A problem as serious as addiction should be treated by well-trained people.
A huge problem in our country is that most of the people whom we trust to provide addiction treatment are poorly qualified or unqualified. The biggest group of these are people without any professional training in human psychology or medicine but who are hired by unscrupulous institutions purely on the basis that they have suffered from addictions themselves: “recovering addicts”. Having stopped their addictive behavior is great for them, and they deserve to be pleased with their achievement.
Lance Dodes, M.D., is a Training and Supervising Analyst Emeritus with the Boston Psychoanalytic Society and Institute and recently retired as an assistant clinical professor of psychiatry at Harvard Medical School. Currently, he is on the faculty of the New Center for Psychoanalysis (Los Angeles). He has been the Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the Alcoholism Treatment Unit at Spaulding Rehabilitation Hospital (now part of Massachusetts General Hospital), and Director of the Boston Center for Problem Gambling.
Editor: Muhammad Talha
But this is not a credential to provide treatment for anyone else. Of course, people who have a history of addiction can provide legitimate treatment if they also have devoted the time and effort to achieve an actual credential. In the addiction field, that means completing the requirements toward a professional degree that bears on the problem. That could be a medical degree with a specialty in psychiatry, a degree in psychology at either the master’s or doctoral level, a degree in social work, a degree in family or mental health counseling, or a degree in nursing.
All of these are legitimate credentials that entitle the person to call him or herself a professional and to treat people. Oddly, the one title that one must be wary about is “addiction counselor”, because there is a risk that people with this title will offer nothing more than “Twelve Step Facilitation” therapy (TSF for short), which is simply encouragement to join AA and is no better than 12-step meetings themselves, which have a known success rate between 5% and 8%. If a counselor knows only TSF, he or she should be avoided for the over 90% who will never benefit from the AA approach.
However, it must be admitted that many of the well-credentialed professionals mentioned above are as unaware of the psychological nature and treatment of addiction as those without training. We are all inundated with the myth that 12-step treatment is effective and necessary, and the myth that addiction is a neurobiological disease with no known cure, and this is still commonly taught in professional schools. Unless professionals have been exposed to better information during their training or afterward, then despite their greater knowledge of human psychology, they are as stuck with these myths as anyone else. This contributes to the sad fact that even excellent therapists often refer their patients “out” to addiction treatment centers as if they are incapable of offering anything helpful when the problem is an addiction.
A question that often arises about this is, “Even if good and knowledgeable psychotherapy is the best treatment for many people suffering from an addiction, there are simply not enough well-trained therapists available to provide that treatment, and the cost is too high for most people. What can we do about that?” This is indeed a significant public health question, but fortunately, there is an answer. There are many thousands of people treating addiction in our country — both highly-credentialed and poorly credentialed — enough to provide knowledgeable, low-cost treatment for the majority of the population suffering from addiction, if only they had the opportunity to learn a better way of understanding and treating their patients.
Except for those who are convinced that the 12 steps are the ultimate and best approach for addiction, despite the overwhelming evidence against this, and are consequently uninterested in hearing something different, everyone else can learn something new. I have tried to contribute to solving this problem in academic papers and my books written for the general public, “The Heart of Addiction” and “Breaking Addiction,” both of which describe and illustrate the psychological basis of addiction and its treatment with many case examples.
Of course, we need more. Since the failure of addiction treatment is a major public health problem, it would be good if the government devoted resources to help better train our front-line therapists in the psychological understanding of the symptom we call addiction. Unfortunately, the government has been a purveyor of the very myths that make addiction treatment so unsuccessful. But we can all do our best for our loved ones and ourselves by being sure that we question those to whom we turn for help about their orientation. As I’ve said previously in this blog, if you learn that proposed treatment consists of either referral to a 12-step program or treatment with Twelve Step Facilitation, unless you are in that 5-8% that will benefit, walk out and look elsewhere.
I am also making a new effort to provide more training and information to therapists of all backgrounds, as well as for anyone interested in learning more about addiction for themselves or loved ones. Starting in one month (June 22), I will be offering an 8-week online course based on my first two books, “The Heart of Addiction” and “Breaking Addiction” (both books are included in the cost of the course). For professionals, the course is designed to provide continuing education credits. Anyone who is interested in learning more about it can find the course description here: http://lance-dodes-course.thinkific.com/courses/lance-dodes-m-d.