A Guide to Finding Outside Assistance for Addictive Problems
By Tom Horvath, PhD, ABPP
Am I an “alcoholic” or “addict?” Do I “need help?” If so, what kind? If you are asking one or more of these questions, this blog is for you!
A somewhat out-of-date but nevertheless helpful federal publication considers these questions.
Although this NIAAA (National Institute Alcohol Abuse and Alcoholism) document is focused on alcohol problems, many of its ideas can also be applied to other addictive problems. In this blog I will attempt to improve upon and expand their ideas. In my opinion NIAAA 1) focuses too much on treatment and not enough on the individual choosing or considering change, 2) does not alert the reader about the serious problems that can arise in treatment, and 3) is not up-to-date on the finding that AA specifically (and by extension other mutual help groups) can be as effective as professional treatment.
Most people with addictive problems do not seek treatment. Even though they do not seek treatment many, perhaps most, reduce or eliminate their problems. These facts taken together suggest that if you have begun to consider your addictive problems the place to begin may be a decision to explore change, with treatment as an option to consider. You cannot resolve a problem that you do not pay attention to.
Seeking Outside Assistance for Addictive Problems – Primary Steps
A primary step in exploring change is to consider what you like about your addictive behavior. What is good about it? What does it do for you? Why do you think “I need this?” The answers to these questions will identify what changes you need to make. If you drink to relax it would make sense to consider reducing your stress, and finding other ways to relax.
Another primary step is to set aside time daily to monitor your progress. You might need only a few minutes. You might need an hour. A written record can be helpful for identifying patterns, successes, and high-risk situations.
Do you need to know exactly how severe your problems are, or what your diagnosis is? Probably not. You do need solutions sufficient to address the problems you have. You could hide behind the idea that “I may have problems, but I’m not an addict/alcoholic.” What you actually mean is that your problems are not severe. Nevertheless, you have some! If you do not address them now, when will you?
Do you need professional assistance for addictive problems?
If you are not making sufficient progress after a suitable effort on your own, professional help is the next step. What is a sufficient progress and a suitable effort? Ideally you are experiencing progress immediately or very soon. If not, how much longer can you afford to experience the problems that are occurring? For some entering an inpatient or residential facility is needed to interrupt the cycle of use. If you are physically dependent on a substance you will need to taper or seek medical help. Seeking medical evaluation is highly recommended, and the provider can suggest medications to consider.
Sometimes family members will ignore or discount your progress because you did not “get help.” They have been misled by the ads and media suggesting that “getting help” is the only route to change. Their entreaties or demands can be difficult to ignore or evade. Nevertheless, you can make these changes on your own, as many people do. With luck you can persuade them to focus on the actual outcome (your success, or clear movement in that direction), rather than a process (getting treatment) they assume is necessary (but is not).
To keep your change process in perspective, people have dealt with alcohol and other substance problems for thousands of years, long before there were modern doctors or 12 step groups like Alcoholics Anonymous (AA). Surely some of these individuals must have successfully addressed their problems! Furthermore, despite modern developments, there is much we do not know about how to resolve these problems. You will need to become your own expert about what works for you, just as many people have done before you.
You Have Options
If in your own process of change you seek outside assistance for addictive problems, there is much assistance available, and it can be very helpful. People learning to play tennis, dance, or draw often find a teacher, class, or book, and they would not be embarrassed to do so. Resolving an addictive problem can be similar.
If you seek outside assistance for addictive problems, the broad categories are behavioral treatment (residential, intensive outpatient, and outpatient), medications, mutual help, reading, and what is termed “recovery support.” These approaches can be combined.
Recent evidence suggests that behavioral treatment and AA are probably equally effective (this is one significant point about which the NIAAA document is out of date). A review of the substantial evidence supporting that idea is here:
That evidence, which is only about AA, needs to be combined with other evidence suggesting that 1) several mutual help groups (SMART Recovery, LifeRing, Women for Sobriety) are equally effective
also reviewed here:
and 2) despite dramatic surface differences these groups may work by the same underlying mechanisms
Finding assistance for addictive problems through support groups: Some may be astonished that free mutual help groups are as effective as treatment that you pay for. There are good reasons not to be surprised by this conclusion (and they may be the subject of a future blog). Of course, neither treatment nor mutual help will work unless you are dedicated to change.
US behavioral treatment and assistance for addictive problems are highly variable. Some of it is excellent, and much of it is not. The problems in the US addiction treatment industry far exceed what most people expect, and the NIAAA document does mention them. Places to begin investigating these problems are the documentary the Business of Recovery (I am interviewed in it), the book Inside Rehab, by Anne Fletcher (I am quoted in it), or a booklet I wrote, From Embattled to Empowered. You can also do an internet search for “addiction treatment fraud.” If you start treatment and it does not seem to fit you or be helping, try someplace else!
Similarly, if you do not like one mutual help group, try another. It can be beneficial to attend more than one type of group. The participants in the group may be more important than the group’s approach to change. In any mutual help group you can expect to learn coping skills and how to lead a revised life (without addictive problems), connect with others and have opportunities to give back to them, and increase your confidence about change and about yourself. Because these groups are free, and many are both in person and online, you are likely to have few barriers to participating in them. The websites of these groups often contain extensive suggestions about books, podcasts, and other sources of individual learning.
Recovery support is a range of activities including recovery coaches and sober living homes. If your life has largely become about obtaining, using, and recovering from substances, intensive recovery support may be beneficial. Typically, a professional will help guide you to relevant resources.
Some Over-arching Guidance:
Many people overestimate how much treatment to get at the beginning, then underestimate how long treatment/support would be helpful. The process of change is often more marathon than sprint. Most individuals do not need residential (inpatient) treatment (despite what your family may think). As already mentioned, starting a journal (handwritten, electronic, audio) for daily notes will help you make sense of the journey. Your friends and family can be your best supporters if you will accurately tell them what is going on both outside you and inside you (and if they are not already burned out). If they are burned out on you, get them back in your life as soon as you can. That process might take months to years. As your addictive problems fade into the background it is common to have underlying or related problems (such as depression, anxiety, trauma, etc.) become more prominent. Addressing them may become an equal or higher priority for you, and you may again be considering how much outside assistance to seek. Although you may need to expend substantial effort in the first 90 days of change, if you are successful during that time period you may then be able to ease up significantly. Nevertheless, it can be helpful to keep your journal going for months or years. As in most parts of life, persistence is crucial. If you slip, get back on track. Most people will slip, some many times. Nevertheless, most people ultimately are successful! You can be too.