By Alex Shohet & Bernadine Fried, LMFT, Co-Founders of Red Door Life
REASON 1: DISCONNECTION, ABANDONMENT, PUNISHMENT
Most treatment centers kick out clients who relapse putting the client at high risk of an overdose, injury, or death. Disconnection is one of the critical causes of overdose and suicide. At their most vulnerable time, clients often are expelled and punished instead of supported with whatever care is possible, keeping inspiration in the picture as well as an easy path to return to treatment open.
REASON 2: DEALING ONLY WITH THE SURFACE ISSUES
Most treatment centers focus on the client’s substance use instead of underlying trauma and other conditions that drive the addiction. Often the underlying trauma can be complex and needs multi-dimensional modalities such as cognitive, emotional, positive psychology, developmental/ skills building, somatic, and nervous system-based modalities to heal.
REASON 3: DISEMPOWERING THE CLIENT
Most treatment centers focus on compliance instead of providing the client with agency over their recovery. Clinicians exclude the client, meeting behind closed doors and clients are expected to conform to a one-size-fits-all pre-developed program.
REASON 4: GENERIC CARE PRACTICES
Most treatment centers treat all clients with the same rules and treatment modalities without differentiating for age, diversity, gender, social determinants, underlying conditions, individualized trauma, family or career obligations, lifestyle preferences, health, and finances.
REASON 5: LACK OF TEAM EFFICIENCY & EFFICACY
Evidence states that the most effective treatment requires a multidisciplinary team of professionals working together. Yet the majority of professionals never have any formal training on working in teams. This leads to poor team communication, overlooked details, finger-pointing, and staff-splitting, all at the expense of the client.
REASON 6: PREMATURELY ENDING TREATMENT
Duration in treatment correlates positively to outcomes. Most treatment centers offer only 30, 60, or 90-day programs. Yet often this is not enough time for the brain to heal its executive function damaged from substance abuse- so one can regain control of their impulses, mood & behavior. It can often take the brain a year or longer for executive function to heal from substance abuse and/or trauma. Executive function is the management system of the brain- a set of mental skills that include working memory, flexible thinking, impulse control, decision-making, and the ability to self-regulate emotions. We use these skills every day to manage our daily lives- to learn, work, focus on our goals, and make constructive decisions- taking into account consequences and our desired future. Most treatment centers are also unable to provide an environment that is engaging enough to have clients want to stay, where they continue to be supported in working on their individualized personal development, participate in sober world re-discovery, and develop purpose.
REASON 7: CRISIS RESPONSE INSTEAD OF PREVENTATIVE CARE
The treatment industry in general is geared towards crisis response, rather than methodology that gets ahead of predictable worsening conditions and creates the best outcomes with the least cost- this capitalizes on a client’s crisis instead of pricing services based on efficacy. Stigma and isolation often prevent one from admitting they have a problem and seeking help, and in this state of disconnection, their condition worsens until they are in a state of crisis. The nuclear family is not typically equipped to support a person with a moderate to severe acuity level and only does so in times of crisis where they have no choice but to pay premium rates.
REASON 8: TREATMENT LACKS CRITICAL DIMENSION
Treatment centers rarely provide the necessary resources to help their clients become productive, self-supporting, or find purpose. Programs tend to focus on sobriety and tools to maintain sobriety while neglecting holistic personal development.
REASON 9: DISCONNECTION
Most treatment centers do not provide the services necessary to maintain a connection to the clients who relapse or leave. The bond is severed and there is no investment in the client’s overall journey or outcome which amplifies whatever duress the client was already in. Furthermore, when clients leave treatment centers they lose their routine, structure, support system, and community.
REASON 10: ONE-SIZE-FITS-ALL APPROACH
Many treatment centers do not provide medication-assisted treatment and believe that abstinence is the only path to positive outcomes. While abstinence is always the goal, the journey may not be linear. Often clients use multiple substances and detoxing off certain substances and stabilizing, then getting off others may improve the overall outcome.
REASON 11: LACK OF INTEGRATION SUPPORT
Every transition raises a person’s chances of relapse. This includes going from a licensed treatment center to a sober living, or from a sober living to living to your own apartment or home. Often clients are left on their own to navigate logistics and the difficult feelings that can arise.
REASON 12: TREATMENT SUDDENLY ENDS
Most treatment centers do not allow their clinicians to continue treating a client who leaves, discharges, or completes the program. Important bonds form while in treatment when a client shares their most vulnerable aspects with those helping them. Suddenly losing that connection and support can be traumatic and activate attachment wounds.
The Top Twelve Ways to Improve Treatment Outcomes
#1 RELAPSE IS PROBABLE, PREPARE FOR IT
When a client goes into treatment there is a high probability of relapse anytime within the first 18 months. We cannot prevent relapse what we can do is respond quickly when a relapse happens to reduce the chances of injury or death and shorten its duration. Much like a fire drill, the treatment center team and the client need to have a plan on what to do in case of relapse.
#2 RECOVERY IS A TEAM SPORT
Help the person assemble a great support team. Depending on the individual this can include an advocate (aka counselor or case manager), psychiatrist, medical doctor, trauma-informed psychotherapist(s)- perhaps incorporating different modalities, holistic practitioners, life coach, peer support specialist (aka sober companion), and other team members if needed. We recommend the person and the whole team meet regularly to discuss progress, goals, and obstacles and adjust as needed.
#3 FIND A RECOVERY COMMUNITY
Living in a recovery community or attending meetings and group activities is important for a multitude of reasons including having shared experiences, being inspired by others who overcame similar struggles and are further down the path, being connected to mentors, being of service to others, being surrounded by support soothes the nervous system and aids mental wellbeing, and helps people naturally stay engaged with their recovery lifestyle and on a positive path.
#4 JOIN A FELLOWSHIP
Secular, Religious, 12 Step- it makes little difference as long as the fellowship is made up of people who are sharing the path toward recovery from addiction and/or mental health disorders and working on personal development. The fellowship should be loving, non-judgmental, not financially driven, inclusive, and supportive.
#5 SUPPORT THE WHOLE FAMILY
Find a great Family Therapist, join Al-Anon, AlAteen, and/ or AlAtot. Network with other family members. For many family members having a person with a substance use disorder is agonizing and damaging. Not knowing if the loved one will survive, feeling that treatment is ineffective, the roller coaster of having hope and then being disappointed and heartbroken time and time again, the impact of having so much attention and resources going to one member of a family at the expense of others can be traumatic which compounds with time. The family needs support as well- whether it is in a group with the struggling person or on their own.
#6 BE CAREFUL OF TRANSITIONS
Any change of medication increases the likelihood of relapse. Any change of lodging increases the likelihood of relapse. Any change in relationships increases the likelihood of relapse. Any change in financial condition increases the likelihood of relapse. Any change of schedule increases the likelihood of relapse. Life is full of transitions; they cannot be avoided. When we acknowledge this, we can prepare in advance and provide extra support and connection during any transition or change in life.
#7 ENGAGE THE PERSON RATHER THAN RESTRICT: AUTONOMY & PURPOSE
“Human beings have an innate inner drive to be autonomous, self-determined, and connected to one another. And when that drive is liberated, people achieve more and live richer lives.” (-Daniel H Pink) With an individualized client-centered approach, clients feel they are a part of a collaboration and invest in their own recovery and personal development, improving treatment outcomes.
#8 FOSTER MASTERY
Every human being has gifts. Helping a person align their giftedness to activities will help motivate a person to be productive and successful. Asking a person to attempt things too far beyond their skills reduces motivation and affects one’s worth. Setting up skills-related goals and tasks that are slightly challenging but achievable increases esteem and dopamine. Individuals in early recovery are handicapped- their brain and ability to function cognitively and emotionally regulate can be greatly diminished and it is critical to reduce expectations and give them time to heal.
#9 FAITH OR HIGHER PURPOSE
In 12 Step Programs, you are encouraged to find a Higher Power, which could be a religious figure or a spiritual belief in the universe or something greater. For people who struggle with the concept of a Higher Power, finding a Higher Purpose is just as effective. People improve their recovery when they develop faith and a sense of purpose.
#10 BE OF SERVICE: HELP OTHERS
By helping others in their recovery, we derive a deeper understanding and commitment to our
own recovery. When we are feeling our worst, we can find simple pleasure in helping someone else who is also struggling. This helps take us out of our own dark ruminations and fears. In addition, remember the acronym “P.E.A,” which stands for People, the Environment, and Animals. By remembering PEA we see many opportunities to help in a variety of ways.
#11 GROWTH MINDSET
Mindset is critical on a recovery journey. The journey is not always linear, and there may be many setbacks and unexpected bumps in the road. It is important to use each of these experiences to learn a lesson and further develop resilience rather than lose hope and fall into self-judgment.
#12 PASSION & LIFE PURPOSE
People who have had a difficult time in life have powerful stories that they can use to inspire and help others in ways not possible had they not suffered. Connecting to a purpose and beginning to build a life from it inspires a higher level of living- building a gratifying life that fuels passion. These are beneficial and sustainable highs in life that help one stay on the recovery path.
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