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Addiction treatment has changed dramatically over the decades, but one thing has remained constant—there are no easy answers, either for those struggling with substance use disorders or those attempting to help them.
Still, science gives us much to hope for, and accumulated experience is teaching us better each day what works and what doesn’t. Here are four predictions for what’s just over the horizon in addiction treatment:
1. We will broaden our definition of success.
By moving away from our current focus on continuous abstinence as the only or best measure of success, we can build upon and celebrate every reduction in drug or alcohol use. The treatment process is then a journey, not a one-time shot at sobriety that the addicted person either passes or fails. It recognizes that people often relapse during the recovery process and that improvement most commonly comes over the long term.
With this more inclusive mindset must come a commitment to providing addiction treatment that follows the individual with a substance use problem through each stage of their journey. That, in turn, translates to less time spent using or drinking and, by extension, better quality of life, a decreased risk of overdose, lower rates of criminal behavior, less risk of sexually transmitted infections, and increased employment—all of which help not only the person in recovery but all those in their orbit.
2. Vaccines will supplement current treatments.
Medical advances promise a brave new world of addiction treatment that includes vaccines that can block or dampen the high from drugs. Already, clinical trials of a cocaine vaccine have indicated promise for creating “immunity” to cocaine. A heroin vaccine shows potential as well.
There are concerns: the protection may last only a limited time in some cases and some fear coercive use of vaccines. Still, for those struggling to put substance use behind them, vaccines could be a powerful tool.
3. We will stop treating every addiction in the same way.
Drugs of abuse either directly or indirectly affect the reward circuitry of the brain, and for that reason, they have been lumped in the same category. As a result, one-size-fits-all treatment has become the norm. It’s an overly simplistic view that ignores the vast differences in the properties of various substances and their effects on those who use them.
The reality is all substances (and the people who use them) are not the same, and treatment shouldn’t be either. Heroin addiction and alcohol addiction, for example, have different risks and challenges and should be approached in different ways. Recognizing this, as well as the reasons behind the person’s substance use, will make success more likely and can head off negative consequences.
4. Treatment of co-occurring disorders will be paramount.
It’s not always clear which came first, but it’s now well-understood that addiction tends to go hand in hand with other disorders, such as depression, anxiety, and trauma. Treating one demands a commitment to treating the other; otherwise a negative outcome is all but certain. Studies have found, for example, that depression quadruples the risk of relapse in alcoholics in the first year of recovery, and an 11-year study of heroin addicts found that mood disorders adversely affected every outcome in both the short and long term.
To provide effective help to those with co-occurring disorders, the skills and training of substance abuse counselors must expand. In addition, it’s crucial that fully integrated psychiatric and mental health diagnosis and treatment be provided at every level of addiction care. It’s a future that won’t come easy, but it’s one that will be well worth the effort.
