catching up to the evidence

most people who have a substance use disorder, (even severe), do not need to be sent off to some far off place to live for 6 months in order to gain and learn to maintain a healthy, abstinent lifestyle.

sending someone away- or choosing to go away to live for a while, is one choice, as is a hammer for a thumb tack.

i recall in the 1990's, when I worked at an acute inpatient psychiatric hospital, people staying 3-6 months.  did it 'work'?  now we have medicaments and other non pharmacological treatments for people, and few people ever stay that long, 3-8 days.  the knowledge base (evidenced based practices) and treatments have made substantial gains in the last 20 years of the twentieth century.

the same is true for addiction medicine.  the field has made tremendous gains and it is time to re- think the main thrust of treatment.  Most people with insurance coverage are offered residential treatment, with few other choices.  maybe a half day intensive outpatient treatment program (IOP), and little alternatives for families who teens and young adults have a substance use issue.

for most people, the choices are a short term (5-7 day) inpatient detox stay, individual psychotherapy, 12 step; with residential being an option if the criteria is met.  far too few health care providers offer the assistance patients the knowledge and sustained support needed in early recovery needed to lay the foundation of recovery.

100% abstinence for the rest of one's life is not the measure of success.

it's like baking...

i can cook.  that is, i can put heat to meat.  bbq? it just takes patience and attending. i can watch my st lii pork ribs slowly milt on my charcol q.  i am not a baker. i cannot bake. but, i do understand some basic principles and facts.  a baseline of excellent ingredients don't make a great cake.  but, a true baker with a keen sense of taste, a soft touch, attention to every detail, an expertise in the effects of each ingredient and the discipline to see it all through...

we have the ingredients. do we have the ethical fortitude and willingness?

community (non residential) based treatment

this begs the question- 'and what exactly does that look like?'

well, simply stated- it looks much like any other medical clinic, along with recovery based services.

more than a bunch of 12 step meetings all day long

more than 'one alcoholic talking with another'

more than a medication dispensary

and it need not cost 10k a month

and it will serve the needs of the average(and two standard deviations) patient

got a better idea?

i recall when it was acceptable to place anyone w a bit other than normal behavior in a psych hospital- or jail, of course.  i know throughout history it was much worse, and is currently much worse on other parts of the world- see saudi arabia.

i am just tinning about people who have a substance use disorder.  lets just say it, we criminal those with the disease of drug dependence.  no i am not talking about when we lock up people who harm other people places or things.

but, i am not thinking about that so much today.

i am thinking about- why isn't that we send folks w significant dependence away for 3-6 months, and or more? and, we call it treatment?

the more i see, read about, learn and watch folks w substance use disorders, the more i think residential is the best answer.  for most, beyond a couple of weeks, its not a good approach... or maybe not a needed approach. that is assuming parsimony in treatment.