Different Approaches to Effective Recovery

“Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.”

– The National Institute on Drug Abuse (NIDA) [1] 

When it comes to getting treatment for a substance use disorder (SUD), there are many reasons why an individual may hesitate to seek help. Admitting the need for help is challenging for many of us, regardless of our relationship to drugs or alcohol, and is often a major stumbling block for those who need treatment. 

Even when individuals find the courage to acknowledge that they have an SUD and take steps toward treatment, this mental health condition is frequently beyond their control. Those who are otherwise responsible citizens may behave completely unlike themselves when using drugs or alcohol. Even those who seek help might find it challenging to stick with a recovery program, attend weekly meetings, etc. 

Considering how challenging it can be for individuals to take steps toward treating a substance use disorder voluntarily, it is unsurprising that many end up in treatment and recovery programs by other means. This often occurs when a person is forced to seek recovery through the enticements of family or workplace managers or the mandates of social or justice systems.

This week we will examine some of the different reasons a person might be encouraged or mandated to seek out treatment for a substance use disorder and how these enticements or sanctions from various places can make a real difference in the recovery process.

Family and Community Influence

As I have addressed before in this blog, individuals with substance use disorders are not the only ones who struggle as a result of their mental health condition. Their families and loved ones are often adversely affected as well. Unsurprisingly, it is often members of a person’s family or their loved ones who either convince or compel them to seek out treatment.

In some cases, this means holding an intervention where multiple members of a person’s family or community gather to convince them to seek treatment, often using reason and emotional arguments. In other cases, family involvement may entail a person’s loved ones issuing an ultimatum – either seek treatment or we will leave/stop helping you. In other cases, family members may work together with treatment facilities to help arrange and support treatment. [2]

Research shows that, compared to other interventions in SUD treatment, family intervention is highly likely to lead to positive outcomes in recovery, both for the individual as well as for their loved ones. [3] However, family or community members are often highly reluctant to take this step, fearing irreparable damage to their relationship with the individual struggling with substance use disorder, which can be a major impediment to the success of this approach.

Employment Settings

Another factor that can convince a person who is struggling with an SUD to seek treatment is their workplace. If an employer, for example, suggests that their employee take time off to visit a rehabilitation facility, this is an enticement to treatment. It may be even more compelling if the employer in question places the individual’s future employment in the balance by mandating that they complete a treatment program to keep their job.

Similar to family influence, the influence of a boss or colleague in convincing a person to seek out treatment for an SUD is often highly effective. But,  like with family-based intervention, workplace-based intervention is fairly rare because it puts workplace relationships at risk and makes companies vulnerable if the treatment is ineffective. 

However, individuals who are enticed to seek out treatment – whether by family or by their employer – tend to better internalize and acknowledge their substance abuse and understand that they have a problem. Research shows that those who are in treatment because they have been convinced to attend, rather than compelled to by law, take to the recovery process differently, which changes treatment practices and can make them more effective. [4] 

The Justice System

Despite their being less effective than other referral circumstances, research shows that between 40 and 70% of all referrals to community alcohol and drug treatment programs result from legal pressures. [4] That is, the majority of people who are in treatment in the United States are there as a result of the law.

In the most straightforward cases, treatment will be mandated by courts after an individual has committed a crime, if it is judged that the crime resulted from substance misuse such as the chronic or problematic consumption of drugs or alcohol. In other cases, specific laws in various states allow the police to directly commit individuals to treatment if they believe there is a significant risk of harm, either to the individual or their community. [5] Though there are ethical issues with this, and the system is not perfect, it can also be a useful way to begin treatment for those who might otherwise be unwilling or unable to accept that they have a substance use disorder.

Once treatment has begun, it becomes much easier to convince a person to continue with it. Starting treatment is often the greatest hurdle for those with an SUD. Whatever the reason for starting treatment – enticement or coercion from family or friends or as a result of a court mandate from a judge – it is a positive first step. 

Sources

[1] NIDA. 2020, September 18. Principles of Effective Treatment. Retrieved from https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment on 2022, August 10

[2] Copello, A. and Velleman, R. (2005) Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review. 24, 369 – 385.

[3] Copello, A. et. al. (2006) Family interventions for drug and alcohol misuse: is there a best practice? Current Opinion in Psychiatry: May 2006 – Volume 19 – Issue 3 – p 271-276

doi: 10.1097/01.yco.0000218597.31184.41

[4] Richard S. Schottenfeld (1989) Involuntary Treatment of Substance Abuse Disorders – Impediments to Success,Psychiatry, 52:2, 164-176, DOI: 10.1080/00332747.1989.11024441
[5] Beletsky, L. et. al. (2018) Involuntary treatment for substance use disorder: A misguided response to the opioid crisis. Harvard Health Blog. Jan 28, https://www.health.harvard.edu/blog/involuntary-treatment-sud-misguided-response-2018012413180