The idea that a person has to stop using all substances in order to engage in addiction treatment is one that is killing countless individuals, harming an immeasurable number of families and adversely impacting communities across our nation.
We currently have a treatment system in the United States that overwhelmingly tells people they must practice total abstinence in order to receive treatment services. If a person states that they are seeking to cease opiate use but wishes to continue to engage in marijuana use, they are often turned away and told them to come back when they are "ready" to stop using all substances. If an individual uses any substances while engaged in treatment, in essence exemplifying symptoms of the very issue that brought them there to begin with, they are often kicked out of treatment with little to no supports in place and once again told to return when they are "ready." This type of practice is sort of like a primary care physician turning somebody away until they are "ready" for treatment of high blood pressure if that individual is able to abstain from fried foods but struggling to stay away from sodium. It would also be like the primary care physician kicking that individual out of treatment for eating french fries. Just as these scenarios would be poor practice on the part of the primary care physician, it is poor practice on the part of a large segment of our addiction treatment system to refuse medical care on the basis of an all-or-nothing approach.
It is important to remember that for many individuals, total abstinence is not the goal. For some, it may not be possible in the moment due to countless co-occurring and intersecting challenges. For others, abstinence is not the presenting goal but perhaps may become the goal later on down the line and for still others, abstinence is not the goal at all and they are able to engage in other substance use without it becoming problem use. Regardless of where on the abstinence spectrum an individual seeking treatment may find themselves, it should never be the business of the treatment provider to withhold care from an individual seeking it solely due to their inability or choice not to practice total abstinence.
As our nation scrambles to address the addiction challenge that has crept into the corners of every community across the country, it is of extreme importance that we look at our current treatment system and make drastic improvements in the provision of care. Nobody should be denied treatment, kicked out of treatment or told to come back later based on an all-or-nothing approach. Not only is this simply abhorrent medical practice, it is killing individuals and devastating families, communities and the nation as a whole.