Keep doing what you do, and nothing will change. A phrase we all often hear in the addiction and recovery circles but it’s wrong. Addiction’s progressive nature means, left untreated, everything changes. Life changes for the worse. All sorts of problems increase or arise in varying degrees. Financial, criminal, intimacy and family problems, never mind the intrinsic physical, mental, emotional and spiritual demise of the individual in long-term, untreated addiction.
Many people believe, inside and outside the sector, that an addict has to reach rock bottom in order to begin to get well and others believe that it does exist and addicts need to reach it before they’ll get well. They believe that addicts need to become bereft of everything that the only way is up. Is this true, based on the premise that addiction is progressive? Left to their own devices, with very few exceptions, all addicts will simply get worse and their rock bottom shifts even further down. So, then surely, the ultimate rock bottom for all addicts is death? Addiction’s progressive nature means, left untreated, everything changes. Life changes for the worse.
When you’re recovery-oriented, you believe that recovery is real and recovery is possible. As long as an addict is living, recovery is possible.
Also, is it ethical to do nothing until an addict appears to hit rock bottom – and who decides what rock bottom is – the addict? Services providers? Family members? For the best chance of recovery, according to research, interventions must occur as soon as possible and we can’t sit back and wait until a person appears to hit rock bottom before treatment is offered – it’s quite simply ethically wrong. The decision for treatment has to occur as soon as a dependence or addiction problem becomes apparent.
The success of any intervention depends on many factors: when; how; where; and who should undertake it?
Individuals and their circumstances are different, family dynamics are different, skill levels of treatment workers are different, access points to treatment vary depending on your postcode and many other factors, not least resources. When and how this happens is different for every addict. Interventions, in the truest sense of the word, can come in many forms, including formal structured family interventions, a visit to the GP, they occur prisons, by attending a fellowship meeting, or simply a chat with a local addiction specialist.
Not Enough Intervention Research
What comes to mind when the word intervention is mentioned is the tradition Johnson method of intervention. A study in the American Journal of Drug and Alcohol Abuse in to interventions, conducted in 1996, found an increased chance of relapse in those who had obtained a formal intervention, compared to people who were referred to treatment by other means[ii]. Not a very positive outcome from this research, certainly not from an interventionists point of view, but those that want help, or are contemplating change have a higher chance of success because they referred themselves for treatment and were ready for change[iii]. Nevertheless, we can’t wait until an addict gets worse before we intervene – they will get worse, so intervention must be done as early as possible – but it must be done correctly and be recovery-oriented and positive – not all interventions are.[sws_pullquote_right]Those that want help, or are contemplating change have a higher chance of success because they referred themselves for treatment.[/sws_pullquote_right]
Despite the number of people in active addiction, the numbers employed directly or indirectly in the treatment industry, either in the public, private or third sectors, and the number of people currently in recovery, there is a severe lack of empirical research into interventions. Whatever intervention research is available tends to focus on early interventions, and the ones that do focus on interventions when addiction is in full grasp, are few and far between. This is because most research in our industry and, more importantly, the funding of such research, goes towards post-intervention treatment. (N.B.There has been very recent research published (October 2014) into Nalmefene – a relatively new ‘wonder drug‘ to stave off alcohol cravings in moderate drinkers, to be offered on the NHS, and therefore an early intervention and certainly marketed as one – published by Alcohol Concern with funding for the research coming from, interestingly enough, the pharamceutical company that makes Nalmefene. Read more about this pharma-industry funded statistical research.)
A Positive Focus
Positive access to treatment and interventions should be factual and concentrate on the reasons for entering treatment, but must focus on the benefits: the joys, the happiness, the opportunities, the gains of finding recovery. Using negative approaches such as coercion, confrontation, threatening or negative consequences of continued use are not the best approach to intervention, but sadly are still common. Unstructured family interventions or other legal or criminal interventions, based on punishment for addiction, rarely work. In fact, studies have shown that people respond in the exact opposite way if the approached in a confrontational, aggressive or penalty system to get them to stop drinking or using[iv].
It’s common for family members to overreact and catastrophise situations – addiction does affect the whole family. Also, many people don’t get the right, or enough, help first time around or can’t engage fully through social and economic reasons, which can lead to dissonance and the rejection of help, which often leads to a quicker downward spiral and exit from treatment.[sws_pullquote_right]many people don’t get the right, or enough, help first time around, which can lead to dissonance and the rejection of help [/sws_pullquote_right]
More Recovery, Less Addiction
Fortunately, addiction intervention, or first point of access to treatment is changing. There’s a shift happening. The fledgling ‘Recovery Movement’ really is moving and gaining momentum everyday. Projects around the country are springing up and highlighting the positives about recovery rather than the negatives about addiction.
Public Health England are becoming more recovery focused and embracing and promoting the benefits of mutual aid, encouraging all from commissioners to key workers by providing clear guidance on how to integrate recovering people and their skills into the workforce and local systems.
We all know it’s about the quality of treatment, recovery capital and other social, economic and lifestyle factors that are influential and paramount to successful recovery. With more research being undertaken in to recovery (as opposed to addiction or intervention), this growing momentum and change throughout the entire industry from intervention, to early treatment, to recovery help and maintenance, through the exceptional work undertaken by organisations around the country means that there is a shift: shift towards the positive nature of entering treatment. For most addicts, the last thing they want to do is stop using, but we’ve seen increasing evidence that positive interventions and recovery work. Projects such as Drug Interventions Programmes offered by the large public treatment providers like Addaction, CRI and Lifeline are ground-breaking, and the approach to interventions in the community and prisons are changing the way people see recovery. There’s a change happening, from addiction to recovery, albeit at incubation stage out there. Projects such as the UK Recovery Walk Charity are looking to change and guide the way the industry works and sees addiction and recovery, offering many free services and products and are about to launch a free recovery coaching manual to help train the country’s addiction workers and drug and alcohol teams to focus more on recovery and all of its positives.
Become Better Than Well
One of the most positive and amazing outcomes of any research in recent years finds that people that have been in long-term recovery (5 years or more) are ‘better than well’ have a better quality of life, have better physical health, psychological health, social relationships and better overall living environment than the general public[v].
We all know recovery is real and recovery is possible, so everyone needs the opportunity to get well. What we don’t know for sure – there is no conclusive research – is when, how or exactly why people get well from addiction, but that every pathway should be offered in order to maximize the chances, something that we do at addiction helper: encourage clients to try every possible pathway out there in order to get well.
All it all starts with an intervention, and the sooner the intervention happens, the better.
[i] William White, Recovery management and recovery oriented systems of care (2012)
[ii] American Journal of Drug and Alcohol Abuse (1996)
[iii] Miller et Al. Treating Addictive Behaviors: Processes of Change (1998)
[iv] Prochaska and DiClemente’s Stages of Change Mode (1983)
[v] Hibbert L, Best D. Assessing recovery and functioning in former problem drinkers at different stages of their recovery journeys. (2011)