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When undertaking the work of treating addiction, it is wise and good practice to take a broad and open minded approach. Addiction or substance dependency knows no bounds of who or whom it can affect. A very complex area of human life, the effective treatment of addictive behavior is sensitive to many areas of consideration and needs to be closely focused on the very fine details of a persons life to be understood and treated effectively. Attention to detail and a broad understanding of addictive theory is crucial in providing adequate treatment and support to individuals who are ready to take responsibility for change in their lives.

Approaches to the treatment and understanding of addictive behavior have changed dramatically over the last few decades. Addiction is now less frequently  understood as a disease, but is more commonly being understood and generally accepted to have a multitude of contributing factors. In terms of treatment, it therefore stands that an effective approach should reflect this.

Addiction and substance dependency are not solely personal conditions, they are also contributed to by social environments, personal history, trauma, cultural norms and learned behavior. Addiction can also be seen as a malady of the spirit, where drugs or alcohol are utilised as methods of trying to escape from reality, from the pressures of life, or from events which have left their toll on someone.

It is crucially important in the treatment of substance misuse to provide consistency in care. Sadly, people with issues with drugs and alcohol are often treated with suspicion or as less worthy than others. This can happen in statutory services as well as within families and the public domain. The misunderstanding of the personal aspect of addictive behavior is a significant problem and often gets in the way of effective treatment. Judgements occur frequently,  even within the care systems established to deal with this specialist field. Often clients report this and it constitutes a significant percentage of private referrals. One of the main problems is a ‘one size fits all’ approach, which may work for some as people are herded toward a satisfactory outcome, but excludes many where a deeper understanding of their isssues is needed.

Statutory services often take a broad brush approach and struggle with professional people within their client group. Similarly working people often find being part of a public service to be rather humiliating, or demeaning. Staff can misconstrue this as resistance and become stern, which goes to enhance the clients experience of alienation more, often leading them to leave.

This inefficiency of the high street drug market is due to the business model they work under. It is a numbers game focused on lower socio economic groups where poorly trained and lowly paid staff attempt to coerce herds of clients toward sobriety with games of incentives and the concerns of having to meet quarterly targets.

Many people fail in such systems as they are singular and inflexible in their approach. This creates a bi product of rejected individuals who either fend for themselves as they always have and discover their cynicism was justified, or if economics allows, discover alternative more suitable treatments which don’t dehumanise people do exist and go on to work within those.

The modern approach to treating alcohol or substance dependency is now formulated and understood through science and observations of human behavior. This has allowed the understanding of dependency to move away from the older models of addiction which believed that dependency was due to an inherent illness and the alcoholic or drug user was something of a lost case, who could look forward to a life of abstinence and complete helpessness in the face of their poison of choice. This idea has become the standardised way in which the general public now view addiction as an intractable life long condition. The problem with this theory is that it does not account for the many people who everyday learn how to give up and live better quality lives with more control and self understanding to their vulnerabilities and limitations. The ‘addiction as illness’ is the standard Alcoholic Anonymous (AA) approach. However, it is not the only way or approach available….

Since dependency treatment has evolved, understanding has moved on beyond a social support system to become a multi modal and comprehensive approach to human wellbeing encompassing biological, psychological and sociological components. This modern scientifically informed ‘bio-psycho-social approach’ examines all contributory factors to human behavior and health. It considers that when there is ‘unhealth’ or imbalance in a system, often human beings will attempt to rebalance this by other external factors.

A bio-psycho-social approach also understands that human behavior is learnt, which equally applies to learning to adopt and use drugs or alcohol. As the human brain exhibits plasticity (ability to change), we then also know that new behaviors can be learnt and old ones rejected with the correct type of modelling and reinforcement. For this to be maximised the neuronal systems of the brain linked to addictive behavior (dopamine pathways) need to be included in this incentive (reward) based focusing approach. This is achieved through challenging old ways of thinking/behaving and replacing them with more rewarding new models of being that are more attractive and replace a possible sense of loss.

This formulation also includes personal history, contributory factors like trauma, underlying mental health and mood disorders like anxiety, stress and depression and present day concerns like employment, relationships, and other social factors. Observation of addictive/dependency conditions are seen to link to underlying personal issues and substances are often used to mask these. By treating such disorders in this manner a unique profile approach is taken and a clear pattern of usage can be seen to emerge upon assessing lifestyle and historical factors.

Such an analysis starts to create the realisation that the substance misuse is more of a symptom of contributory factors rather than the causal factor alone. Treatment then focuses on resolution of contributory factors via the appropriate therapeutic approach coupled with psycho education around moving forward and increasing self awareness and well being.

Lying at the heart of treatment is a thorough assessment to begin the process of building a picture of what has been happening in a persons life and how they have ended up looking for support to get better. From there and with the information gathered an appropriate way forward can be mapped.

Many detox centres do not provide post detox support. This is a fatal flaw within recovery. It is when leaving care and especially after detox, when someone is at their most vulnerable. It is the time when most lapses and relapses occur and in the worst situations overdoses occur.

The traditional approach is to focus on rehab and detox as the treatment protocol. However, this fails to recognise that it is when people return home that they will be at their most vulnerable and when what they have been taught will have to be put into practice. Without solid aftercare, developmental work and learning ceases. There is no one to learn and reflect through, no professional to discuss matters of personal recovery with and no one to help to alleviate the pressure and stress.

It is when someone returns back home that the real learning begins, everything else has been a dressed rehearsal. The essential component of recovery is played out after rehab and detox, not during!

To have proper professional aftercare is essential to recovery. It is when the inevitable lapses can be understood and worked through and reflection and non judgemental learning can take place. It is the time when someone really learns to live in their usual environment without the aid of their normal crutch, has an opportunity to put into practice the skills taught to them and work through any issues with ongoing assistance. It is the time when treatment begins to comes together.