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Which Intervention is Best for Addicts - Brief, Long-term, or None?

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A woman who had struggled with substance addiction, and who also had read my book, was now involved with helping others in her field (health care) get the counseling they need.

She wrote to me about how hostile her higher-ups often got when someone chose short-term over long-term intervention. Suspecting that in many cases brief interventions would be plenty, and feeling strongly that those who choose that route should not be derided, she asked for my opinion.

I told her that in my view, short term is usually best. I gave her some context: originally, psychoanalysis rarely lasted for years and years as it does today. Freud and Jung might treat someone for a long time, but typically only in cases involving difficulties far more serious than what most people today call 'neurosis'. I added:

"Similarly, people are now told that they must attend AA (NA, GA, CA ...) indefinitely. A civilization obsessed with naval gazing has something to do with it, though the pecuniary interests of the treatment bizz have obviously played a role. Sure they get angry when someone points out that one week of therapy might be preferable to a year. It's like telling the owners of McDonald's that people should eat fewer burgers."

By no means do I suggest that long-term care is never warranted, but the mere fact that most people leave their addictions without treatment or 12 Step participation does suggest that we should not simply assume that someone with a substance addiction requires treatment at all, let alone lots of it.

I myself recall talking to a psychiatrist at an inpatient addiction clinic, and seeing him shake his head and expressing doubt after I suggested that I might try it without treatment. At the time, I was a hard case, and his point was that someone in my situation is very unlikely to succeed without treatment. Despite being a hard case, I was also a knowledgeable addiction professional. I knew that he was wrong. His insistence on my need for treatment was all I needed to opt for no treatment.

Aside from the financial interests involved, there is another - more insidious - agenda at work. The center I visited is a case in point. It's not just that they want your money (or the government's), they also want a piece of your soul. At this institution (I found out later) people are told things such as the following: don't ask why, no buts please, you can't think with a broken brain. See, they try to break you down and, from there, rebuild you from scratch. So one is told that as a substance addict, all her statements are likely to be functions of denial. Another will be told that the substance use has messed him up so badly that trusting his own thoughts is a bad idea (the broken brain business).

At the time, there were many things wrong with me, but my "brain" (meaning cognitive functioning) was pretty darn good. I could think - in fact, as a professional thinker, that might have been one of the few things I could still do well (better than that shrink by far - BTY).

I had even tried a few outpatient sessions at that place - one on one, with a very nice though not too bright counselor. Here it is in a nutshell: any time I tried to talk about addicts as such rather than myself only, she'd correct me. For example I'd say - and I was right - "We don't just get hooked on the dope, we get hooked on the action." I was referring to how the hustle, or the sex, or some aspect of the action draws us just as strongly as the drug. This was true of every other crackhead I knew, and I was simply trying to identify. But she wanted me to "speak from the I" - essentially an infantile approach to communication: don't rise above the personal, talk only about your own feelings, experiences and viewpoint (like a toddler really).

They infantilise you, tell you that your thinking capacity is gone and then, of course, that someone else must decide what you need (maybe six months of inpatient care with lifelong aftercare to follow). Well, they did help me. Confronted with a choice of either getting it together or having to deal with condescending, self-important pseudo-pros, I got it together. My efforts have not been perfect, but I am here writing this column, and working in my field with a new book under my belt (and another to follow).

Whether or not you require lots of treatment, a little, or no treatment is for you to decide. Just don't allow yourself to be bullied into a decision if your heart, your guts and, yes, your brain, tell you that it's wrong.