Category: History

How to choose the best treatment

If you or a loved one find yourself in need of help with addiction counseling or treatment the choices can seem as bewildering as the addiction itself. Like most health problems we don’t usually spend a lot of time learning about various treatment options until there is a crisis. At that point, most people want the best they can afford. In the US there are thousands of treatment facilities. They have shifted from talking about sobriety to boasting about their rates of treatment completion.  Some claim outlandish “cures.” How can you decide what is best for you or the one you love?

Recall that the essential problem with addiction is perception.  The mind of the addict simply does not perceive various risks, costs, and benefits to certain actions or use of drugs.  Yes the problem is all in the mind and the behavior is what we observe.  The mind of the addict further, can’t tell where the mis-measurement occurs.  It seems to the individual with the mis-measuring illness that the choices they make are perfectly reasonable and logical.

There are three main areas that can help reflect reality back on the perceiving mind so that the person can make a healthy choice.  They are the areas of accountability, education, and community.  We will take these in order and then see if we can make sense of the whole picture.


Most people who suffer from addiction illness have no idea that they have this problem.  For them it seems like they are drinking for relief. When it is suggested that stopping drugs and alcohol are the only way to be free and happy, it may as well be saying to “Why don’t you just live without oxygen.”  It seems inconceivable. Switching to the idea that drugs are in fact bad is extremely difficult.  Education about the exact nature of the problem is essential for relief from the suffering of addiction.

As science advances it will ultimately solve the riddle of addiction.  In the meantime for the individual becoming aware that the decision-making process itself is faulty is the first step towards freedom.  When a person learns that their coping structure, the way they process information, is itself damaged they can begin to put a question mark after their thoughts.  Do I really need a drink?

I am not saying that every thought that a person with addiction has is incorrect, wrong, or crazy.  What I am saying is that many of the thoughts are disordered in terms of the actual costs and benefits of a specific behavior.

If you didn’t know that drinking alcohol before climbing before the wheel of a car would impair your ability to drive the automobile, then you might get in the car and drive drunk.  More subtle education includes a genetic relationship of alcoholism to the individual, the phenomenon of cross addiction and switching substances, the belief that one is “no good” and other remarkably consistent, and self-damaging patterns in the addict.

Speaking with others, reading, and surfing websites such as this one are all ways to learn about the exact nature of the problem that you or your loved-one are dealing with. It provides perspective, and relief-giving information. It provides another external frame of reference within which to gauge your thoughts and actions. The unexamined life, as Socrates famously said, is not worth living.

If you take the time to start learning about the essence of addiction or alcoholism you are bound to come away with a more open mind. You are certain to see that you are at the very least, not the only one who has consumed to excess or had bad thoughts and behaviors. Your experience will have many similarities to the experiences of others. With enough education you will see you are not alone and that the experience and counsel of others is helpful.


Dovetailing with the idea of education is the requirement for community.  Human beings are pack animals.  We need each other for survival, obviously.  I mean this beyond the simple reproductive sense, but also to include the human requirement for nurturing.

Classic experiments from the 1950’s regarding monkeys and artificial mothers have confirmed that primates need one another for their existence.  Interestingly, the process of addiction separates an individual from his group.  The secrecy alone keeps one from connecting in a meaningful way.  Peers frown upon most of the addictive behaviors.  Society in general does not embrace the fall-down drunk.  The progressive risk taking and requirement for additional chemicals associated with simple tolerance leads to increasingly bizarre activities on the part of individuals. You can probably maintain a $20 a week splurge on a drug or behavior but a $200 a day habit that must be fed is far more difficult to manage.

In the case of gambling addiction, where a person loses the money required for monthly support of the family, and in the case of sex addiction where infidelity and exposure to diseases are rarely welcomed at home, secrecy is one of the keystone features of addictive behavior.

It goes like this:  The addict feeling isolation, loneliness, and a sense of being separate, engages in addictive behavior to soothe those feelings.  Unfortunately the temporary relief of that discomfort leads to further isolation.  With the inherent instability and chaos that surrounds progressive behavior in addiction the sense of isolation and separateness grows. We have a vicious circle on our hands in no time.

Community is the antidote for feelings of isolation.  Most of us when we first come in to a community with other people suffering from addiction are washed over by a sense of relief.  Speaking personally, I had so much shame and guilt around my own beliefs about weakness and failure that I thought no one could understand how I felt.  Sitting in a room with other physicians who had been through the same process and derived the same insight about their own behavior was itself tremendously therapeutic.

I have continued to reach out to a community of my peers and broadened what constitutes my peers as the years have gone by.  It turns out that I have a lot to learn from not just other doctors.

Community may also be found at home.  The gifts of joy available in simple interactions with one’s romantic partner and children are incomparable.  This is not to say that certain communities shouldn’t be avoided.  Where the rule of the relationship is strife and criticism, seeking community may not be in one’s best interest.  Additionally, many members of one’s prior community (drug dealers, fellow “partiers”) may not be the best companions as one seeks sobriety.  One has to be choosy about one’s companions.

Nevertheless, the feelings of loneliness and isolation are really only assuaged by engagement with other people.  I felt like I was on the outside looking in until I went inside.

It is also through community interactions that one gains perspective.  This perspective extends beyond chemical dependency.  How to be a parent, how to be a spouse, how to be a good worker among one’s fellow workers, are all lessons available by listening to the experience available of one’s peers.  There really is no need to reinvent the wheel.  Furthermore, experience shared at the community level benefits others.  That is in fact the purpose for this entire website.


Accountability is the opposite of addictive behavior.  In addiction everyone is seeking something for nothing.  If not for nothing, then for the lowest cost possible.

When I feel lonely, sad, or angry, the shortest distance between those feelings and relief is a drink or a drug.  The neurotransmitters that I take in internally almost immediately change the way I feel.  If I am uncomfortable with my feelings, then I can blur or erase them with drugs, alcohol, or other behaviors.  What I miss in doing that is accountability for my own feelings.  If I find a particular feeling unpleasant, scary, or distasteful, then the healthy approach to dealing with that feeling is to stand, face it, and be accountable.  If I am afraid of losing something and I find the fear of that loss so strong that I have to get out of here by using a drug then I will wind up continuing to be afraid, if not more afraid.

The antidote for fear is education and community.  If I avoid those two processes, then I am not accountable to myself for my own feelings.  This accountability extends to others.  If I simply do what I agreed to do and show up in my own life, then I will feel like a member of the community.  As I behave appropriately over time, I will learn that I actually can be a member of society.

All of the criminal justice system arranged around deterring drug use and associated behaviors is focused on accountability.  Drug testing itself is probably the most basic approach to accountability.  The essence of drug testing implies that we don’t believe you.  The reportage of the truth is extremely flimsy in the life of the practicing addict.  In fact, voracity is the first casualty.  It occurs prior to the use as the person does not report to his community his actual feelings and fears.

Okay, so we don’t believe you.  That’s why we test for drugs.  We know that one of the most fundamental disorders in addiction is reporting the truth.  By the time drugs are found in a person’s urine or blood, the process of addiction is well down the road.  So much better to report at the time of use, and better still before the use.  Even better than that is to report feelings of discomfort, restlessness, or irritability.  Sometimes feeling good is as uncomfortable as feeling bad.  For most addicts feeling anything at all is the problem.

So how do we foster accountability?  I have a very sophisticated monitoring system that I use in my addiction medicine practice.  This instrument and its reliability at helping me detect early problems is unparalleled.  That instrument:  the telephone.

One of the hallmarks of florid addiction is unmanageability.  If I call someone and they’re not answering, there’s usually a problem.  If I consistently call someone and they usually answer, and all of a sudden they stop, it’s virtually diagnostic of trouble.  They may not have returned to substance use at that point, but my experience is it’s not far off.

Routines, structure, and checklists help to keep the mental illness of addiction under wraps.  Speaking the same time every week or going to the same community support meeting or going to the gym with regularity are all ways that an early-warning system is established to catch digression from healthy routines.  When I call a patient and her voice mail is full and full for days, it usually means only one thing:  relapse.

The most broken part of a person in mid to late stage addiction is trust.  They don’t join or participate in a community because they mistrust others.  They don’t relate in a way that keeps them accountable for their actions because they don’t trust the person they imagine relating to with the information.  Prior hurts, prior misuses of the information and in general a lack of understanding on the part of other previous confidantes, all have eroded trust.  The only way back in to a healthy life is to begin to trust another person.

None of the “secrets” in my experience should threaten a person’s life.  Yet, many people laboring under fear of discovery by family members and other friends keep these secrets literally to the grave.  Some of this gets into the area of spirituality.  If a person orders his understanding of the world in a way that’s punishing and adversarial, then fear of honesty naturally follows.  If no one knows how badly you behaved, then you won’t suffer the consequences for it.

The antidote to this fear is accountability.  One’s accountability partners have to be well chosen.  You may have found yourself in circumstances where your accountability partners have been chosen for you.  If you are reporting to a judge or the legal system, then you know what I’m talking about.  If you are a professional and on a last chance contract at work or with your professional society, then you also know what I’m talking about.

But for the down and dirty deep dark secrets, then you must find someone that you can share the information with and that when the going gets tough, you will reach out to.  This accountability is bi-directional as well.

As you accumulate more time and experience in living a sober life, you become a person others will want to be accountable to.  People will seek you out and you will be their confidante.  You will receive information and people will tag up in talking to you.

This is where accountability really blossoms.  When in confidence you hear stories from other people that are remarkably like your own, then true healing takes place.  When you can see in perspective that the same fears and misgivings that are torturing others have had the same effect on you, then you get a clearer picture of how disordered your own mental processes are.  Accountability is critical for escape from the loop of addiction, and for staying out of the trap later.

So how does all of this work together?  If education, community, and accountability are the three legs of the recovery stool, then how do they work together?

I hope that reading this article has provided some education on the matter.  Addiction is like looking at an optical illusion.  The truth or reality is not as it appears.  Learning that addiction is a collection of disordered thought processes that are remarkably consistent from individual to individual, is itself therapeutic.  I felt a lot worse until I knew the exact nature of my problem.

Like being diagnosed with any illness, finding people who have been through what you have been through is important.  As I look back, much of my education on addiction has come from my community of fellow sober people.  The authors of the book “Alcoholics Anonymous” knew this too.  In addition to the didactic, text book-like material found in the first hundred or so pages, there are numerous stories.  Even the didactic material is laced with anecdotes.  Three quarters of the book is all personal stories.  While each story taken individually lacks scientific rigor, in the aggregate a pattern emerges.  Since defiance is one of the key characteristics of the addict, listening to other people’s experiences and drawing one’s own relationship to them is oftentimes the only way to get a thought into the addict’s head.

The community provides an education and the individuals educate the community as well.

As one becomes initially connected to another recovering member of the community, then accountability grows.  When this is extended to a network basis, then one has tremendous support available.  If you can borrow the feelings of successfully avoiding the drug or behavior by talking to one’s peers, then the sense of power and control over one’s addiction grows.  The more one uses the tool of accountability, which is not something to be avoided but rather sought, then the better one feels about oneself.

As accountability grows, we educate ourselves on just exactly what the problem is.  Most of our troubles it turns out are of our own making.

If you are accessing this information through the internet, then you can already see it is a wonderful platform for the three ideas we have been mentioning.  The principle reason people consult the internet at all is for education.  Whether that is learning the definition of a word, or how to treat their medical ailment, or even entertainment, people seek the internet for knowledge.  It is a knowledge information system.

Community is also obviously available.  Email itself is communication between individuals.  With the explosion of social network sites and information communities, one need never be alone.  Email, instant messaging, twitter following, Facebook, and others, are all tools to stay connected.  Connection fatigue can be its own problem, but community is always available.  Further, with the stigma associated with addiction and its treatment, the community can be privately accessed.  True anonymity is available when connecting through the internet.  A person can lurk and glean information about the community before deciding to post or join it.

Accountability is available here too.  Today people earn degrees in online coursework.  Many sponsors have their sponsees email them a “gratitude” list.  This is a simple way to cement and encourage accountability to the process and to a person.  A gratitude list contains 5 or 10 things that you are grateful for.  It helps to break negative pessimistic thought patterns and allow you to focus on the good things in your life.

In summary, some of the foregoing can be found at various treatment options, including online. What if you don’t have substantial resources or you have a significant community problem with addiction? Using the guidelines above you can find a physician for a check-up if your local doctor has questions she can write me and I’ll do what I can to help from here. Next get together with other people trying to stay sober right near where you live and then make an agreement to help each other through the rough spots. You can find them at an AA meeting, in church, temple or even the local judge can point you to them.

Good luck to you and let me know how things are going.