Maia Szalavitz takes on an important area that needs significant reform: the treatment industry.
There are so many areas of this industry that are broken or just plain corrupt. Part of this is due to historical non-evidence-based stigmatizing approaches toward addiction, some due to the lack of science in the federal government’s laws and regulations, and some due to the attempts to cash in on a potentially lucrative captive market by unscrupulous players.
“What we simply need is a nice bulldozer, so that we could level the entire industry and start from scratch,” says Dr. Mark Willenbring […] “Another approach is that you could use dynamite,” he deadpans. […]
And in no other area of medicine do insurers pay for hours of group “therapy,” films and lectures that consist overwhelmingly of indoctrination into the teachings of a self-help group, available for free in church basements. […]
In any other area of medicine, if patients were not informed about a treatment that cuts mortality by at least half—while being given one that has no effect on it—it would be considered malpractice. […] But in the addictions field—largely because the dominant abstinence-only model historically hasn’t recognized medication-assisted treatment (MAT) as an acceptable form of recovery—this happens almost every time someone with an opioid addiction enters an abstinence-only 28-day rehab, a detox or an abstinence-based outpatient program. […] Given this, stigmatizing maintenance or telling patients that it is “not really recovery,” is basically killing people. […]
In the past year, the addiction treatment industry—never trouble-free in the best of times—has been wracked by scandal. […]
But the treatment industry has for too long relied on referrals from the criminal justice system to stay solvent. […] Several problems result. For one, since their biggest customer is often the criminal justice system, many programs shape themselves to its dictates. “The field has been so distorted by its dependence on the criminal justice system, which is really the client,” […]
Unfortunately, nearly all long-term residential treatment centers in America— i.e., “therapeutic community” programs that last three months or longer—were originally modeled on a destructive cult called Synanon. […] While many have moved away from the most extreme tactics, a widespread belief that all people with addiction are lying “whenever their lips are moving” and a sense that negative experience is necessary to get people to realize that they need to change remains common. […]
Research has long shown that in most cases, outpatient treatment is as effective as inpatient care for alcoholism and other addictions. […]
We also need national standards for counselor education, for best practices in all types of treatment and for informed consent regarding options like medication. All counselors need to be educated about all aspects of addiction, not just their own recovery […]
These are some great critiques, and something that more people need to acknowledge. There is a tendency, by some, to simply talk about treatment being better than enforcement without noting that prohibition has seriously tainted the treatment field. Simply spending more on treatment without paying attention to what you’re getting is not reform.