Lately, when I think about the linear progression of addiction treatment in this country, and the world for that matter, an old adage comes to mind, “if you don’t know where you are going, any road will take you there”. Come to find out that the refrain is actually a paraphrase derived from an exchange between Alice and the Cheshire Cat in Lewis Carroll’s Alice’s Adventures in Wonderland, “Then it doesn’t matter which way you go”. If there is any irony to be had here, it lies in the fact that critical literature has often proposed Freudian interpretations of the book as “a descent into the dark world of the subconscious”.
The subconscious is where addiction lives. In nearly thirty-five years of treating addicts, I’ve never once met a single person who woke up one morning and made the conscious decision to walk down the road to becoming a full-fledged addict. It just simply doesn’t work that way. But more to the point of effective addiction treatment, the broad and sweeping programs that have served us so well in the past have been expanded into so many directions out of familiarity and convenience that they too have lost their way.
For years, I’ve been of the opinion that one of the greatest obstacles to curbing our drug epidemic lies in the way we view it. Most people think of it as this great big monolithic structure and believe some pharmaceutical company will develop a single panacea for it – boom, problem solved. However, that is just not the case. The reality of the largest drug epidemic known to man is far more complex. The drug epidemic as a whole is comprised of several subsets of drug epidemics, each requiring their own specific treatment protocols and modalities. Experience has taught us that there is no one single treatment or pill that can effectively blanket all addictions with any measure of success.
It’s important that you know that I don’t mean to be condescending, nor am I presenting an indictment of addiction treatment as we know it; but rather it’s my intention to provide an objective and realistic account of the roots and progression of the protocols and modalities used today. So please take it in the spirit it’s being offered.
With that being said, let’s take a look at the two programs that have had the most profound impact to date on the way we treat addiction- the 12 Step Fellowship and the Minnesota Model. With a few exceptions, these two programs are the cornerstone of every addiction treatment program in the U.S. For all intent and purposes they are the standard of addiction treatment today.
The 12 Steps were cutting edge when it was introduced and continues to be the backbone of addiction treatment and recovery today. It began as Alcoholics Anonymous (AA) founded by Bill Wilson and Dr. Robert Holbrook Smith – known to other AA members at the time as Bill W. and Dr. Bob – in Akron, Ohio. This was the first twelve-step fellowship.
The American Psychological Association summarized the 12 Step Fellowship as follows:
• admitting that one cannot control one’s alcoholism, addiction or compulsion
• recognizing a higher power that can give strength
• examining past errors with the help of a sponsor (experienced member)
• making amends for these errors
• learning to live a new life with a new code of behavior
• helping others who suffer from the same alcoholism, addictions or compulsions
In a short period of time, Wilson and Smith recognized that AA was helping people overcome their addiction. They decided to document their success in hopes of helping others outside the geographic limits of Akron by writing the book, Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, colloquially known as The Big Book. To date, it is one of the best-selling books of all time, having sold over 35 million copies.
It wasn’t long after the 12 Step Fellowship swept the world that the Minnesota Model, a.k.a. the abstinence model, was developed at a Minnesota state mental hospital by two young men, one who was to become a psychologist, the other who was to become a psychiatrist, neither of whom had prior experience treating addicts or alcoholics. It was an inpatient program – which later became a residential program as well – building on the AA 12 Step ethos. However, the Minnesota Model added new components that included a blended staff of medical professionals with trained recovering staff. Additionally, patients were required to stay in intense treatment, from dawn to dusk 7 days a week, for 28 days. The Minnesota Model was developed by a small not-for-profit organization called the Hazelden Foundation before it was adopted by treatment centers throughout the country.
Again it is not my intention to throw shade; I’m a big believer in both these programs and have used them throughout my career. But it is important that you realize that both the 12 Step Fellowship and the Minnesota Model were designed predominately for alcoholics. At the time these programs took hold in the mid 30’s and early 50’s respectively, alcoholism was far more prevalent than drug addiction. That paradigm flipped over 25 years ago with the advent of the largest drug epidemic the world has ever seen; yet we continue to use 80 year-old technology designed for alcoholism to treat drug addiction. I’m not suggesting that the 12 Step Fellowship and the Minnesota Model are obsolete, but rather in need of modifications and the addition of strong evidenced based and scientifically-proven modalities specifically targeting the individual addictions to complement it.
Moreover, there is a biological component to addiction that only a handful of centers treat. Heavy metal toxicity, thyroid conditions, leaky gut, closed head injuries and other conditions are all known to cause depression that can lead to addiction and potentially relapse. All of these conditions need to be addressed and treated if we’re to have a comprehensive treatment program.
It’s simply astonishing to me that we live in a world where its scientists, doctors and researchers can contain some of the deadliest diseases of our time such as HIV/AIDS, SARS, Ebola, Influenza and others while addiction treatment remains a lost ship at sea.
We know how to treat addiction. We’ve learned more about addiction and its treatment in the last 30 years than all of the combined knowledge prior. It was in April exactly twenty nine years ago when a paper, written by my good friend and colleague Dr. Kenneth Blum, identifying the addiction gene, was published in the bible of the medical field, The Journal of the American Medical Association (JAMA). This was a game changer, yet, therapies based in this new information were slow to get off the drawing board – if ever – and into practice.
Even before Doctor Blum’s seminal discovery, physicians developed their own successful treatment program for doctors addicted to drugs and/or alcohol. The Physicians Health Plan (PHP) is currently in 48 states and governed by their state medical board. The program is what you would find in most treatment centers, Minnesota 12 Step Model, with a couple of modifications; the most important in my mind being that the patient is required to stay a minimum of 90 days, and often longer up to 180 days, in inpatient or residential treatment.
This is where I feel the Minnesota Model comes up short and requires modification. The 28 days of inpatient or residential treatment as outlined in the program was plucked out of thin air by two young men who were not doctors, nor had either one of them ever treated anyone for addiction or alcoholism. They basically just made it up.
The PHP’s 90 to 180 day inpatient/residential requirement consistently delivers a high (79.3%) success rate in treating drug addiction. Their success provides the empirical evidence proving beyond a shadow of a doubt that longer stays in inpatient or residential programs significantly improves outcomes. Sadly, the principles of the PHP program are not being implemented and made available to the masses because it is expensive and insurance companies don’t make it available on most policies.
However, there are other new cutting edge therapies that can help curb this epidemic that are simply not being utilized. Doctor Blum has spent a lifetime developing the Genetic Addiction Risk Score Test (GARS). GARS, as the test has become known, is a GPS of your addictive self. Through a simple cheek swab, Dr. Blum can identify the genes associated with addiction. The data is then analyzed with the results showing a persons’ vulnerability to addiction with remarkable accuracy. Imagine the different choices people would make knowing that they or their loved one or child have a genetic predisposition to addiction.
In concert with Genetic Addiction Risk Score Test, Doctor Blum also developed Precision Addiction Management, or PAM for short. I was involved in the early research and development of the PAM system and contributed to several of the technical papers that were published in peer-reviewed medical and scientific journals.
PAM is perhaps one of the greatest achievements in addiction treatment in recent history. The GARS test information provides Dr. Blum and his staff with the ability to identify specific parts of the brain related to addiction that are not functioning properly. With this information in hand, Dr. Blum has developed a family of neuro-nutrients, each one designed to improve specific areas and parts of the brain not functioning properly. When you know where you are going it is easier to find a road that will take you there. All indications are that the PAM system can be a vital asset for addicts still using and in recovery.
These are just a few of a host of new targeted evidenced-based and scientifically-proven treatments available today that can improve outcomes. As I mentioned earlier, there never will be one sweeping treatment for addiction. That said, we must look to the targeted modalities with the help and assistance of medical professionals that can do the most good for you.
As the legendary Hall of Fame Baseball player Yogi Berra – who was known for his malapropisms – once said; ‘If you don’t know where you are going, you’ll end up someplace else.’
John Giordano is the founder of ‘Life Enhancement Aftercare & Chronic Relapse Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 69 papers published in peer-reviewed scientific and medical journals. www.PreventAddictionRelapse.com, www.HolisticAddictionInfo.com
For more information on the Genetic Addiction Risk Score Test (GARS) and/or Precision Addiction Management (PAM) please visit www.geneushealth.com