The first article that I ever published appeared in The Alcoholics Anonymous Grapevine in June 1975 and began with my admission that I did not understand alcoholism. Forty years later, I have made some progress. I plan to use a series of articles to summarize my current thinking about this disease and particularly how people recover from addiction. I will organize these observations into four areas:
- How people change. The approach that I have found to be most helpful in understanding this issue has been the “Stages of Change” concept of Drs. James Prochaska and Carlo DiClemente, two psychologists who studied how people stopped using tobacco. Their insight that change is better conceptualized as a process than an event has been widely embraced within the field of addictions and forms the foundation for clinical interventions.
- Getting people into treatment. This has been a challenge for our field. There is a general consensus that treatment is effective, yet the vast majority of people with addiction never receive treatment. Of the many reasons behind this regrettable situation, the one that I will focus on will be the psychological barriers. Once again, two psychologists, Drs. William Miller and Stephen Rollnick, have described an approach to working with people who are reluctant to commit to recovery. Known as “Motivational Interviewing,” their approach has gradually replaced the more directive strategies that had previously dominated the addiction treatment field.
- Making Addiction Treatment Effective and Efficient. Once people enter treatment, most of them do best in specialized addiction programs in which abstinence from all addictive substances is established at the start of treatment and maintained as a long-term goal. Treatment in a group setting has better outcomes than programs that rely on individual therapy. Various group models can work, and I will describe the approach that we use at Kolmac.
- Recovery support community. Treatment is time-limited with an ultimate goal of bridging the person into the recovery support community where, in collaboration with others, people can continue their recovery without the need for continuing professional treatment. The 12-Step programs, beginning with Alcoholics Anonymous, have been the best-known example and have also given direction to professionals, such as myself, about the most effective way to treat addiction. In recent years, other alternatives have evolved, thus providing people with choices that might better fit their individual situations and preferences.
In posts over the next several weeks, I will cover each of these areas in greater detail.