Addiction Treatment Today: What Everyone Needs to Know

Wednesday, September 30th, 2015

Benajamin Nordstrom, M.D., Ph.D.Last month, Phoenix House welcomed Benjamin Nordstrom, M.D., Ph.D., as its new Vice President and Medical Director for Program Development. Dr. Nordstrom’s background includes completing an Addiction Psychiatry fellowship at Columbia University, which included a rotation at Phoenix House; serving as the Medical Director for the inpatient detox and rehabilitation programs and intensive outpatient program at the University of Pennsylvania; and serving as Director of Addiction Services at the Geisel School of Medicine at Dartmouth. We recently asked Dr. Nordstrom about addiction treatment, how it’s changed, and what many people misunderstand about it.

PH: What are the biggest misunderstandings people have about treatment?

BN: One big misunderstanding is people often think they have to have everything completely solved in their brain before they look into treatment. You don’t have to be willing to sign on the dotted line that you will never touch substances again. That is putting the result ahead of the process. A person just has to be open to the idea that, “Hey, maybe my substance use is actually the cause of some of the problems I’m having in my life, and just not a response to the problems.”

You also don’t have to affix to yourself any label you’re uncomfortable with. If you don’t like the word “addict,” don’t use it. Or if you say, “I’m not an alcoholic,” that’s OK. Why would we get into this power struggle over labels when we could be focusing on what behaviors are likely to help you versus harm you?

PH: Are there misunderstandings about the process, such as the idea that detoxification equals treatment or about the role of medication in treatment?

BN: Detoxification is the absolute first stage of treatment for the people who need it. It essentially allows treatment to even be a possibility.   Sometimes it is unrealistic, or even unsafe, to stop using substances abruptly.  In those cases detoxification is a necessary first step—but it is only ever a first step.

And if a person requires medication—such as a buprenorphine preparation to stay abstinent from opioids—this in no way takes away from what they’ve accomplished. Especially among the older crowd, medication is looked at as somehow cheating or using a crutch, but it is not recovery magic in a pill. Medications just level the playing field so people can participate in treatment. A person on medication still has to work as hard as anyone else.

PH: How has treatment in the U.S. shifted over the past few decades?

BN: The biggest shift is we no longer insist that someone admit they have an unmanageable problem before we try to engage with them. Treatment really shifted when providers recognized that change happens in stages, and there are specific techniques they can use to enhance someone’s motivation to move through these stages. Recovery now is a much more open, less confrontational, and more collaborative process, where you’re trying to facilitate insight and the growth of motivation.

Another big difference from 30 or 40 years ago is people used to think if we could just understand the roots of why a person is drinking or drugging and address those causes, we could get the person to stop. This doesn’t really work.  If people are essentially saying, “I have to drink or use drugs to numb the pain of what I lived through,” going in and saying to them, “No, let’s talk about that traumatic material,” before you have given them any other ways of dealing with these feelings—well, it’s like you’re just pouring gasoline on a fire.

We recognize now that we have to stop the use first, and then help the person learn–or relearn–new and more adaptive ways of managing negative emotions. Once those coping strategies are bedrock, then you can start talking about things that make them anxious or depressed.

PH: How long does treatment take?

BN: Time in treatment is the part that is very open to individual variation. Sometimes treatment can be done with a very, very small footprint–and this is exactly what some people need. However, others need much more comprehensive treatment. There is a huge individual variation, and the nice thing about our system is we have lots of different levels of intensity of treatment to correspond to different levels of addition.

PH: What do people find most surprising about being in recovery?

BN: Usually it’s that they had no idea how easy and uncomplicated life can be.  When they start living a recovery lifestyle, they no longer have to do all of the crazy things people do to sustain an addiction and outrun its consequences. This includes the secrets and lies, the compartmentalization, and the amount of energy they expend trying to keep all of these plates spinning. That’s something people have no real awareness of until it stops. Then they’re like, “Oh, my God, I had no idea every day doesn’t have to be a thrash.”

PH: Any thoughts you’d like to add for anyone considering treatment?

BN: Sample it. Sample what life can be like in recovery. People frequently don’t know how much happier, productive, and engaged with family and friends they can be when they get off this treadmill. So you don’t have to commit to a lifetime of anything right now. Run the experiment and see how it feels.

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1 Comment

  • Charlesetta Garrett

    I’d like to also add that being disturbed mentally as a child could end up destroying a persons entire life if they never get to experience being in a stable society because this type of society could be totally different from where they were raised and it’s at that point they realize what they were raised to believe something one way when it is really another. It takes one to adventure life to find your true destiny and solutions to variety of adolescent issues that occurred during childhood. From that experience it became a belief that this is the way it should be then it became a practiced habit which became a part of our mentality. Most addictions are picked up from someone in your circle or group the environment either the chosen environment or the environment you had no choice but to be around like family. So my question is who’s liable or at fault here?