New study finds the blind spots of addiction treatment systems – and asks what can be done about them

Drugs, Alcohol

The article is written by a researcher, on request of popNAD
Published 6 Nov 2020

The article highlights successes and shortcomings of addiction treatment systems, benchmarking them against features of an ‘ideal system’. Controversial points to consider are: Resistance to change, consensus building and innovation; political influence and group bias (youngsters and women); the ‘holy cow’ of best evidence and guidelines; myths of addiction and ethical deficits (‘hitting rock bottom only’ and ‘my will is your way?!?’); the treatment gap (few seek treatment, most recover ‘on their own’); and the forgotten user perspectives (‘I want to have a choice and be respected’).

We wanted to identify the weak points of current treatment offers which might prevent people from seeking help, even when they need it. This obviously requires some benchmarking or a ‘gold standard’ telling us what an ‘ideal treatment system’ should look like.

We assume that the ultimate goal of such systems should be to minimise or prevent the effects of alcohol and drug on the health and safety of the population and thereby to fight human suffering. System efficiency also requires an appropriate mix of services, research evidence on treatment methods, and an understanding of the barriers scaring people away from help.

Why change anything? Resistance to change

Even when overwhelming evidence contradicts the current makeup of treatment systems, the programmes and schemes evolve rather slowly. Major reasons include prevailing beliefs about addiction among professionals and the general population, that is, sentiments about ‘the nature’ of addictions and ‘addicts’, and chances of change.

Is ‘the addict’ to be blamed or is the society at fault? Political culture plays a role which can favour moral crusades or pragmatism. Switzerland, for example, has managed to adopt a pragmatic, non-dogmatic approach, triggered mainly by open drug scenes and the spread of the HIV epidemic. This shows that the bridge between reducing harm and recovery is essential.

Politics and ‘darlings’ of treatment

What kind of treatment should we invest in? Who should it be offered to and how should it be expanded?

‘Where the worst damage is done, of course!’ But it is not necessarily so. There is no “war” on alcohol, tobacco and sugar with powerful industries in the background, but instead on illicit drugs, which in comparison represent only a minor burden of disease according to World Health Organization statistics.

And the ‘darlings’? There is an age-old consensus that we need to change the ‘misbehaviour’ of young people (and possibly of women) even though they do not cause objectively the most problems.

This leads to the neglect of important groups and needs mostly out of moral or political reasons. What is needed, to mention just a few, are gender-sensitive programmes for men, and culture-specific help for migrants in ‘liberal’ Western countries and older adults struggling with dangerous alcohol-medication ‘cocktails’.

Quest for the best treatment and ‘minding the gap’

Many trials and international studies have come to the conclusion that ‘everything seems to work equally’ and ‘everybody is a winner’, as the Dodo bird declared after the race in Alice in Wonderland.

Sketch of a dodobird

There are many ways into addiction but also many ways out. As self-change research has amply demonstrated, the majority of people with addiction problems quit on their own without professional help.

We are all more or less familiar with self-change from the context of quitting the hard drug nicotine without professional help. Yet, ideas that substance users are able to make informed decisions and not only suffering is a trigger for change, but also positive ambitions in life, are   –  against all evidence – seemingly hard to accept.

What to do: the way forward

Politicians and policy makers need to think about political consensus building; decentralisation and striking a balance between local, regional, and national involvement; conceptual integration of prevention, harm reduction, control, and treatment; acceptance of multiple treatment goals; and openness toward those who are controlled.

New investments should favour groups who need it the most and should not be channelled ‘politically correctly’ by the interests of political and professional stakeholders and lobbyists.

Harald Klingemann
Bern University of Applied Sciences BFH
Bern University of the Arts HKB
Institute of Design Research