One Important Reason Why Treatment So Often Fails

12 Steps, Family Addiction, Hope for Families TV, Treatment, Why I Do What I Do | 0 comments

Welcome to episode #8 in my “Why I do what I do” series!

Have you ever wondered why treatment outcomes are so poor? One of the biggest reasons for such poor treatment outcomes informs reason #8 of why I do what I do.

I do what I do because upwards of 50% of people with substance use problems also have another co-occurring mental disorder, whether that be depression, bipolar disorder, ADHD or some other mental disorder.

While the presence of a co-occurring mental disorder, or what is sometimes referred to as dual diagnosis, presents unique challenges, if both the mental disorder and the substance abuse are not addressed together, the chances of recovery reduce drastically.

And, the chance of the addiction becoming fatal increases significantly as well.

But often treatment programs fail to adequately account for this reality.

Very few treatment providers are equipped to provide the kind of integrated, holistic care that would allow them effectively treat people with co-occurring disorders. Therapists will often turn people away, saying they can’t treat, say the depression, or the bipolar disorder, until the person gets sober.

And yet, the person needs treatment for those things if they are going to have a reasonable chance of getting sober as they are often subconsciously using the the substance treat the mental disorder.

One of the reasons so few treatment programs effectively address the existence of co-occurring mental disorders is that the treatment protocol at many treatment providers is still largely informed by the Minnesota Model, one of the earliest treatment models that have been developed.

The Minnesota Model heavily integrates the principles of 12-Step recovery, and focuses primarily on group therapy, with some limited individual counseling.

The Minnesota Model also relies heavily on staff members who are in recovery themselves. But because substance abuse treatment is not broadly regulated across the United States, these staff members may or may no be professionally trained and credentialed in drug and alcohol counseling. Their only qualification may be that they have recovered from a substance use disorder themselves. They are not likely to have any mental health credentials.

While some people do have success undergoing treatment using the Minnesota Model, addiction treatment is not one-size-fits-all. Different people will require different approaches. And more evidence-based treatment approaches, such as cognitive behavioral therapy, have been developed since the advent of the Minnesota Model.

More importantly, there are underlying factors that contribute to substance use disorders that the Minnesota Model is just not designed to address. Factors like high levels of chronic stress, a history of dysfunctional family relationship dynamics, and trauma, all increase a person’s vulnerability to both substance use disorders and mental health disorders.

But the majority of 12-Step programs, on which the Minnesota model is based, begin the premise that the reasons for the substance use are unimportant. And that just isn’t true in many cases.

And while the 12-Step process can offer tremendous value, it does not work with the majority of mental health issues, especially trauma. These are things you can’t just work steps 1, 2, and 3 on, or turn over to your Higher Power, or do a 4th step on. These things require professionally trained mental health intervention. And this is what many treatment centers don’t provide enough of.

I’ll interject a little bit of my own experience here as a family member who has been working multiple 12-Step programs – which I still have a tremendous amount of respect for – in trying to heal my own experience family addiction.

For much of my time in 12-Step recovery, I was in complete denial about the amount of trauma I had been subjected to because of the amount of addiction and mental health disorders among members of my family. I had pretty much internalized my family’s unwritten rules that anything that happened was in the past and you just needed to get over it. And I couldn’t figure out why other people in my 12-Step recovery groups were experiencing so much more recovery than I was, despite the fact that I was earnestly working the 12 Steps too.

This isn’t to say I didn’t experience any recovery. I absolutely did. But I couldn’t seem to get to where other people were getting, no matter how hard I tried.

Once I realized I did need help addressing the trauma I had experienced, I found a trauma therapist who also happened to be in a 12-Step fellowship. And one of the things that I said to her in our first session was “Do you know how many fourth steps I’ve done?” (The fourth step, by the way, is to make a searching and fearless moral inventory of yourself.) And when I said this to her, she simply said, “Fourth steps don’t heal trauma.” And they don’t. Professional trauma therapy heals trauma.

The 12-Step process can be tremendously valuable in creating structure and providing emotional support for your personal and spiritual growth. They are a beautiful tool for recognizing what you can and cannot control in your life and for taking responsibility for what you can control. And they are an incredibly helpful, and one of the most effective tools I’ve seen, when it comes to healing relationships, which, if you’ve seen my free video series The Family Guide to the 5 Actions Required for Substance Abuse Recovery, you know is an essential part of healing from a substance use disorder.

12-Step programs also provide a shit ton of hope and inspiration for anyone suffering from a substance use disorder or struggling with someone who is. And all of this, of course, supports mental health. But they are not a remedy for genuine mental health disorders.

That absolutely proved to be true in my case. Once I had a fair bit of trauma therapy under my belt, I started experiencing the kind of recovery that I was seeing other people get out of the 12-Step process.

Our entire treatment industry needs to provide much more holistic and personalized treatment options if we are ever going to resolve the addiction crisis. More people die because the treatment industry is failing to consistently solve for the presence of co-occurring mental disorders. Treatment options that can address substance use with co-occurring disorders are unbelievably lacking in this country. Which is insane given that so many people, up to 50% of people with a substance use disorder, suffer from a co-occurring mental disorder, and the substance use is often an attempt to medicate the other mental disorder.

It’s unconscionable that we are letting this reality slide. I do what I do because we need broader awareness of that problem, and we need people, especially families, but really everyone, advocating to change that.


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