Addiction,Suitable,Case,For,Tr health Addiction: A Suitable Case For Treatment?

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Today most people take forgranted that addiction is a condition that requires medical attention. However,it is only relatively recently that addiction has been treated by the medicalprofession at all. A hundred years ago addiction was not a term that manypeople would have recognized and, even if they had recognized it, they wouldnot they would not have considered it to require medical attention. Indeed, itwasn't until the 1950s that the major medical bodies in the USA decided to makeaddiction treatment widely available and even later, in the 1960s, beforepsychiatrists started to address it. Prior to this time, addiction wasconsidered to be criminal justice or moral problem, the answer being punishmentor sermons. Recovery from addiction problems in those times tended to somethingpeople achieved by themselves or with the aid of friends and relations, doctorswere rarely if ever consulted. Currently, while recognition of addiction as amedical problem has brought benefits, for example, treatment rather thanpunishment, many believe the pendulum has swung too far with any risky behaviornow regarded as an addiction and requiring medical attention. Indeed many askif we are medicalising issues that should be more appropriately dealt with inother ways? Certainly many including well-respected researchers think that thisis exactly the case.In the 1970s and 80s a couple of researchers carriedout some interesting studies. They found that some people recovered from addictionproblems, alcohol and heroin addiction, without ever going to treatment,medical or otherwise. At the time, the medical profession recognized that thiswas a possibility but they also considered that it was extremely rare. Researchover the last decade has dispelled that myth consistently finding that between70 and 85% of people who recover from addiction problems do so without the aidof treatment, including AA and NA. Other research found that even for peoplewho have actually gone to treatment, when they are asked to name the mostimportant influences on their recovery, it is rare for them to list treatment.So what are the implications of this research does thismean that we should close treatment that we no longer need it? No of coursenot, there will always be some people who need treatment. What it means is thatmedical treatment should not be seen as the first and only option for addictionproblems. Some commentators suggest that we should be looking at what they callstepped care, basically that inpatient treatment would be the final option, notthe first and that the less intensive options would be tried first.For example, if someone were to go their doctor with adrinking problem, the doctor's first reaction should not be that here wassomeone who needs to be in treatment, go to AA and be abstinent for the rest oftheir life. Instead the doctor should be looking at various other measures thatare much less intensive and or extreme. Not everyone with a drinking problem isan alcoholic, and not everyone with a drinking problem needs to abstain fromalcohol forever. Many alcohol problems are transient, that is they may be thebehavior of youth, which later disappears when the person is faced withmarriage and responsibility. Other ‘problems’ are reactions to lifecircumstances, eg bereavement or job loss. When we again look at the researchwe find is that people are reluctant to attend doctors or treatment agencieswith an alcohol problem. The reason they give is that they will be branded analcoholic, have the shame and stigma of being an alcoholic and never be able todrink again in the lives. Given these reasons it is hardly surprising thatpeople do not attend for treatment of drinking problems until they aredesperate or hit rock bottom.There are two rather worrisome side-effects fromtreating alcohol problems in the way described above. The first of these isthat because people are reluctant to go to treatment because of stigma, etc itmeans that people delay addressing their alcohol problem until it is so severethey have no choice or they have reached rock bottom. Perhaps with a lessmedicalised system people would perhaps seek treatment earlier and suffer lessdamage as a consequence. However, the second side-effect is perhaps even moreworrying. Because this attitude to addiction problems, breeds dependence on thedoctor or a medical system for a solution to their dependence on substances orother behaviors. Similar things have been written about 12 step groups, thatpeople become dependent upon the group or the organisation. Thus they aretransferring dependence from one thing to another.If we are going to reduce the incidence and effects ofaddiction then, rather than have a system that substitutes one dependence foranother, what we really need is a system that allows people to be free ofdependence, of any kind. This is not a radical new idea, if anything it is atrip into a time past where we dealt with the problems in the community ratherthan expected the doctor to cure them all. However, in order to do this, weneed to have a system that teaches people life skills. For example, how tosolve their problems, how to set goals for the future and perhaps the mostbasic skill of all, how to communicate with each other. Maybe if people hadmore of these skills, they would be less likely to develop addiction problemsin the first place. If they did develop addiction problems, they will be lesslikely to be severe. If the addiction problems were severe, they would be morelikely to find a solution. Thus perhaps the solution lies in empowering peopleto ‘treat’ themselves rather than creating more addiction specialists.