Regardless of your political views, Chris Christie’s town-hall talk about addiction and how we treat addicts in our society is worth watching:
Christie’s mom was fortunate not to have faced any stigma when battling lung cancer. But stigmas surrounding addiction, including stigmas regarding medical complications due to drug use, are still prevalent. As a treatment professional, I would argue that stigmas exist within the treatment industry itself and are maintained through outdated treatment modalities.
The Definition Has Changed. Why Haven’t We?
Seeing Christie speak, and watching events like the United to Face Addiction march in Washington, DC last month, I am both grateful that public attitudes are changing and aware that in the addiction treatment industry, we are not changing fast enough. In 2011, the American Society of Addiction Medicine (ASAM) defined addiction as a disease of the brain. And yet, the primary standard methodology of addiction treatment today continues to be Motivational Interviewing, which was developed around 2002, nine years before the definition of addiction was officially changed in the medical literature. Now that we agree as a society and as an industry that addiction is a disease and not a choice, and we can begin to discuss the need to treat addiction instead of punish addiction, we in the field of addiction need to create and implement better and different treatment methodologies that target the deficiencies of the addicted brain. Motivational Interviewing strategies aimed to encourage clients to be “better” participants in treatment can smack of blaming the addict. If we’re focused on encouraging the addict to find a stronger motivation to change, we run the risk of echoing outdated popular sentiment, saying to the addicted person, “Well, if you wanted to change badly enough, you would stop being an addict.”
Let’s Treat the Brain How it Wants to Be Treated.
As researchers grow in their understanding of the disease of addiction, we as providers need to make sure that we tweak our treatment modalities accordingly. Medication interventions that subdue the dopamine reward system in the brain are a positive step forward, and we should also look to new research showing medication interventions that target unmet biological attachment needs in the brain, such as Oxytocin treatment. We should be looking at addiction research regarding memory deficits, processing delays and executive functioning issues that show that those prone to addiction have great difficulties remembering negative consequences or planning a productive day. There is a plethora of research showing that a lack of myelination and low serotonin levels in the brain put people at risk for poor impulse control and self-destructive behaviors. We know now that addiction-prone brains are often unable to identify, let alone process, their own emotions or the emotions of others. Effective treatment, then, should include memory training, life skills development, empathy training, self-compassion / mindfulness training, programs to increase executive functioning physical fitness, supplementation with fish oils and omega 3s, as well as traditional medication interventions and motivational strategies, just to start.
If We Work to Break the Stigma, Others Will Follow.
In the addiction field, we can’t expect public opinion to change while we are still stuck in old thinking patterns and treatment modalities. De-stigmatizing and decriminalizing addiction are important steps, and I appreciate Chris Christie and others who lend their voices to this cause. But we as treatment providers need to come together and build new and more robust treatment models that address addiction as a complex, multi-faceted brain disease. Motivational Interviewing and medication assisted treatment may be pieces to the puzzle, but they are not nearly enough. We need more complex treatment, and we need to make sure that we are not adding to the stigma of addiction by faulting someone’s motivation to change.