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Addiction Is a Mental Illness -- Treat It That Way

In order to effectively address both the addiction and what drives it, providers require training and skills in psychotherapy.
 
 
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The recent suicide of country singer Mindy McCready brings the death toll of patients who were treated onCelebrity Rehab to five. On Monday, Fix columnist Maia Szalavitz  questioned the effectiveness and ethics of Dr. Drew’s specific approach. But McCready’s death also calls for us to reflect more generally on the nature of addiction and its treatment. In addition, the loss of these five entertainers and public figures speaks to how devastating both addiction and mental illness remain as well as how our society conceives of addiction.

The DSM-IV-TR and the upcoming revision, DSM-V, due out in May, define addictions to alcohol and drugs as psychiatric disorders. Nora Volkow, MD, the director of the National Institute on Drug Abuse, agrees, saying, “We need to first recognize that drug addiction is a mental illness." This focus on mental health also conforms to research increasingly revealing the many ways that addiction is a brain disease.

By contrast, Alcoholics Anonymous has been centered on a model of alcoholism established before the development of this kind of disease paradigm, and it has not espoused clinically complex models of psychological motivation. As AA cofounder Dr. Bob told attendees at a 1950 AA convention: “There are two or three things that flashed into my mind on which it would be fitting to lay a little emphasis; one is the simplicity of our program. Let’s not louse it up with Freudian complexes and things that are interesting to the scientific mind, but have very little to do with our actual AA work.”

Our own approach to addiction, which we call Integrative Addiction Psychotherapy, is based on the following assumptions: 

• Addictions are psychiatric/mental health disorders. 

• Many, if not most, addicts also have additional psychiatric issues such as PTSD, depression, anxiety disorders, psychosis, ADHD, and various personality disorders.

• With or without a diagnosable condition, people use substances for reasons that need to be respected and addressed.

• The treatment of addictions require professionals trained in mental health, skilled in psychotherapy, knowledgeable about the full range of psychological treatments, and fluent in the use of both addiction and psychiatric medications. Passion and dedication are important, but they do not make up for deep skill and knowledge.

What does an Integrative Addiction Psychotherapy based on these assumptions look like? Building on themes that were addressed in a previous Fix  article and a related  article on addiction treatment reform, we believe there are seven essential components:

1. Individual Psychotherapy: Each patient is unique and treatment must be individualized to address their specific needs, history, biology, pain, dreams and desires. While group experiences may be very powerful, even life changing, the integrity and depth of the individual psychotherapy session remains a uniquely curative experience—and the cornerstone of this approach.

2. Therapeutic Alliance: The connection between the patient and the therapist is of vital importance as it is at the heart of treatment. Good therapists will demonstrate love for their patients and will work with authenticity, optimism, courage and determination. Research in both addiction treatment and psychotherapy show the positive benefits of patients having a good relationship with their therapists.

3. Drug Use Is Meaningful: As noted earlier, people use substances for complex and deep-seated reasons that may need to be addressed before the individual will be willing to make changes in their use. Drugs may serve as a pathway to pleasure, as a way to reduce inner pain and suffering, as a method for coping with medical problems, as a vehicle for making and affirming social connection, and as a response to social oppression and poverty.

4. Multiplicity of Self: People who use drugs often have conflicting motivational forces at work—some of which support the continued use, others that fight for change. The motivations for change might include concerns about the family, anxiety related to economic or prestige threats, existential or spiritual concerns, health issues and legal problems. This inner conflict can be usefully re-conceptualized as a community of voices, modes, selves or parts. In this way, each of these energies can be respected and given a chance to speak, and dialogues can be created among the different parts to address their needs and desires.

 
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