Renaming and Rethinking Drug Treatment

We Help Thousands of Addicts Quit. Who Answers?

Years ago I started asking counselors in training with me to buck the trend and stop using the term “drug treatment” to describe the help and services they provide to people with alcohol and other drug problems.

First, consider the meaning of “treatment.” It describes the manner in which one person behaves toward another. It’s a one-way street, not an interaction. In medicine, orthopedists provide treatment for broken arms. Oncologists provide cancer treatment. As patients, we may not fully understand what they do, but we generally trust them and hope for the best possible outcomes. In day-to-day life, treatment may refer to the way a husband treats a wife, a wife treats a husband, and a parent treats a child. In close relationships such as these, people hope for the royal treatment, not the silent treatment, and certainly not abusive treatment. Treatment can also describe the way we handle other things, besides people. Interior designers prepare window treatments. Hollywood screenwriters prepare script treatments. Garbage truck drivers deliver a load for waste treatment.

In drug treatment, the treatment providers lay out the program, telling clients what to do, and urging them to follow the prescribed regimen. They use lectures and information about the dangers of drugs as well as inspirational speeches and stories to show clients a better way of life. They probe with ever more clever questions, trying to convince their clients that they have been harmed by drugs and need to quit. These and other interventions are designed to remediate an assumed lack of awareness about the harmfulness of drugs, spiritual shortcomings, and insufficient will power.

It corresponds with the traditional idea that people with drug problems are basically oblivious or ill informed about drugs, perhaps morally deficient, and largely powerless.-Robert Schwebel

It’s no coincidence that the word treatment has been used to describe these services. It corresponds with the traditional idea that people with drug problems are basically oblivious or ill informed about drugs, perhaps morally deficient, and largely powerless. They need someone to intervene and tell them how to live better. The notion of “treatment” casts clients as passive recipients of the advice, wisdom, and directives of the experts who provide the answers. Inevitably, drug treatment calls for abstinence.

“You do what we say and you’ll get better.”

When treatment protocols require abstinence, the result for compliant individuals will always be abstinence. That would be a treatment success. When clients continue to drink or use drugs, they would fail, but that would be counted as treatment non-compliance. Darn it: If those pesky drinkers or drug users would only follow the program, they would get well. This convenient set–up reminds me of the supervision experiences of clinical psychology graduate students: If their clients are doing well, then they are brilliant therapists. If their clients are not doing well, then they are working with resistant clients. The problem with these self-serving interpretations of outcomes is that a lot of people who need good help, tailored to their needs, are not getting it.

The problem with these self-serving interpretations of [addiction treatment] outcomes is that a lot of people who need good help, tailored to their needs, are not getting it.-Robert Schwebel

Lecturing, moralizing, asking clever questions, and telling people how to behave will succeed only with a small percentage of the population. Most people don’t want their behavior to be manipulated or dictated. They don’t want a top down approach. Furthermore, the provider’s treatment of the drug problem may not suit them well. They may not like it. They may disagree with it. They may not be prepared to succeed with it. It might not be a good fit for their needs. They may prefer a completely different approach to coping with life’s difficulties.

When helping clients with drug problems, I suggest we stop thinking in terms of treatment, and start thinking in terms of counseling.

In stark contrast to the top down approach of treatment, counseling offers a collaborative and empowering interaction. In counseling, professionals help clients clarify their own values, become aware of their options, expand their options, make their own decisions about how to behave, and then follow through with their decisions. If they make mistakes or suffer setbacks, they learn from them. It’s a flexible process that can be tailored to the needs of each unique client. It encourages and empowers clients to take charge of their own lives.

…counseling offers a way to better serve a larger and more diverse group of people who have problems with drugs.-Robert Schwebel

Treatment and counseling represent fundamentally different ways of viewing clients. In treatment, clients are seen as relatively powerless and in need of someone to tell them what to do. The power for change resides in the provider. In counseling, clients are seen as having agency over the direction of their lives and capable of making their own decisions. The power for change resides within the individuals. Furthermore, the more that people are involved in making their own decisions, the more they will be committed in following through. As I see it, counseling offers a way to better serve a larger and more diverse group of people who have problems with drugs.

How about the “drug” part of drug treatment? The idea of limiting counseling to the topic of “drugs” and placing a singular focus on changing drug use behavior misses the complexity of issues that underlie drug problems. Drug use and drug problems do not occur in a vacuum. They occur within a society, culture, community, and family. People use drugs for a purpose. They want the benefits. They seek pleasure (fun, recreation, excitement, thrills, mind-expanding experiences). They also seek to escape from problem situations (family, school, work, legal) and unpleasant feelings and emotions (stress, anxiety, depression, pain, frustration, anger). Drug use offers numerous benefits. It also can cause all kinds of harm, which range from mild embarrassment all the way to serious health problems and even death.

Drug use has everything to do with everything that happens in a person’s life. It cannot be understood without consideration of the entire context of an individual’s personality, environment, and situation. Instead of focusing on counseling sessions narrowly limited to drug use behavior, it makes much more sense to think in terms of life counseling.

I believe we would have much better outcomes and benefit a lot more people if we stopped ‘treating drug problems,’ and started thinking in terms of providing comprehensive counseling…-Robert Schwebel

In my opinion, it’s time to retire the term drug treatment. I believe we would have much better outcomes and benefit a lot more people if we stopped “treating drug problems,” and started thinking in terms of providing comprehensive counseling that incorporates work on drug problems. Instead of telling people how to behave, let’s empower them and offer them an opportunity to enjoy a good life without having to rely on drugs.




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