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Substance Users Most Frustrating Obstacle to Recovery is Problem Recognition

Substance use in the US continues to persist despite its destructive impact on society. Per the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH) in 2020, “25.9 million past-year users of alcohol and 10.9 million past-year users of drugs other than alcohol reported they were using these substances “a little more or much more” than they did before the COVID-19 pandemic began.”

The COVID-19 pandemic does seem to have led to an increase in substance use, presumably by requiring people to stay home and isolate from social contact. This belief came from the fact that in 2017, SAMHSA found that more than 20 million Americans aged 12 and over met the criteria for a substance use disorder based on their annual consumption of alcohol or illicit substances. Over 14 million people had an alcohol use disorder, while 7 million people had an illicit substance use disorder. Although the measures from the two surveys are not the same, it still seems to suggest an increase in substance use by Americans.

Photo by Nicola Barts

An obvious step to take to address substance use that affects so many Americans is making treatment more accessible. In all honesty, over the last ten years, I have noticed a push to move away from criminalizing those with substance use issues and treating those who struggle with addiction like it’s a disease. I think this is a positive step, but some considerations exist.  

A particular point that citizens need to know is that those who enter treatment often do not complete the program. SAMHSA stated that in 2005, the graduation rate of clients in publicly funded programs was 44 percent across treatment modalities and 36 percent for those serviced by outpatient providers, the most common form of service delivery in the US.

It is essential to acknowledge that the success rate of treating many diseases is not high, and relapse usually occurs. However, 40 percent is a bit concerning since treatment is becoming the standard practice for civilians and those involved in the criminal justice system. The question becomes, “what causes treatment programs to struggle with retention?” One study gives us a perplexing possibility.

A study by Laudet et al. (2009) documented participants in two publicly funded, state-licensed, intensive outpatient treatment programs in New York City between September 2003 and December 2004. Participants were members of underserved minorities and were, recruited in inner-city neighborhoods. Laudet et al. (2009) stated that 60 percent of the clients left the program before completion, with two-thirds claiming that nothing could have been done by the program to prevent them from disengaging in treatment services.

While the study is small (278 total participants), it gives the layperson valuable insight into those struggling with addiction. Laudet et al. (2009) state some feedback from the 30 percent of those participants who left the program because of an issue with the facility (dislike of some aspect of the program, program interferes with other activities, continued substance use etc). The disturbing part revolves around those who left the program but said nothing would have kept them in treatment longer. What are we supposed to make of that?

Laudet et al. (2009) state that problem recognition is a possible significant culprit in treatment retention challenges. The belief is that most Americans with substance use disorders never get treatment due to denial of a problem. I have written about delusion in one of my previous stories; it seems to fit with what Laudet et al. (2009) suggest.

The finding about denial probably does not come as much of a surprise to those who struggle with addiction or have family members with a substance use disorder. The denial of it all, the apparent lies, can cause strains in relationships, especially with those they love.

Photo by Alex Green

There is no magical answer to deal with addiction besides hopefully preventing it from occurring in the first place. Once someone has a substance use diagnosis, I believe encouraging the person to enter into treatment and/or to support groups like AA or NA give them the best chance at attaining recovery.

Addiction serves as a symptom of a much larger problem in society. On an individual level, underlying issues generally lead to a substance use disorder. Denial serves as an end to a means. One has to continue to deny, to partake in the substance using behavior. This fact can act as a warning sign for all of us. Seeing the results of our behavior over time matters more than what we prefer. If we keep running into a brick wall while doing something we like but believe it will not happen the next time, we must reconsider our grasp on reality.

Vertis Williams is a Positive Habits Life Coach and a Mindfulness Trainer. He is a regular presenter at employee and team-development events. Contact him to request more info on his Workshops or on his Coaching Services! Click HERE to Request a Complimentary Habit Coaching Session!

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