent thinkers, people from other industries, progressive healthcare providers, and risk takers. Partnerships that, on paper, make little sense but in practice lead to transformational ideas.
THESE PARTNERSHIPS WILL PRODUCE RADICAL IDEAS. People will actively push back on the ideas. When that happens, it indicates that the proposed idea is probably the right type of idea…bureaucratic objection especially, is a litmus test for a great idea. Almost as promising as when a treatment provider tells you “that’s not the way we do it”…. then you are on the right track.
It’s going to take a cartel…A RECOVERY cartel. Like any good cartel we need to have our organizing principles and our mutual goals… From my perspective the CARTEL holds the following principles near and dear.
Within the CARTEL we embrace the concept of “keep coming back”. For us, this is not just a cliché or a theoretical ideal. For us, it is the measure of our success and the single most important aspect of the recovery process. We know that people who stay engaged in a recovery process, regardless of the specific pathway, tend to get better. Even if you struggle along the way your life starts to improve. Even if you “mess up” and use, things begin to get better. Furthermore, we believe that the vast majority of people that continue to work a recovery program do eventually sustain long term recovery.
On a very practical level this means we will never preach to you or judge you. It means that we are all on equal footing in terms of our recovery. It means there is no hierarchy of recovery or right or wrong way to do recovery. We don’t count days. We don’t prescribe specific pathways. We just want to see your life improve. We just want to see families get put back together. We will meet you where you are in this process. If you are still using our goal is to help you figure out next steps and how this behavior fits in with YOUR personal values. Not ours. We have no agenda other than your welfare.
We believe substance misuse is a healthcare issue. We offer you a place to discuss it as a healthcare issue. It is not a moral failing. If you are struggling with substances you probably have considered stopping. You may have tried before. We believe we can provide you with new information, supportive coaching and unconditional positive regard.
Our core recovery principles include the following:
1. You are in recovery if you say you are in recovery.
Admittedly this philosophy is NOT exclusive to the CARTEL. Many other recovery community organization have adopted this perspective. I have been in situations where the definition of recovery has been a hot topic of debate. I have been in situations where people have contested the merits of the term “in recovery” versus the term “recovered”. I have little tolerance for such things.
Entering into recovery is a difficult process. If we make people stand at the threshold and question if they “qualify” it is only going to drive people away. Therefore, for our purposes remember…you decide if you are in recovery. No need to fill out an application or get your passport renewed. You’re in.
We hope to assist you in the journey and we know that recovery is process not an event. If we offer advice and support it is in the spirit of guidance and it comes with unconditional positive regard. We stand in radical non-judgment of your journey. However, we will tell you if your ship is sinking. We will just do it in a very loving and caring manner. No shame. No punishment. No judgement.
We want to welcome you to recovery, regardless of how you define recovery!
Recovery is NOT a contest…
2. There are multiple pathways to recovery.
Again, this may not be earth shattering. As a matter of fact I hope people read this and say “of course there are multiple pathways. My fear is, there are many who believe that there are only specific ways to recover and any effort outside of that framework is futile, inferior and doomed for failure. I used to think that way. What a horrible outlook on recovery that was.
“Rather we shall reflect that the roads to recovery are many.” – Bill Wilson Co-Founder, Alcoholics Anonymous
People find recovery through countless avenues. Research indicates that the majority of people with a diagnosable substance use disorder will recovery via a process of “natural” recovery. In other words, they will find ways to eliminate their substance abuse and live a productive life without formal intervention and formal “recovery programs”.
I do not dispute this research. However, I have concerns with waiting for people to “figure it out”. In this age of overdose, we need to be very aggressive, assertive and effective in promoting recovery. That said, the key part of the message needs to be multiple pathways exist and you can invent your own pathway. We just believe that you can get that done more effectively if you have a coach or a mentor to help you figure that out.
Recoveryism is a term that has been used to describe the phenomenon that exists where people hold the position that their personal path of recovery is the “best path of recovery”. Actually, many believe that their personal pathway of recovery is the ONLY pathway of recovery.
This is a most dangerous form of tribalism. Can you imagine how many people have been alienated or chased away via such attitudes? There is no legitimate place for this in the recovery world and certainly should be ZERO tolerance for this in the professional community.
3. You should not be required to “quit” prior to becoming involved in a professional program. The person who is “not sure” what they want to do with substance use, has a right to, support, coaching, and direction.
Change happens across a predictable and universal process. The stages of change have been well researched and validated over and over. They apply to anyone making a behavioral change including someone dealing with a substance use disorder.
Many people struggle with commitment to change and a constant process of “thinking about” change (ie. Contemplation stage). This is completely natural.
Most programs require “willingness” and will only work with the person in the action stage of change. We believe, instead, that working with a person in contemplation is just as important as working with the person in preparation or action.
We also believe that many people in contemplation will move to preparation and action if they have people to talk to about the issue. Processing information about the change moves the person through the change process. Isolation does not.
Therefore, we would love to see you even if you are not sure you want to quit. Even if you are not sure you are an addict. Even if you want to come to just get the heat off for a little while. We will help you get the most out of your experience.
4. We believe family recovery support is also a primary part of the process.
Family recovery stands on its own merit and should be available regardless of the status of the addicted loved one. Some type of recovery plan is essential for all family members. We know that family members can benefit and experience improved mental health, reduced stress and ostensibly better overall physical health. Therefore, the primary purpose of family recovery is improved health and welfare of the in and of itself.
However, we have observed an interesting phenomenon. When the family takes “care of itself” the addict frequently follows suit. This has been validated by a wide variety of resources. ARISE intervention model teaches this very philosophy. It was in my ARISE certification training that I first heard the statistic “1 family member is as powerful as 8 professionals”. Additional studies have been done on the impact of the family. Behavioral couples therapy for example has been shown to deliver around 66% success in getting the addicted individual into services.
Very important: Tough Love is an oxymoron. YOU NEED TO FOCUS ON APPROPRIATE EXPRESSION OF LOVE. NOT TOUGH LOVE. Sometimes, setting limits and boundaries is the appropriate expression of love.
We do not believe in complete disengagement. Many things you hear about family role in recovery are dangerous.
WE HOPE TO DISPEL THESE MYTHS.
5. We believe that recovery is a process not an event
We know that, statistically speaking, it takes on average 4 or 5 genuine attempts at recovery before “it sticks”. This isn’t to say relapse is a necessity. It is not. However, relapse is nothing to be ashamed of and should be met with loving compassion. There is a need to make “returning to recovery” as easy as possible.
We also believe that professional services that specialize in re-engagement are essential to the continuum. There is a glaring hole in our professional service structure and we need to provide long term support. We need to re-vamp our system to support long term, chronic disease management rather than episodic acute care.
6. And finally…we believe RECOVERY will bitch slap addiction if we allow it to.
If we come out of the shadows and conduct ourselves as responsible members of society the community will embrace us. If family members become open about their struggles the community will embrace them. There is power in numbers.
However, our efforts in this area have been set back by “advocates” who reinforce the stigma when they speak for recovery. Much work has been done on messaging and identifying the most effective way to carry the message. Market studies have been done. Focus groups have been conducted. There is productive way to share the message of recovery and there is a counter-productive way to carry the recovery message.
A public lead meeting or online speaker meeting is not the way to promote recovery. This type of spectacle works for those already in recovery. However, we are not trying to preach to the choir. We are trying to reach the masses. If the goal is true advocacy then please adopt some type of intentional recovery messaging.
If the goal is to fill your treatment center than keep doing what you are doing.
However, in the interest of “rigorous honesty” please give up the word advocate.
