Addiction Treatment Through a Continuum of Care:
The continuum of care treatment model as it pertains specifically to treating drug addiction is almost entirely overlooked and undervalued as an option in contributing to a successful outcome for patients. Continuum of care involves consistent compassionate support, guidance, and accountability over some time and is typically provided by recovery coaches or other professionals whose services are not covered by insurance. Providing a Continuum of care services for people seeking treatment for drug addiction offers a unique opportunity. These services contribute to a positive outcome regardless of the category of treatment for addiction undertaken. That is to say, it benefits all types of patients undergoing any kind of formal or informal treatment for drug addiction. Continuum of care is not in and of itself the best treatment option on its own but rather reliably improves treatment outcomes and recovery success among those fortunate enough to have it.
The NIDA suggests the relapse rate post addiction treatment is between 40%-60% and is casually explained in a truly disempowering way; that this rate is very similar to rates of relapse of other chronic diseases like hypertension, asthma, obesity or type II diabetes. I believe to some degree the absence of a well-funded continuum of care approach towards some of these other chronic diseases may account for the high rate of relapse. Having continued support and accountability around diet and exercise could reasonably lower the relapse rate around diseases such as hypertension, obesity or type II diabetes.
Defining drug addiction as exclusively a chronic disease is, in my opinion, is a huge mistake. Many psychological and physiological aspects of drug addiction indeed resemble what some might call a chronic disease however how our society meets this “diagnosis” merits a more holistic view from those involved in treatment.
To my knowledge, there is no other widespread chronic disease of epidemic proportions that shares with substance use disorder the criminalization of its presented symptoms. Using the criminalization of addiction, drug use and drug procurement as a metric, it is clear that we collectively lack the same sort of empathy for those suffering from substance use disorder that we readily offer those experiencing chronic diseases such as hypertension, obesity or type II diabetes, which like substance use disorder, are often exasperated by lifestyle choice.
The barometer for defining something like addiction as a disease on a personal level should be whether or not taking the view of it being a disease or a choice results in a sense of empowerment that can help support transformation and healing or promote making better choices in the future. This is best explained by looking at the benefits and costs of defining oneself as a victim of a certain event or circumstance. I argue that the assumption of victimhood, a quite natural response to receiving a diagnosis of chronic disease, initially supports healing and growth however that over time a transformation must happen concurrently with the healing. If this transformation away from victimhood does not occur appropriately, the assumption of victimhood begins to erode the sense of empowerment those suffering from chronic diseases need to continue growing and healing beyond their diagnosis.
To elucidate this point I use an example of someone experiencing addiction whose circumstance, most would agree, contributed almost entirely to the presence of the addiction in their life. Imagine an addicted individual whose parents were both IV users of Heroin and was administered IV Heroin from a very early age, let’s say 9 or 10 years old, by their parents until they were 18 years old. If this individual found themselves addicted to IV Heroin use at the age of 25 most would be very cautious in suggesting that the cause of their addiction could be attributed to anything besides the circumstances in which they were raised. They never really had a chance to avoid drug addiction and were truly a victim of their circumstance.
Entering treatment, connecting to this sense of victimhood can be immensely beneficial. Reinforcement of victimhood in initial treatment can have the effect of breaking down the psychological trappings such an addiction can cause. That of being bad, wrong or broken in and of themselves, unable to break the addiction and deserving of their current circumstance under their own choices. These psychological trappings are more disempowering and detrimental to growth and healing than assuming a state of victimhood during this time. As new stories are written in place of the psychological trappings that reinforced addictive behaviors, the shift away from victimhood on a personal level becomes necessary to maintain the momentum of empowerment, growth, and healing. Externally most would continue to view this individual as a true victim of their circumstances however internally, within the individual, a shift must begin to occur away from assuming the role of the victim. The timing of this transition away from victimhood differs for each person and each journey. A good determining factor is whether or not the assumption of victimhood is limiting the individual’s ability to make positive changes in their life. Initially, the assumption of victimhood can have the effect of offering a sense of freedom, while at some point along the way it becomes far more restricting.
Many who overcome circumstances that we all would agree make them sincerely an undeserving victim see a shift away from victimhood as an essential part of continuing their healing. It represents in part a maturing beyond the circumstances internally, no longer entertaining the idea of the circumstance being worthy of defining their sense of self or identity. In its most mature form, genuine empathy for the causes of the circumstances that led to their victimhood is present. They may now view their circumstance under the most positive light possible, seeing it as an important element in creating the person they are today, a person they feel happy about being. Though they recognize outwardly that they were an undeserving victim of the actual circumstance, they find at a certain point that adopting such a view internally does not serve their growth and healing.
This transformation is a difficult but necessary one and requires longitudinal support and accountability to complete reliably. The current 30-90 day inpatient treatment model with minimal follow-up for drug addiction serves mostly the establishment of a sense of victimhood. Shortly after it is often coupled with strange, disharmonic conditioning that, now that you’ve gotten sober you are no longer a victim and must immediately assume full personal responsibility for all of your actions. This makes sense to most of us, it is true that we must assume personal responsibility for our actions however the circumstances that led to the initial victimhood are far from over, let alone processed. The persistence of these conditions in the beliefs and actions of the individual is rarely treated directly. The current treatment model does follow the transformational steps in the right order, the problem is they are hurried through, attempting to take months or years of post-addiction processing and compress them, sometimes into as little as 1 week. The lack of compassion, presence, patience, and gentleness in supporting this transformation is the main driving component of why treatment for drug addiction has a relapse rate between 40%-60%, not the inherent nature of addicts or the substance they used.