What Questions to Ask When Looking into Addiction Treatment

In late February the National Institute on Drug Abuse (NIDA), a government agency dedicated to studying addiction, published a free resource on what to ask when looking into addiction treatment programs. This short booklet, which can be viewed online or downloaded for free, lists 5 questions to ask any addiction treatment provider you are considering seeing and offers the reasons why it is important to ask these particular 5 questions. As part of the description of their reasoning the booklet’s authors provide useful information about the types of available addiction treatments, as well as the important elements of effective addiction treatments. In looking over the booklet I began to think about additional questions that might be helpful to ask when pursuing addiction treatment. In no particular order, here are the:

Additional questions you may want to consider. 

  • What is the treatment philosophy or model? Many programs include or heavily emphasize the 12 steps (AA, NA) approach. Although the 12 step model can be very helpful to people in recovery, it may not be the best fit for some. If you are not a fan of the 12 steps, be sure to ask if there are alternative programs available (e.g., SMART Recovery).
  • What resources are available after treatment ends? Check to see if the treatment program offers monthly groups or other services once the intensive phase (i.e., the phase where you participate in treatment frequently) is over. As stated in the booklet, treatment needs to be long enough to work; research suggests that a minimum of 3 months of treatment is needed for many people to stop or decrease drug/alcohol use. This does not mean that you need 3 months of inpatient treatment (i.e., you live at a facility where you receive treatment), but it does mean that you may need to stay in some type of treatment, whether it’s weekly group meetings, one-on-one meetings with a therapist, etc., for at least 3 months. When looking into treatment programs, be sure to ask what treatment is available after the intensive phase is complete to make sure you have the resources you need to be successful.
  • What about family or couples therapy? The booklet briefly mentions that family therapy may be needed as part of treatment, but if you are looking for or think you may need family or couples therapy be sure to ask about them directly. You may be wondering why you would need family or couples therapy. When a person is addicted to drugs or alcohol it not only affects the person, but the person’s relationships with his/her family or partner. Many family members and partners have learned how to relate to their loved one when he/she was addicted; it can be quite difficult to learn how to relate to a loved one when he/she is sober. Some family members feel at a loss as to how to best support their loved one’s sobriety, or worse, they may unknowingly interact with their loved ones in ways that are detrimental to their loved one’s recovery. This does not mean that family members cause loved ones to use! The choice to use still resides with the person who uses, but family members can be positive or negative influences in a person’s path to recovery (one type of therapy that works with family members and partners to be allies in their loved one’s recovery is called Community Reinforcement and Family Training (CRAFT). CRAFT is a highly effective treatment for family members and for people with addictions). Family and couples therapy can help family members and partners heal from their loved one’s use and to learn new, supportive ways of interacting with their loved ones while they are recovering.
  • Depending on your needs, you may need to ask about:
    • Whether the program will meet requirements for assessment and/or treatment that is court-ordered (e.g., DUII).
    • Assistance with job placement, housing, or other needs.
    • Spiritual services. Does the treatment program offer the opportunity to continue with your spiritual practices?
    • Insurance and payment options.

Of course, the above is not a complete list of questions to consider, but hopefully it helps you start thinking about what your own unique needs may be and what questions you want answered before committing to treatment.

Finding the right treatment can be difficult, but knowing your needs and the types of questions to ask, can put you on the path to finding the treatment program that will work best for you.

The myth of security– Embracing vulnerability, uncertainty, and ambiguity in our relationships and in our world

“Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing. “– Helen Keller
Something many of us yearn for in our relationships is a sense of security. We long to feel certain and secure in our relationships, to feel like no matter what, we will not be hurt in this love.  Where there’s doubt or insecurity, we view it as a sign that something is wrong—that something needs to be fixed.

And our desire for security extends beyond our intimate relationships. On all levels, our world appears to be increasingly focused on trying to ensure we won’t be hurt. Our federal government even has an entire cabinet department dedicated to trying to help us feel secure—Department of Homeland Security.

We attempt to eradicate feelings of insecurity in the hope that if we can just feel secure—secure in ourselves, our relationships, our world around us—then we will be “safe” and happy.

But What If Trying to Feel Secure Actually Makes Us Less Secure?

Sometimes it can be useful to exercise more security in our lives: we lock our doors at night, get life insurance, or carry “bear spray” when camping in the backwoods. However, much of the time we are trying to achieve a feeling of security—a certainty that we aren’t vulnerable to hurt. But suppose our attempts to try to feel secure actually make us more alone, more insular, and more insecure?

Eve Ensler on Security

This is the argument that Eve Ensler, the Tony Award winning playwright, activist, and creator of the Vagina Monologues, makes in her TED talk on the subject of security. In her eloquent and inspiring talk, Ms. Ensler argues that our attempts to feel invulnerable and secure—personally, politically—are actually making us more insecure through the loss of connection with our shared experience. Ms. Ensler encourages people to willingly embrace difficult thoughts and feelings—including insecurity, doubt, ambiguity, and fear—in the service of living a life that is truly more connected, vibrant, and meaningful.

In a similar vein, but drawing from Acceptance and Commitment Therapy, I help the people I work with in therapy accept their doubts and insecurities in the service of moving towards what’s important to them. As Ms. Ensler points out, sometimes our lives become very small and unsatisfying when we spend all our energies trying to be secure.

She says:

“Real security is not only being able to tolerate mystery, complexity, ambiguity but hungering for them and only trusting a situation when they are present…In the shared future… the end goal will be to become vulnerable, realizing the place of our connection to one another rather than becoming secure, in control, and alone.”

This has been my experience as well. I highly recommend watching Ensler’s entire talk.

Help! How Do I find Resources for My Loved One with an Addiction?

Recently a colleague alerted me to an article in the Chicago Tribune about CRAFT (Community Reinforcement and Family Training). A few months back I wrote a blog post about CRAFT that described the research support and basic ideas of the treatment. Briefly, CRAFT teaches family members with loved ones with addictions how to non-confrontationally change their loved one’s substance use. Additionally, CRAFT helps family members learn skills to improve the quality of their lives by breaking free of the cycle of their loved one’s addiction.

First, I think it’s awesome that CRAFT is getting noticed by the mainstream press and that people may learn about the treatment and, as a result, get help for themselves. The article offers interesting facts about the rise of prescription pain killer dependence, as well as tips for helping your loved one. While the tips for getting you and your loved one help were useful, I felt they were incomplete. Additionally, the article didn’t offer resources to help family members access services, get support, or learn the skills discussed in the article. With so many people affected by addiction, I think an opportunity to provide resources for substance use related issues was missed.

How to Find Help for Yourself and Your Loved One:  Some Tips and Resources

While this isn’t a complete list, here are some ideas on how and where you might find the resources mentioned in the Chicago Tribune article.

  • Ask people you trust about resources. Talk to your friends, a family physician, a spiritual leader, and family members about substance use treatment programs, counselors/therapists who specialize in addiction, or community programs tailored to you or your family members’ needs. For example, Dual Recovery Anonymous is a peer-run 12-step program for people experiencing addictions AND mental health problems.
  • Check out your local hospital. Many hospitals offer substance use treatment (e.g., detox, outpatient treatment). Contact your local hospital’s psychiatry department to see what options are available. In the Portland area some hospitals that offer substance use treatment are Providence and Cedar Hills.
  • Check out peer support organizations.
    • 12-step organizations for individuals with addictions (AA, NA) and for family members (Al-Anon, Nar-Anon) offer support and have information on substance use treatment programs in your community.
    • People who prefer not to use the 12-step approach are encouraged to check out SMART Recovery, an alternative to the 12-step approach that uses evidence-based principles to help people overcome their addictions. SMART Recovery also has meetings and resources for family members (SMART Recovery Family Resources). SMART Recovery has a list of national providers and substance use treatment programs that use CRAFT or therapies similar to CRAFT.
  • Check out your state’s department of health website. The websites for your state’s department of health often include a list of mental health and substance use treatment centers that are licensed by the department of health to provide these services. In Oregon, go to:  http://www.oregon.gov/OHA/addiction/index.shtml.
  • If you are experiencing domestic violence, or there is threat of domestic violence, contact local or national domestic violence agencies.  
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