Different Strokes for Different Folks

By Noah Kass, LCSW

Different Strokes for Different Folks

I believe that each and every client with an addiction to drugs or alcohol, benefits from case specific, individualized treatment.

Although as clinicians we have many treatment modalities and interventions available to us, we must be keenly aware that the implementation of any modality will have differing results depending on their individual scenarios.

Our client’s identifying symptoms, psychological development, biological makeup, environmental stressors and spiritual alertness, are only some of the factors we need to be attuned to. Therefore, it’s essential to weigh all specifics as we go about choosing a specific treatment course.

As a licensed clinical social worker and psychotherapist, I can attest to clients benefitting from regular attendance at self-help meetings. Alcoholics Anonymous has had an amazing impact on my client’s recoveries. Clients I treat who also attend AA meetings have had very impressive turnarounds in character development and personal integrity.

However, in other cases, I’ve found Alcoholics Anonymous treatment to prove counter-productive, and at times even destructive to a client’s recovery.

For these clients, the Alcoholics Anonymous meetings reinforced deeply rooted self-esteem issues, encouraged them to manage newly-experienced traumatic symptoms unsafely, and created a fall sense of commonality that was a step backward in understanding their own addiction and recovery plans.

Psychotropic medication has helped many clients of mine minimize their anxiety and depressive symptoms; thus eliminating the need to abuse not only their drug of choice, but any mood/mind altering substances. Their specific medications became the linchpin of their treatments. Without responsibly using these medications, it could be argued that no progress would have been made.

It should also be stated that I have seen the reckless manner in which some “addiction psychiatrists” recklessly prescribe pills, in a manner that to the addict mirrors the former drug culture/lifestyle they were so heavily involved in. In these cases the choice of medication was inappropriate, the dosage frequency was off, or the medication was simply not needed. Situations like this often resulted in dangerous lethal outcomes.

Psychodynamic therapy has helped many of those suffering from chemical dependence unlock years of anger, self-loathing and devastating trauma. Therapy can help unlock the burden of past pain and unspoken emotion, allowing the recovery process to finally start and the healing to really begin.

On the flipside, there are times when a client’s psyche is so bruised, that it becomes irresponsible to solely use psychoanalytic therapy. The client’s present “emotional rawness” makes it incredibly difficult to handle the often monumental discoveries and intense feelings that psychoanalytical therapy aids in releasing. Without the necessary ego strengths to guide him/her through the pain, the client is left with bear-naked overly vulnerable emotions, with only their drug of choice to comfort and aid them.

As the former Clinical Director of two drug treatment facilities (outpatient and inpatient), I have seen many clinicians run the gamut of other recovery modalities with their clients; removal of environmental stressors, replacement therapy medication (i.e.. cameral or suboxine), holistic therapy options.

Sometimes in trying to use every treatment modality available none is used effectively. The client begins to feel like a guinea pig, with little to no understanding of how their individual treatment course works.

When it comes down to it, we all know one thing to be true; treating and actually helping a person addicted to drugs or alcohol are two very different things.

I repeat again how an awareness of modality choices is paramount to an effective treatment course. If we as clinicians can abandon rigid one-size-fits-all models of care, we can focus more deeply on in-depth personalized assessments.

If we can make singular case-specific treatment the gold standard of care, we’ll have a much better chance to help more of our beloved clients, recovery fully.

Noah Kass, LCSW is a psychotherapist and licensed Clinical Social Worker. specializing in addiction, relationship issues and work stressors. He has been Clinical Director at The Dunes East Hampton and Realization Center in Union Square, both addiction treatment facilities. He writes a weekly advice column (ASK NOAH) on Jim Cramer’s thestreet.com and The Huffington Post. Mr. Kass was the “resident therapist” on MSNBC’S The Dylan Ratigan Show (KASS COUCH) and is a frequent guest on various television programs and radio stations.