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Are You Venturing Outside the Lines?

September 1, 2006
by Gary A. Enos, Editor
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This issue's main cover story on page 12 addresses a topic that not long ago would have found virtually no support in the mainstream treatment community: the idea of giving treatment clients the equivalent of cash rewards as an incentive for maintaining abstinence.

Yet today, armed with research evidence indicating that modest prize incentives can help improve treatment retention, nationally renowned treatment organizations such as WestBridge in New Hampshire are attempting to integrate these efforts into established programs. This is but one example of how organizations appear to be welcoming new ideas in treatment as never before—not necessarily to do away with their traditional approaches, but to make their time-tested interventions work more effectively.

Many of these initiatives are helping the field to reaffirm that addiction is indeed a chronic, relapsing illness and that programs need to consider all the tools at their disposal as potential responses to this insidious threat. This magazine's first cover story in January 2003 discussed how programs were becoming more flexible in addressing a client's relapse to substance use while in treatment. Since then, agencies and clinicians have shown no sign of relenting in their attempts to challenge the old rules about what constitutes an effective and efficiently run treatment program.

If addiction indeed resembles other chronic medical conditions such as diabetes and hypertension, then it stands to reason that some of the longer-term, trial-and-error approaches that often characterize treatment for those illnesses should apply equally to addiction. As Chip Dempsey of Addiction Intervention Resources states in his feature article on page 32, if the airline industry and the medical profession have seen members with addictions fare better through structured aftercare with long-term monitoring, why shouldn't these strategies be applied more broadly to the general public?

I'm interested in your perspective on whether your practice or organization is venturing “outside the lines” in treatment, and what the effects have been. Have you integrated into your program any approaches that five years ago would have been considered off-limits? Are your program's leaders showing an inclination to be more “experimental,” and what are the challenges to operating in this fashion?

Send your thoughts to me via e-mail at, and perhaps your experiences can be shared with your colleagues in a letter to the editor or as the subject of an upcoming feature. We want this magazine to continue to serve as a forum for the ideas that can bring success to your clients and affirmation to the challenging work you do every day.

Gary A. Enos, Editor