Effective treatment of addiction (and how we get this wrong)

Addiction is currently treated as a medical or behavioral problem. Rehab for drug use averages about 10% success. If a car averaged 10% success in getting you from point A to point B, someone would start asking questions. What if we are approaching the problem incorrectly?

The fact is, addiction starts out as an emotional issue in most cases, a way of coping with difficult things in life. And while there are medical and behavioral components to addiction, emotion remains the major factor contributing to continued substance abuse.

For example, take a study of Vietnam veterans quoted recently by leading traumatologist Vincent Felitti. About 75% of service members who went to Vietnam tried heroin. Many came back to America addicted. However, a study showed that after a year, only 10% were still using. Why did the addiction disappear without treatment? Well, the war was over. Vietnam was over, and for 90% of these men, that meant there was no emotional reinforcement for addiction.

Another argument comes from the landmark ACE study of Adverse Childhood Experiences. ACE's are things like abuse, neglect, drugs in the home, parental divorce, etc. (there are ten in the study, and you can Google it). So the ACE study showed that with merely four or more ACE's, IV drug use was increased by 2440%. With six or more ACE's, that number is 4600%. Those are not typos. Simply doubling the risk of severe addiction, i.e. two times the risk, would be clinically astounding, but we are talking about 24 times, 46 times the risk. With four or more ACE's, there was seven times the risk of alcoholism. Is any more proof needed that addiction is tied to emotional experience?

The last argument comes from my personal experience as a therapist. Whenever a client comes in who has struggled with, or is struggling with a substance abuse issue, usually they are coming to me to treat PTSD or some other trauma disorder. However, I always ask (and many clients have been in AA or NA), "Have you ever known an addict or alcoholic who didn't have childhood trauma?" After asking that question dozens of times, I've never heard "no." I have a friend who is an alcoholic who does not have a trauma history, so I don't want to make a blanket statement. But in my experience, addiction primarily originates when someone is overwhelmed emotionally, with intrusive thoughts and anxiety, memories they wish they could just get out of their head--and drugs or alcohol work better than "talk therapy" to numb this out.

What is crazy is that we send addicts to rehab for extensive talk therapy, which doesn't help with trauma, and then spit them right back out into the emotional environment in which their use began and continued. No wonder there is a 90% relapse rate! When someone has attended a religious rehab program, they have often had a transformational experience. In these cases, I believe there is a tragic risk for spiritual wounds if there is relapse. If someone came to rehab, secular or religious, with a broken leg, the rehab program would send them to a surgeon immediately to have it fixed. Yet when there is trauma, which is a physical wound to the brain, they do not address it. This would be a serious shortcoming on its own, but as I hope I have proven, addiction is mainly reinforced by emotional issues, and trauma is a huge component of that. So the fact that rehab doesn't address trauma is inexcusable, and sets people up for relapse.

A recent client came to me straight from rehab. She reported that talking about her trauma in group therapy in rehab, over and over in awful detail, actually made her want to use. Testing showed that she had severe, complex PTSD with over 12 distinct traumatizing experiences including sexual abuse, kidnapping, rapes, and having a gun to her head. The stress from these experiences was pushing her toward using, because drugs are the only thing that has "worked" for her to numb it all out. Using EMDR 2.0 (see my blog entry on this method), her PTSD was cured in two sessions (IES-R score of 60 to score of 13). She reported that she no longer wanted to use, because she felt no stress and was happy. She even reported that she had even encountered a former abuser and was not triggered, but felt strong and simply stayed away. Now, she is working on deeper emotional issues and traumatic grief, but with all of her classic "PTSD nightmare experiences" healed, she no longer has the emotional stress that promotes relapse. Hopefully, the danger is gone and the real work of rebuilding her life can begin.

Dr. Ad de Jongh, a Dutch researcher who developed EMDR 2.0, points out that the method's speed helps reduce dropout from therapy. What if we treated trauma after an overdose, or after an arrest, or during rehab? I'll bet that follow-through would skyrocket with aftercare, such as job placement and housing assistance. Addressing the major risk factor, emotional stress, on the front end, would help ensure that a client sticks around for a thorough treatment, and does not relapse before or during. Currently, we are asking clients in rehab or aftercare to simply get by on willpower while adjusting to a healthy lifestyle, and that's not only backward, it's unfair.

If you are trying to stay sober, or have a relative who has failed out of rehab, and if any of what I have written makes sense, given me a call at 615-598-7587.

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