When 'All Or Nothing' Means Life Or Death

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With the overwhelming majority of addiction treatment programs and recovery residences in this country demanding complete abstinence as a requirement for receiving services, we are in essence operating systems that exclude an overwhelmingly large number of individuals in need of help. While hard data does not exist that would capture just how many lives are lost due to people being turned away from or kicked out of treatment and/or housing services as a result of substance use, any person actively using substances or in recovery could name at least one person they know who has met this senseless fate. An increasing number of family members also know of at least one person who has met this senseless fate. To continue on with this old fashioned “all of nothing” approach is not only harmful and killing people, it also defies much of what we know about addiction.

Stages of Change

For a person to be at a place of readiness to sustain abstinence, if that is even their desired goal, that individual must be in the “action” stage of change. “Action is the stage in which individuals modify their behavior, experiences, and/or environment to overcome their problems. Action involves the most overt behavioral changes and requires considerable commitment of time and energy” (Norcross et al, 2011). Many treatment and recovery residence programs are designed for individuals who are in the action stage of change and, by in large, operate under the premise that if an individual isn’t in the action stage of change then they must “not be ready” for recovery. This is faulty logic for a number of reasons, but for the sake of this article, let’s just look at one reason.

We know that the overwhelming majority of people in or seeking treatment, 80 percent to be exact, are not actually in the action stage of change. We know that 40 percent of people are in what is called the “pre-contemplation” stage of change and another 40 percent are in the “contemplation” stage of change (Norcross et al, 2011). What this means is that eight out of ten people showing up at treatment or recovery residence services are in a place of either not really recognizing they have a problem or kind of toggling back and forth between recognition of a problem and an inability to see it. All told, this results in treatment and recovery residence programs designed for only two out of ten individuals to be successful in them. This would be unacceptable in any other health care arena.

“We need treatment and recovery residence programs that are designed to meet people at the various stages of change they arrive in.”

The old way of thinking would be that those eight people who weren’t successful “just weren’t ready.” The new way of thinking needs to be more like “our program isn’t adequately equipped to support those eight people, and we need to fix that.” If we know that the majority of people who make it into a treatment or recovery residence program are not going to be in the action stage of change, whose fault is it really when people aren’t successful in our programs? Who is responsible when our programs are not designed to engage and support people in the stage of change they arrive to us in?

The reality is this: The all or nothing approach to treatment and recovery residence services is one that is ineffective at best and killing people at worst. We can make all of the funding in the world available for increased treatment and housing services in this country, but if we don’t address the fact that our current systems are insufficient, we will never see an increase in people getting better.

We need treatment and recovery residence programs that are designed to meet people at the various stages of change they arrive in. As advocates across the country fight for increased access to care, we must also be demanding increased access to quality care that meets people where they are at. Two out of ten should never be ok for any of us, not when we know what happens to many of the eight who are excluded from a real opportunity for recovery.

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.