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Programs over people?

December 6, 2011
by Dan Cain
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Treatment organizations need to acknowledge that no single approach works for all

You probably have seen commercials for the medication Lipitor or the phone service Verizon Wireless, wherein they claim to be superior to their competitors and the answer to all your problems. In the corporate world, securing a bigger market share is the goal, and cornering the market is utopia. In truth, Lipitor works—for some people. For others, Crestor or the much cheaper generic version of Zocor work just fine, and for still others diet and exercise are enough to control their cholesterol. And there are many places where you can’t get a Verizon signal for miles, but AT&T works great.

The message here, as it relates to the substance abuse treatment world, is nothing works for everyone, everything works for someone, and some people are so ready for change that virtually anything at all will work for them.

Unfortunately, elements of the treatment industry more and more are resembling the corporate world in trying to get a leg up on the competition. This isn’t an entirely a new phenomenon. The newly sober have always needed to embrace whatever program keeps them sober as the one true religion. But generally speaking, the dinosaurs among us simply smile when we hear that you need a 12-Step program to remain sober, or that if you’re an opiate addict methadone is the ticket, or that faith-based programs far exceed the success of mainstream programs.

We smile when neophytes make those claims. But I cringe when treatment professionals make them.

Dangerous terminologies

Perhaps the most egregious example of this is found with the program leader from Malibu who purchases television time to promote his book (The Alcoholism and Addiction Cure) and his $67,000 per month celebrity treatment experience. But lesser examples abound.

Coining the term “evidence-based practices”, while seemingly innocuous, has implied something new and innovative and further has suggested that before use of the term, treatments were not researched for effectiveness. Today, a program that doesn’t market its services as evidence-based, despite the fact that it might do nothing different from what it always has done, is considered to be behind the curve.

“Harm reduction,” a term that can mean anything and nothing, and more often than not was used as a less objectionable term for what we in the industry call enabling, has now become so mainstream that the publishing arm of a major Minnesota-based treatment program uses it in its promotional materials. It’s reminiscent of when “crack” became the epidemic of the moment and programs that never had treated a cocaine addict marketed “cocaine treatment programs,” or when programs having no experience with diversity market “culturally specific services.”

We are coming dangerously close to where marketing programs is taking precedence over helping people.

Insecurity reigns

An industry where selling is more important than doing reflects an insecurity in its product. This is illustrated in our industry by our propensity to adapt to whatever “flavor of the month” is advanced by those outside our field, such as medical or mental health professionals, or those purported insiders who write books and do research but never have actually treated anyone.

The truth is, the medical and pharmaceutical professions have done way more to increase addiction than to remedy it. And while both the medical and mental health communities held sway over responses to abuse and addiction for decades, it was largely grassroots efforts that created responses that work.

Substance abuse and addiction are conditions that have biological, psychological, social, behavioral and spiritual implications. No cookie-cutter program or one response can effectively address the mix of needs that each individual brings to the table. Programs can put together a recipe of services that are most likely to address the needs of a particular subset of addicts and abusers. But nothing works for everyone.

And some interventions, while they might “work” in the minds of researchers, don’t always support the quality of recovery that most people would choose if they knew they had a choice.

We need to return to a time where we put people above programs. Each and every one of us should have the primary goal of working ourselves out of a job, not of adjusting our actions, ethics, values and beliefs to ensure that we have a job for the immediate future.

And lest we forget, while programs can get people the tools to change their circumstances, it takes a community, well outside the treatment purview, to sustain those changes. We in the industry need to focus on helping create those individual communities and on role modeling pro–community values. In my community, the competition isn’t other programs or approaches—it’s addiction and the conditions that lead to and sustain it.

Dan Cain is President of RS Eden, a Minneapolis-based agency that operates chemical dependency treatment programs, correctional halfway houses and a drug testing lab among its services. He has 39 years of experience in the chemical dependency field as a counselor, clinical supervisor and administrator. In 2007 he received Hazelden’s C.A.R.E. Award for continuous service to the recovery community. His e-mail address is