One size never fits all, whether it is a pair of stretch pants, the “universal” television remote, or an adjustable wrench. Why would we assume that there is only one method or program of recovery for addiction? Many people do assume there is only one path, especially if they themselves have become sober on it.
With the best of intentions, they may exhort others to follow that same path. This view has a companion, namely that there are no viable alternatives. Combined, these two views produce a belief that if people fail with this method, they perhaps are not trying hard enough.
Each person’s addiction has its own trajectory. People begin to use and abuse alcohol and other drugs for particular reasons and these reasons may have a stranglehold on a person. Some are just looking for fun while others are seeking release from trauma, grief, depression, or anxiety. This is not to say there are not commonalities to people’s addictions. Where there are commonalities, it is important to recognize differences between people with the same addictions. Some people may have other physical or psychological co-occurring conditions, which means some treatment methods may not be effective.
Consider that some believe people in recovery must be abstinent from any kind of drugs, even those that are medically prescribed and used as prescribed. Would we tell someone with high blood pressure, high cholesterol, and kidney disease that they may not take medications to relieve these conditions? An addiction treatment program that does not allow for medically supervised prescription drugs to be used to treat a co-occurring condition may have a very low chance of success.
Addictions vary dramatically in the sorts of pleasures or highs or other effects they produce. The brain responds differently to different substances and behaviors. The frenetic high that is produced by cocaine is different from the on-beyond mellow of heroin is different from the dissociative effects of other drugs. Different drugs affect different parts of one’s psyche as well as the body itself. This matters in terms of what treatment options might be more effective.
Medication Assisted Therapies (MATs) are evidence-based practices for treating some addictions. There are medications that may help with alcoholism by reducing the cravings. Medications such as methadone or suboxone are effective for people who are addicted to opioids. Those medications are themselves opioids, but they do not produce the euphoria of heroin or pharmaceutically produced opioids.
MATS are often greeted with suspicion that a person is swapping one drug for another. The person remains an addict. On one accounting, they may still have a physical dependency. However, not all forms of physical dependency are bad; asthma inhalers keep many of us breathing well. MATs reduce harm to the individuals who are struggling, their families, and even broader communities. With regular, controlled, and safe dosages, a person becomes more stabilized and functional.
While much of the focus on drugs and overdoses has been on the opioids, methamphetamine deserves as much attention. At present, there are no effective medications for this type of addiction. There is, however, a form of treatment called Contingency Management (CM) that is proving itself effective. CM works by offering rewards for a “clean” or negative drug test. The rewards may be affirmations (“Great job!”) or small monetary ones (winning a $5.00 gift card). The rewards may increase the longer one is able to have negative test results. While some worry that is “rewarding bad behavior,” part of the reason CM may work is that people begin to see themselves as being capable of making change. They start to cultivate a sense of self-worth, which is often a very early casualty with addiction.
The context in which one lives and is trying to be sober matters enormously. If a person’s choice of drugs has been a matter of opportunity and accessibility, so too may their choice of treatment options. Some people will have access to first-rate medical care; they may have insurance that will pay for in-patient treatment with medical staff to manage withdrawal. Some may need and want the nearly cloistered nature of in-patient while others want to figure out how to become sober in the place where they live and work. One is not objectively better than the other; the measure of goodness is whether it works for a particular person.
Some people may want to become sober in the company of others who have lived the same struggles. There are various self and mutual help groups that do this. If there is any slight glimmer from the pandemic, it is that many mutual help programs have more robust online presence. This includes Alcoholics Anonymous, Women for Sobriety, Rational Recovery, SMART recovery, Moderation Management, and LifeRing that offer online meetings. Some people may prefer to do this work privately on their own, while others may do so in the privacy of a supportive family and friend network. Others may seek help from a psychologist, social worker, licensed alcohol and drug counselor, or religious person. Each of these is a wonderful place to start. Access and opportunity may be the first consideration, but they need not be the only or the last.
People who have been in recovery—even or especially those with long-term sobriety—may find themselves needing to recommit to their sobriety. For some, this will be redoubling their efforts with a method that has been tried and true for them. Others will need and want something new or different. Since we as people are constantly changing, our needs in recovery will as well. There are more options now than even 20 years ago, but we must continue to multiply these options.
Peg O’Connor, Ph.D., is a Professor of Philosophy at Gustavus Adolphus College in St. Peter, Minnesota. Her training is in moral philosophy, feminist philosophy, and addiction studies. Peg is a recovering alcoholic who maintains that philosophy has helped her to stay sober. Dr. O’Connor is the author of the new book, Higher and Friendly Powers: Transforming Addiction and Suffering (Wildhouse Publications, 2022) and Life on the Rocks: Finding Meaning in Addiction and Recovery (Central Recovery Press, 2016).