(EDITOR’S NOTE: This commentary was submitted in response to our April 6 blog posting titled “Are professionals open to alternatives?”)
I have been licensed for more than 30 years and in the field for more than 40. Frankly, I find the dogmatism that permeates “Therapyland,” as I describe it to my staff, consumers and students, to be as real as that in religion. It is sad that we the professionals become and remain rigid in our approach and attitude, and consumers end up suffering. We many times still use the old adage that they were “resistant” or just not ready to change.
As someone who came into the field in a non-traditional treatment setting (the federal prison system and California Youth Authority pre-release residential services with an outpatient component), I was fortunate. In 1976, I had a boss who was a recovering alcoholic and did psychotherapy during his recovery. He said we were going to treat everything—substance abuse disorders and psychiatric diagnoses at the same time. He said that these all posed barriers to consumers staying out of prison.
My boss was deeply committed to treatment and to meeting people where they were. He was exposing me informally to the fundamentals of co-occurring work in a psychiatric rehabilitation model, or what Patt Denning ended up calling harm reduction treatment for substance use disorders. Whether the consumer got stable or clean with or without pharmaceutical support was much less important than whether they got a job, returned to their families, had stable housing, and over time found ways to live more satisfying lives.
So I treated all diagnoses together with a goal of all consumers staying out of prison and returning to work, school and/or family. I did not know the gift my boss gave me at the time. I was a brash young psych grad student who wanted to change the world, and I was open to find ways to get people functioning again.
I have been doing co-occurring disorders work in my part-time family therapy practice since 1991. I am the guy in central California who is known for working with consumers while they are still using. Understand that I want to see every person with the diagnosis of dependency be able to manage their symptoms. However, I also believe that there is a systemic bias, may I say prejudice, against this class of disorders. We say the illness is chronic, and yet we provide acute care services. We have failed our consumers by agreeing to and using an inadequate system of care.
I believe that we need not only a willingness to be open to alternatives, but a social justice agenda toward which to work, demanding better services for persons with substance use disorders. I made a commitment in 1991 that I would work for two things: that consumers and families living with the challenges of substance use disorders would have a full continuum of care similar to that of mental health systems, and that those consumers living with other thinking, feeling and behavioral challenges (psychiatric diagnoses) would know that they can recover also.
May you nudge those who are stuck to consider walking in others’ shoes, so we can become willing and able to use alternatives as our Higher Power sees fit to show us.
Les C. Lucas, LMFT, is a Clinical Supervisor at the Fresno County, Calif. Department of Behavioral Health, Substance Abuse Division. His e-mail address is LLucas@co.fresno.ca.us.
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