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A Long-term Approach

An AA plaque urges a long-term approach to recovery.

Because addiction is best viewed as a chronic, relapsing disease, experts say treatment strategies should be designed to suit such a condition. Professor A. Thomas McLellan, Ph.D., of the University of Pennsylvania's Center for Studies of Addiction, says that physicians, other treatment providers, and the public need to adjust their attitudes about addiction treatment. A realistic goal is patient improvement; an expectation of "cures," unrealistic. Treatment outcomes for addiction, he says, are about as successful as treatment of other chronic disorders. Relapse is more the rule than the exception when it comes to addiction, and shouldn't be viewed as a treatment failure, he adds.

The more times a person tries to confront their addiction, the better chances that person has for recovery. Also, viewing the disease as a long-term challenge aids recovery, adds Patricia Owen, Ph.D., director of the Butler Center for Research and Education at the Hazelden Institute in Center City, Minnesota: "For a person who is in recovery, an important part of the change process is maintaining that recovery -- doing things intentionally to maintain it that you wouldn't do if you thought you were 'cured.'"

McLellan also notes that when people with other chronic illnesses have relapses, they are not derided as moral failures, as often happens with addicts who "slip." Rather, they are urged to try new strategies for recovery. Too often, even substance abuse treatment providers haven't done the same for addicted people, he says. "They have castigated people who have relapsed -- and people who have relapsed felt terrible . . . so terrible that they didn't think they should get back into treatment."

Like treatment for hypertension, diabetes, and asthma, then, successful addiction treatment must have long-term components. Recovery is a process that needs to address body, mind and spirit, say many treatment professionals, as well as work, social, legal, family, and vocational issues. Mere detoxification, or getting the alcohol or other drugs out of the addict's system and stabilizing him or her medically, is only the first step in a long process of recovery. Charles O'Brien, M.D., Ph.D., of the Department of Psychiatry at the Veterans Administration Medical Center in Pennsylvania, says addiction does not end when the drug is removed from the body or when acute post-drug-taking illness subsides. Detoxification is the first stage of the treatment process, a process designed to stabilize a heavy drug user until he or she is free of illicit drugs. Although detoxification helps people get off drugs, says McLellan, it "does not address the underlying disorder" that leads to addiction.

If the treatment field measured its success by the proportion of people who start detoxification and finish it, adds McLellan, it would be viewed as highly effective. But the goal is "to keep somebody off." Behavioral change is necessary, and behavioral change needs to be practiced and supported. He notes that a recovering heroin addict, for example, would initially find it very difficult to walk through the neighborhood associated with his drug use without feeling a craving. Treatment should help the addict learn to practice behavioral changes and sustain them, according to McLellan, who says that if addicts aren't prepared to handle life challenges such as these they "cannot possibly have a lasting recovery."

Counselor and recovering women

Addictions counselor Mimi Bazuin discusses coping strategies with recovering women.

"All addicts need to learn to avoid people, places, and things that may trigger use," says Owen. "We try to help identify their own behavioral cues. . . . [and] teach them refusal skills or other techniques to manage the situation." Says Tim Sheehan, Ph.D., vice president of recovery services at Hazelden, "[Recovery] isn't based on a 'cure' but rather a way to cope with a chronic condition that necessitates abstinence. Since there is no cure for addiction, oftentimes the treatment and recovery process uses spirituality to encourage hope, reduce feelings of isolation, and promote a sense of community with other recovering people."

-- Janet Firshein

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