A Both/And Solution to the Addiction Epidemic

I have been in the addiction recovery “business” for thirty years (before it was a business), and have stood in the middle, watching the pendulum swing between extremes: no medication allowed in treatment programs; Alcoholics Anonymous-only; abstinence-based; moderation models; some psychotropics allowed; methadone/suboxone medication treatment. These kinds of either/or examples of thinking exemplify the insanity of doing the same thing repeatedly and expecting different results, the hallmark of addictive thinking.  Our culture is addicted to either/or solutions for both/and problems.

Addiction is a disease of body, mind, and spirit; a failure to integrate these parts of the self, to alternate between them. It follows that recovery from addiction requires an integrative approach that addresses mind, brain, body, and soul. Recovery from addiction, from the fragmentation of the human condition, is the quest for wholeness – an integrated self. This is a process of transformation and self-examination that requires deeply investigating the questions about what it means to be human: Who am I? Am I worthy? What is the meaning and purpose of my life? Life is a journey without end, an ongoing wrestling with the conflicting parts of oneself. Recovery requires a commitment to spiritual and emotional growth.

Medication-assisted treatment (MAT) addresses the symptoms, not the disease. It is the “insulin” without the necessary lifestyle changes. It can reduce harm and save lives for those people who don’t choose to engage in the recovery process. If we identify the drug abuse as the only problem, MAT is the best solution. If, however, we identify drug use as the symptom of the existential, emotional, and spiritual challenges of being a broken human being, it is not the solution. Transformation does not always feel good, growth is painful, and suffering is necessary. Life is uncertain for all of us, there are no guarantees. How do I find meaning in the face of adversity and mortality? There is no pill that answers these challenges.

However, abstinence, integration, growth, and change cannot occur if a person is additionally burdened by untreated depression, anxiety, PTSD, ADHD, bipolar disorder, and the like. Nationally, it has been found that approximately one-half of all people suffering from addiction suffer from co-occurring psychiatric illness.

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