Addictions Treatment – What it is, and what it isn’t

This is the first of two articles regarding information about treatment -- what it is and what it isn't' and the different formats that describe treatment. The series is written by East Kootenay Addiction Services' Executive Director, Dean Nicholson. The article below does not necessarily reflect the views and opinions of East Kootenay Addiction Services. 

Over the past number of months there has been a lot of media focus on the fentanyl crisis in B.C.  Many of the stories have talked about the lack of treatment, or the wait for treatment, often with the subtext that if people could have gotten treatment than the problem would have been solved.  But what exactly is ‘addictions treatment’ and how does it work?

We typically think of ‘treatment’ as some kind of intervention that brings about a ‘cure’ or an end to the problems we’ve been having.  Antibiotics are a good example.  We are sick with an infection, we do a treatment of antibiotics which kills the bacteria, and in a few weeks we are back to our normal health.  Dealing with addiction problems is very different.   Addictions treatment does not provide a ‘cure’, nor does the problem go away.  ‘Treatment Centers’ are programs where individuals typically stay for 2-3 months.  These programs provide structure, opportunity for group and individual counselling and support, education, safety, regular food and social connection.  But despite what certain programs might say, they cannot provide a ‘cure’ to addiction.  Any program that promises to cure someone of their addiction is selling a bill of goods.

Why isn’t there a cure for addiction or substance abuse?  Addiction and substance abuse are basically brain disorders.  People use substances for a variety of reasons, but one of the main reasons is because they like the way substances make them feel, at least in the beginning.  Our brain is designed to turn behaviours that we do repeatedly into habits.   The thinking part of our brain doesn’t have to be involved as much, and a deeper part of our brain controls the behaviour.  Think of driving a car – when we first learned we had to pay attention to every single thing we had to do – braking, accelerating, signaling etc.  After a few months we could do most of that without actually thinking about it.  Much of driving had become habitual.  The same thing happens when we use substances.  If we use a substance enough times our brain develops a habit for using, or for using to feel a certain way.   We don’t have to think about how to use, a deeper part of the brain makes it happen.   If we use certain substances long enough, the brain actually goes through physical changes, so that the substance use is regarded as essential to feel a certain way.  As a person progresses from social use to habitual use to addicted use, the amount of choice and control that the person has over using decreases.  When a person has developed an addiction, there is a part of their brain that will control their behaviour and compel them use the substance even when they know it is harming them or that it could kill them.  

The good news is that the brain is remarkably able to rewire itself.  New habits can be learned to replace old harmful habits.  But just as it takes time to develop a habit or an addiction, so too does it take to develop new ways of behaving.  The reality of addiction is that there is no simple way to change a brain.  Even when people want to stop using recovery is a long-term process, often with many setbacks, that requires a lot of effort.  Factor in that many people are ambivalent about changing or stopping their use, and the process becomes even more difficult.  Difficult doesn’t mean impossible, but it does mean that there is no simple ‘cure’, no ‘treatment’ that can be imposed on someone that will make their brain automatically change.  

As a culture we have come to believe that there should be quick fixes.  We don’t like to be uncomfortable or to suffer.  We have a society built around instant gratification.  This expectation is part of what fuels people getting in to trouble with substances, and then it becomes part of what fuels people having unrealistic expectations about recovery.  Does this mean there is no hope?  Absolutely not.  Every day at East Kootenay Addiction Services we see people who are learning to reorganize their lives, develop new skills and move away from addiction towards happy and fulfilling lives.  And what makes those people successful?  They have come to recognize that there isn’t a quick fix.  Life requires ongoing effort and focus, whether that is recovering from an addiction, having a family, or building a career.  Accepting that recovery is a process and not a cure has allowed those people to work realistically and productively towards better lives.