The Language We Use in Addiction Treatment

The language we use related to alcohol and drug use disorders is often stigmatizing and misguided. Alltyr’s mission is to transform addiction treatment in America. Changing language is a necessary step in that process.

Here’s is Alltyr’s guide to addiction language for the 21^st Century.

Instead of saying:	Say:
alcoholic	person with an alcohol use disorder (AUD)
addict	person with a substance use disorder (SUD)
alcohol /drug abuse	risky use, heavy drinking, risky drinking
sober	abstaining, in remission
betrayer, liar, cheat, thief, selfish	addicted person, sick, ill
enabler	loved one
enabling	unhelpful or unskillful behavior
tough love	self-care, setting reasonable limits and expectations
unmotivated, denial	ambivalent about change, non-adherent, not yet able to overcome barriers to change, demoralized
dry drunk	irritable, moody, troubled, erratic, struggling
slip, lapse, relapse	use episode, recurrence, set-back
recovery (abstinence + spiritual growth)	remission (absence of illness once present)
relapse	recurrence, set-back
relapse prevention	recovery skills training
treatment program	rehab
Treatment (meaning rehab)	treatment (includes all levels of care)
MAT (medication assisted treatment)	treatment, pharmacotherapy, anti-relapse meds
compliance	adherence
non-compliant	non-adherent
harm reduction	treatment, chronic care management, partial response

Want to learn more about The Alltyr Model of Care™? Visit our website: www.alltyr.com 

Maintenance, not abstinence, will save addicts' lives

Read Dr W's Op-Ed in this week's Star Tribune:

http://www.startribune.com/opinion/commentaries/246619891.html

We Still Have a Ways to Go

Very excited to feature a post written by Paula DeSanto, Founder and President of Minnesota Alternatives and a leader in the movement to bring paradigm change to chemical dependency and mental health treatment in Minnesota. Thank you, Paula

We Still Have a Ways to Go

Four years ago I was inspired to open a clinic to help people with substance use issues because of the many, many stories I was hearing about ineffective and often times, harmful treatment.

While we are making progress with embracing more person-centered, stage matched interventions; I continue to have experiences that affirm how far we still have to go.  For example:

I was training a large group of clinicians and practitioners about person-centered care, and we were having a very spirited discussion about why drug and alcohol counselors seem compelled to report their clients use to probation officers.  I have worked as a mental health professional for over 2 decades and mental health clinicians don’t share this compulsion.   In fact, I can’t recall any MH worker ever thinking that this was their professional responsibility.

As this discussion progressed, a man raised his hand and offered a useful perspective.  He commented, “I worked as a probation officer for over 8 years, and throughout that time, we always thought of addiction providers as extensions of us.  There was a strong sense of “we – they” and the counselors job entailed trying to catch the clients using.”

Why do drug and alcohol clinicians think their job includes the role of a correctional officer?

No wonder clients “go underground” in treatment and say whatever they think others want to hear.

Another example:

I was interviewing a young woman who smoked a large quantity of cannabis daily and her parents were very concerned about her well-being.  She had been in treatment previously including some very prominent programs.   I asked this young woman why she smoked pot but before she had a chance to answer her mother jumped and stating, “She smokes because she has a brain disease, and her disease is controlling of her life”.

I again asked the young woman why she smokes, and she proceeded to explain that she smokes to relax especially at night before bed. What unfolded was a discussion about other motives for use and exploration as to whether this young woman even thought she had a problem.

A few days later her mother called me and shared this comment:

“My daughter has been in some of the best programs in the state and I have never heard anyone ever ask her why she uses.  She has always been told that she has a brain disease and they have the fix for it.”

“Kudos to you for asking.”

Living With Success and Failure in Treating Addiction

A number of my recent postings have focused on chronicity, treatment-resistant disease, and staying connected with people who are not doing well no matter what. These are important principles to me and to others who are dedicated to helping people with addictions overcome them if possible, but to continue to work with them if it is not. It is so important to talk about this, to advocate for this, because too often people who have addictions unresponsive to current treatment are condemned, abandoned by their families and friends in the guise of "tough love," prosecuted for crimes and imprisoned, unemployed and homeless because background checks reveal a criminal history. They deserve our care and compassion in spite of, indeed because of, their plight. This service is informed by our humility in the face of a difficult, complicated problem that too often defies effort, faith and science.

However, I witness a lot of successful outcomes, and I need to share those too. As an addiction psychiatrist, I don't see run-of-the-mill patients, I see those with multiple, usually chronic, addictive, mental and physical disorders who have failed to respond to multiple rehabs, or to other approaches. Many patients are referred from hospital based physicians who are seeing the most treatment-refractory group of patients with addictions.

But most of the time, a change in antidepressants, treating a previously undiagnosed disorder, or changing pain medication makes positive difference. Sometimes it is dramatic. I've had patients with chronic pain who were on the edge of despair, even suicide, whose lives turned around dramatically by simply changing the pain medication. Others have depression, anxiety, post-traumatic stress disorder or borderline personality disorder, but where a sophisticated diagnosis and change in treatment results in dramatic improvement.

For most of us, I think our challenges are more salient, bothering us. We fell short. We didn't solve the problem. We failed our patients. But in the majority of cases, we can make a difference. Sometimes that difference is relatively small but meaningful. For example, one patient was able to pick up her grandchild for the first time because of adjustments in pain medications. Another one was able to establish and maintain long-term sobriety for the first time because of a combination of psychotherapy and anti-relapse medications over a 3 year period (but not without some early recurrences.)

Last week, a colleague of mine, a very compassionate family physician called me. He is seeing a patient who has several ongoing chronic illnesses, one of which is alcohol dependence. In spite of everything he and others, including his physician, have tried, he continues to struggle with his drinking. My colleague called to ask, "Am I enabling? Should I send him away, somewhere else?"

My answer came from my own experience more than 25 years ago: "Who is better situated than you to stay with him, and continue to work with him to overcome his disease? Do you discharge people with diabetes, heart disease or arthritis because their disorders don't respond to treatment? How would it help him get better if you were to abandon him? Isn't he demoralized enough by his own 'failure' to respond to treatment?"

He was grateful for my advice and support, and then he added, "I feel like I'm all alone out here [in my primary care clinic.]" I told him I understood, I felt the same way.

Transformation in Action

Most people realize that the current system of care, developed in 1950 and based on the Big Book of Alcoholics Anonymous (AA), is not meeting the needs of patients, families, employers, the criminal justice system, or society at large. There is tremendous waste in providing the same series of lectures, group sessions, films and AA to people over and over again, thinking that someday it will "take." As a physician, that seems similar to treating one of the new "superbugs" with penicillin over and over, thinking that perhaps "this time" it will work. Even worse, in addiction treatment we blame the patient for not responding. At least the poor patient with treatment-resistant infection doesn't have to endure that: being blamed for not responding to available treatments.

The good news is this: people who suffer from addictions, their families and friends, employers, payers, and health care systems are not only ready for change, they are desperate for a new approach. The bad new is this: in order to fully implement modern, scientifically based treatment for addiction, we have to confront a very difficult reality. With the exception of maintenance therapy for opioid (painkiller or heroin) addiction, most other treatments we currently have only have modest effectiveness. To state that is not to belittle it, or to imply that addiction treatment is less effective than treatment for other conditions. When was the last time you knew someone who was cured of their diabetes or high blood pressure? Most chronic ailments respond modestly to available treatments. That's not ideal of course, but it's OK. After all, chronic diseases in humans are extremely complicated and difficult to treat.

We have an easier time accepting that for diseases below the neck. That's my term for diseases we consider "physical" or "medical," as opposed to "psychological." But this is old-fashioned thinking. Consider "psychological" illnesses, such as depression, anorexia, addiction or schizophrenia. If these disorders aren't "physical" what are they? Do they occur without a body, a physical structure which in this case happens to be the brain? No, they don't. The brain is a flesh-and-blood organ that regulates things, just like other organs. And, just like other organs it can get "sick," dysregulated, where it cannot perform it's intended function as well as it should.

MW