Addiction & The New Decade

by Thaddeus Camlin, Psy.D.

Milestones are opportunities to reflect and refine.  Each New Year many resolve to make important changes, and such resolutions can carry even more weight when years stack up and we move into new decades and new centuries.  The 21st century has already seen significant change when it comes to understanding and treating addiction, much of which has been related to broadening access to multiple pathways of treatment as the tyranny of abstinence-only slowly and steadily decays.  As we move into the 2020’s, it’s worth considering what positive changes the decade will bring as we continue to improve the treatment available to people who aim to change addictive behaviors.

One significant change to understanding and treating addiction that will continue to gain momentum in the 2020’s is the continued, slow death of prohibition.  The failure of alcohol prohibition was a welcomed change to failed policy in 1933, at least to those who thought critically on the matter.  The next major, positive step towards ending the failure of prohibition wouldn’t come until nearly 80 years later when Washington became the first state in the US to legalize recreational cannabis.  Currently, 11 US states have legalized recreational cannabis.  Decriminalization is the first logical step towards a practical, sensible drug policy that ends the tragic legacy of mass incarceration.  In the 2020’s we will hopefully see the federal decriminalization and, ideally, legalization of cannabis.  Some US cities already decriminalized plant medicines like ayahuasca and psilocybin, so national movement towards decriminalizing psychedelics will also be an area of progress towards ending harmful, prohibition-based drug policies that only make addictive problems more likely.

The 2010’s saw significant progress in improving the research and understanding of addiction.  Strong movement away from a strictly neurobiological, disease model of addiction was seen in the past decade, a prominent example being the New England Journal of Medicine publishing an article highlighting how addiction is an example of normal, healthy learning rather than pathological disease.  Strong evidence continues to pour in showing the efficacy of harm-reduction approaches.  The 2020’s will see great progress in advancing medication-assisted treatments and methods that help people moderate addictive behaviors, with such approaches spreading out beyond opiates to help with addictions to other substances as well (like methamphetamines).  Tough love, confrontational approaches like the ones sensationalized on misinformed media programs like the TV show Intervention will continue to fall away as more effective, compassionate, evidence-based approaches like CRAFT continue to gain prominence.  The current difficulty in accessing treatment from anything other than a 12-step, abstinence-only modality will decrease dramatically in the next 10 years.

Lastly, in addition to progress towards ending prohibition and improving research and theory on addiction, addiction treatment will advance greatly in the next decade.  There will be increasing access to self-empowering peer support groups like SMART Recovery to help those who do not respond well to a powerlessness-based approach.  Clinicians will continue to receive improved training in the area of addictive problems so they will be better equipped to do more than refer people to 12-step groups and 30-day rehabs.  Technological advancements will bring exciting areas like virtual reality and artificial intelligence onto the main stage of addiction treatment.  Psychedelic-assisted approaches garnered quite impressive research results in the 2010’s, and with the opening of the Johns Hopkins Psychedelic Research Center, compounds like psilocybin, ayahuasca, and ibogaine will finally receive thorough scientific investigation for various ailments, including addiction.  Application of psychedelic-assisted treatment to addictions will, based on research results to-date, greatly improve treatment outcomes.

As is often the case for those who seek positive change, the pace is of change regarding the research, theory, and treatment of addiction is frustratingly slow, but the results make the effort worth it.  In the 2020’s we are likely to see great progress towards ending prohibition and the mass incarceration that stems from it.  In the 2020’s we are also likely to see increased access to self-empowering, harm-reduction methods of treating addiction, as well as a growing understanding that addiction is much more than just a neurobiological disease.  There will be much work left to do come 2030, and it will be exciting to be a part of addiction & the new decade as we all help to propel important advancements to the current paradigm.