Tag Archives: About Treatment

What Is Treatment?

Treatment. It’s a loaded word when talking about substance abuse and recovery services. There are many misconceptions about substance use disorder treatment around. This leads to misunderstandings from potential clients about what happens, which can be significant barriers to seeking needed help. With this confusion, what is treatment about?

Treatment is Not Shaming

First, let’s talk about what treatment is not about. First, treatment is not about shaming people. I know, there’s an old school treatment concept that still exists which includes shaming tactics under the guise of helping the client. Treatment programs built this method around the concept that addiction is a moral failing and people continue using despite negative consequences they’ve experienced. This is not true.

Let me say it again—addiction is not a moral failing. Research has proven this in a variety of ways under many circumstances. Addiction is a brain disease. This means the concept of choice plays an insignificant role in substance use disorders. Yes, technically people have a choice to use. However, there are multiple things influencing that choice which are beyond a person’s control. And, the bigger part of the equation to use is that once the person picks up, any subsequent use is beyond their control. Period. No ifs, ands, or buts about it. Therefore, shaming tactics are ineffective and, most times, much more harmful than helpful. Treatment should never be about shaming. Any treatment tactic that includes a shaming component will inherently be problematic.

Treatment is Not About a Cure

Treatment is also not about “curing” people. Think about it a minute. Can you forget, truly forget, how to ride a bicycle? Outside of other influences that affect memory and the brain, it isn’t possible, is it? This principle also applies to substance use. A person who has turned to substances as a coping skill has learned, for a short time, substances provide relief from their distress. That’s impossible to forget. And, the problem is, these underlying pieces are generally not “curable” pieces. For example, we cannot yet “cure” the discriminatory behaviors ingrained in our society. Thus, the distressing and traumatic personal experiences with this discrimination are still incurable for an individual. Which means the temptation to return to substance use as a way to cope will never completely go away either.

Treatment is Not About Not Using

Finally, treatment is not about not using. You read that right. Treatment is not about not using. Yes, there is that piece in there. However, the bulk of treatment is about other issues. The not using part is only a small piece of a much larger puzzle. The larger puzzle is more what treatment focuses on instead. Why is the person using? What barriers exist to sobriety for the person? What can treatment staff do to address the reasons for use and the barriers to recovery? What supports does the person need to continue in recovery? These are some examples of what treatment is about.

Treatment is About Resources

Treatment is about finding resources for people. It is about rebuilding connections people have to their families, friends, jobs, and communities. It is about helping them address underlying trauma issues, underlying mental health concerns, financial problems, social problems, and more. Because we live in a society that criminalizes addiction, it is about helping people navigate and address legal involvement. For adolescents, it’s about addressing school needs and parental conflict.

Treatment Is about Respect and Dignity

Most importantly, treatment is about helping people find dignity and respect for themselves again. See, part of what addiction and substance use problems do is rob people of their own sense of self-worth, compassion for themselves, and their sense of well-being. People who struggle with use and the negative behaviors associated with it are acutely aware of how these behaviors have affected loved ones in their lives. The shame and self-loathing they experience is as bad, if not worse, than anything anyone else can evoke in them. Therefore, treatment is about building people back up again. About helping people through these dark periods in their lives when they can’t find the light for themselves. Treatment becomes that light.

Yes, treatment is a loaded word when we look at substance abuse treatment. But it doesn’t have to be scary. Understanding what treatment is, and what treatment is not, is a key piece of removing the stigma and fear around seeking help. Treatment is about humanizing people. It’s about understanding.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.

The Doorway Into Treatment

Treatment centers regularly get phone calls. Someone is calling looking for some help. Sometimes it’s for themselves. Other times, in fact most often with adolescents, it’s someone else looking for help for a loved one. But the caller is lost. He or she may not understand where to get help, regardless of who it is for. Or they think because they’re looking for help, they can check themselves in to a program as the first step. However, there is a critical first step to finding help for a substance use concern. It’s the comprehensive assessment.

What Is the Comprehensive Assessment?

While they can go by other names, such as a Rule 25 assessment here in Minnesota, the comprehensive assessment is about getting a global view of the client’s life. Therefore, any decision to seek treatment for a substance use disorder for someone of any age should start here. See, the comprehensive assessment will review substance use patterns and the consequences of using for a person. It will also evaluate other factors in the client’s life—things like jobs, transportation, community supports, and more. It’s these factors that have just as much influence on the level of treatment recommended as the use itself does.

Understanding Substance Use Patterns

First, and foremost, the assessment will examine what substances the client uses and how the client uses those substances. This is about how much they use of a substance, how they use it, and how often they are using overall. Understanding this pattern of use helps LADCs assess the risk in the way a client is using. For example, adolescents have a riskier pattern of use than adults in general. This is because adolescents tend to experiment with more substances, mix substances, and use in binge patterns. Adolescents use like this because often they are uncertain when they will get to use again so they’re “going to make it count”. They also don’t always understand why they’re not feeling the effects of a substance right away, so they use more thinking it will help. Then, by the time the substance takes effect, the adolescent has pushed it to where they’re risking an overdose.

The route, or way, someone is using also influences the level of care recommendation. People who are using intravenously run significantly higher risks of overdosing and of having serious secondary health problems. The intravenous use can be more difficult to reduce and eliminate due to how fast the substance takes effect in the brain. Oral only use, while still perilous, does not carry quite as much weight. Substances ingested orally take 30 minutes or more to affect brain function. This means there’s a greater window to address an overdose. It should be noted, though, that this effect is also what contributes to adolescent binge use patterns and can place adolescents in particular at a higher risk of overdose. Now, these are just a couple examples of how counselors consider a person’s patterns of substance use. Each person’s situation is unique and cannot be fully explored here. Questions regarding a specific person’s situation should be directed to a treatment provider for more information.

Reasons for Substance Use

Once the counselor assessing a person understands the patterns of use and potential risk factors associated with this aspect of the assessment, the counselor will explore other areas of the client’s life. Physical health issues can contribute to a person’s substance use. This is one significant factor that can lead to opioid addictions. Mental health is another area in which there are several risk factors that contribute to substance use. For example, those who have experienced traumatic events have a much higher rate of substance use disorders than the general population. This is because of how the trauma influences and distorts the relationship between one’s mind and body. As you can see, the goal here is for the counselor to find and understand potential areas that are feeding into the ongoing substance use. It’s these areas that treatment must address so a person can decrease and stop using substances in harmful ways.

Barriers to Treatment

After exploring potential underlying reasons for substance use, the counselor will look at potential barriers to treatment. For adults, these barriers could be job concerns, child care issues, housing issues, other relationship issues, and more. For adolescents, these barriers include school, jobs, sports, and trying to explain to parents what is happening. The recommendations will not be helpful to a client if a counselor does not consider these factors. After all, why would a client be expected to follow recommendations for treatment if the cost they pay includes things like a place to live, no way of taking care of children, or not being able to graduate from school? The counselor involved can help address these barriers when they come to light. Therefore, the counselor will ask questions about these seemingly unrelated areas.

Assessing Strengths

Finally, throughout the assessment, the counselor will look for strengths in the client. This is a critical piece of an assessment. After all, no person is without some strengths. Those strengths become the foundation on which everything that happens in treatment is built. A person’s strengths are what counselors use to see people through treatment and to help people develop ways to build up limitations and overcome barriers. For example, someone using in part as a response to trauma has the strength of being a survivor. That simple fact—a person survived a traumatic event—becomes the start of a new chapter in their narrative where they survive the aftermath of that trauma and the subsequent substance use. e 4 Accent

Finally, the Recommendations

Once the assessment is done, the counselor will weigh out all the strengths, barriers, and risks a client presents with to the assessment. And, the ones discussed here aren’t even everything a counselor will explore during the assessment. They are just a sampling of the things under consideration. They weigh each recommendation in the context of each person’s life. Because there are so many unique combinations of things going on for people, this assessment becomes a critical tool in determining what the recommendations for helping a client should be.

And it’s not a case of substance use treatment or not. Often there can be recommendations such as mental health therapy, a medication management evaluation, family or relationship therapy, connecting with sober support groups, a physical health evaluation, referrals to state or county resources, and more. Many people make the mistake of thinking the assessment is about using and if someone goes to treatment or not. The assessment, and treatment itself, is so much more than that. It’s about how to help support a whole person in every aspect of their lives so they can get to a place of health and happiness.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.