The new treatments for addiction

Lisa Fields

As we ever strive to further understand the disease better, new help has emerged for the addicted and for their loved ones

When Hollywood actress Claudia Christian was in her twenties, she had an unremarkable relationship with alcohol. By her late thirties, however, she was drinking too much and had become fixated on alcohol, craving it even when she abstained for months at a time. She tried Alcoholics Anonymous, psychotherapy, hypnotherapy and inpatient rehab centres, but nothing helped.

“My parents didn’t know what to do,” Christian says. “I got constantly bombarded with ‘Why can’t you just stop?’ Nobody could understand [that I was] being consumed by a compulsive disorder.”

Claudia Christian battled alcoholism for years before she found the right programme for herself

While her family judged her and many friends abandoned her, Christian’s best friend, Holly Evans, remained supportive.

“She was basically just trying to hide it all the time,” Evans says. “Sometimes she wanted me to be like a policeman, and I was—then in the glove compartment, [I’d find] a bottle of something. [And] I thought, Well, maybe there’s something I can do to fix the situation. [But] nothing that I did worked.”

 

There are currently 32 million Europeans with alcohol dependence, 1.3 million high-risk opioid users, and millions more use cocaine, marijuana and other illicit substances. About 1.2 million people in the EU received treatment for illicit drug use in 2017. Much of that treatment relied upon traditional programmes such as AA.

But the time to rely on decades-old models is over. Today, newer, research-proven treatments are available, offering more, and more effective, help for the addicted and their family members and friends.

“They’re using stuff that was done in the 1940s, 50s and 60s, for crying out loud,” says Robert Meyers PhD, Associate Research Professor Emeritus of Psychology at the University of New Mexico’s Centre for Alcoholism, Substance Abuse and Addictions. “Do you go to a doctor and say, ‘Operate on me the same way they did in 1950?’ No, you wouldn’t. That’s crazy.”

"We are dealing with a chronic relapsing disease. We don't give up on people"

 

New thinking

In decades past, if your relative had an addiction, you were instructed to offer harsh words with “tough love” to make them quit. They were expected to muster willpower to stop drinking or taking drugs and abstain indefinitely. In reality, harsh words could lead to arguments and estrangement. When someone relapsed, they were considered too morally weak to combat addiction, and relatives often blamed themselves because their efforts didn’t help.

Today, addiction is recognised as a disease, and treatments include medication and newer thinking. Opioid-substitution treatment is the most common treatment for opioid addiction in the EU, because it’s proven to reduce harm and the risk of overdose. And it also helps to reconnect substance abusers with their families. Relapse is recognised as part of addiction, so people aren’t chastised; they’re encouraged to continue treatment.

“We assume that we are dealing with a chronic relapsing disease, so we don’t give up on people,” says Dr João Castel-Branco Goulão, director general of Portugal’s Addictive Behaviour and Dependency Intervention Service in Lisbon. “If they don’t achieve success in the first event or the second and again, there’s no limit.”

Relatives are encouraged to provide love, support and kind words, not harsh criticisms, since they’re dealing with an illness, not a moral failing.

“Family members and friends play an important role in the decision to enter treatment,” says Dr Dagmar Hedrich, lead scientist in harm reduction with the European Monitoring Centre for Drugs and Drug Addiction in Lisbon. “Self-referral, including referral by family members or friends as opposed to doctors, continues to be the most common route into specialised drug treatment in Europe,” she says. “It accounted for more than half of those entering such drug treatment in 2017.”

Different programmes offer valuable knowledge to family members who want better interactions with, and greater understanding of, relatives with an addiction.

“Nobody wants to become an alcohol abuser, or a heroin abuser—they just don’t know how to stop,” Professor Meyers says. “We can help the family member learn different ways to interact.”

The following treatments may help you help loved ones.

 

CRAFT

The Community Reinforcement and Family Training (CRAFT) was created by Professor Meyers. He was inspired to make help available to the partners of addicted individuals while he was doing couples counselling; he realised that women had some influence over partners who drank or used drugs, and he wanted to leverage that sway to help those people enter treatment.

"Today my son feels secure and trusts me because I don't blame him"

CRAFT teaches you to interact positively and empathetically without shouting or judging, to provide positive reinforcements for sober behaviour, to ignore negative behaviour and to suggest treatment when your relative would be the most receptive.

If your husband comes home sober, spend quality time with him. If he comes home drunk, says Professor Meyers, author of Get Your Loved One Sober, "We teach them to say, ‘I’m glad you’re home safe. I love you, but I feel bad when I see you like this, so I’m going to go to bed, and maybe we can talk tomorrow.’ And just kind of walk away.”

Family members using CRAFT get loved ones into treatment 65 to 75 per cent of the time, compared to 12 per cent for AA participants, according to Professor Meyers’ research.

CRAFT also addresses the low self-esteem, anxiety and depression that many people feel when relatives drink or use drugs. You realise that your relative’s addiction isn’t your fault. You’re encouraged to live life more fully, doing things that you enjoy.

“Under CRAFT studies, we found even a year after family members had been through the programme, they lowered their depression, their anxiety, their anger,” Professor Meyers says.

There are trained CRAFT therapists in Belgium, the Netherlands, Germany, England, Scotland, the Republic of Ireland, Wales and the Scandinavian countries.

 

SMART Recovery

L Hein, 50, of Søborg, Denmark, felt like a failure when she learned that her then teenage son was using marijuana. Both her father and ex-husband had been drug users, and she hadn’t been able to prevent her son following. She says, “I couldn't manage it. I got very ill because of all the stress, and I lost my job and I needed to get help.”

She found SMART Recovery (Self-Management and Recovery Training) where the Family and Friends meetings spoke to her. The program combines CRAFT with SMART Recovery, which teaches relatives to stay motivated, cope with negative feelings and live a balanced life, based on research-proven principles like cognitive behavioural therapy (CBT) and motivational enhancement therapy. Relatives learn to apply those lessons to their lives.

“Relatives don’t know what to do, so they scold people, they beg, they try anything to help them get out of the problem, but it’s often contradicted,” says Bendt Hansen, chairman of SMART Recovery Denmark in Copenhagen. “Family and Friends helps them to get out of the habit of playing policeman.”

Hein learned to manage her anger and to speak calmly to her son. Eventually, he saw a psychologist about his drug use. Today he’s 23, works full-time and sees his mother regularly.

“We have a good relationship,” she says. “My son trusts me—he feels a certain security with me today, because I don’t blame him.”

SMART Recovery International is an organisation of support groups that helps people overcome any addiction, as well as provide support for family members and friends. They can be found in centres across across Europe.

 

5-step method

After researchers in England in the early 2000s studied the experiences of family members whose relatives had addiction, they created the 5-Step Method to help them cope with stress and receive support. A trained professional listens to what you’ve endured because of your loved one’s habit, provides relevant information about the addiction, helps you figure out ways to better cope, discusses available social support and decides whether you need additional help.

“Often, family members report using less emotional confrontation, having increased awareness of the relative’s misuse problem and of their own life and needs,” says Alex Copello, PhD, Honorary Professor of Addiction Research at the University of Birmingham and one of the 5-Step Method’s creators.

"The stigma of addiction still stops individuals getting the help they need"

The method may help lower your stress levels, improve your relationship and guide your relative towards treatment.

“We know from our research and clinical experience that family members can influence the process, for example by encouraging the person to seek help earlier,” Professor Copello says. There are programmes in England and Ireland.

 

ContrAl and Sinclair Methods

ContrAl Clinics combine the Sinclair Method—the use of medication to counteract cravings for alcohol—with cognitive behavioural therapy to change drinking habits. The aim of the programme isn’t abstinence but getting people to drink less, and 78 per cent of people succeed. People are prescribed an opiate-blocker and are advised to take it before drinking alcohol, because it dampens the desire to drink to excess. They also see a doctor and psychologist eight times over six months to learn strategies to help them drink less. People drink more responsibly and lead more productive lives.

“It’s much easier for the customers to engage in a treatment method like ours when they know that, ‘I don’t have to quit completely just now,’” says Jukka Keski-Pukkila, CEO of ContrAl Clinics in Helsinki.

Your loved one may bring you to one or two sessions so you can learn how to be supportive and why abstinence isn’t necessary.

“The traditional way of thinking, when you are talking about alcohol-use disorder, is so deep in people’s minds that they can’t think that it’s possible to just reduce and get it into control,” Keski-Pukkila says. “We try to teach the loved ones to support the patient as much as possible and not to judge.” ContrAL clinics are found in Finland, Canada and the US. They offer their services to people from all over Europe, in Finnish, English and Russian.

 

Plenty of research focuses on addiction, and a number of alternatives to 12-step programmes are available, but millions are still affected by addiction.

Experts recognise addiction as a disease, yet longstanding social stigma keeps many people from receiving the support and treatment they’d get if they had cancer, diabetes or another favourably viewed condition, partly because society tends to blame people with addiction.

“There are many lifestyle components with, say, type 2 diabetes that have to do with controlling your diet, testing regularly, getting enough exercise—and there is a lot of non-compliance, which leads to bad outcomes medically,” says Elise Schiller, the US-based author of Even If Your Heart Would Listen: Losing My Daughter To Heroin. “Yet we would never say, ‘You’re not worth treating,’ or, ‘This is your fault.’”

Experts believe that greater access to programmes serving people with addiction and their relatives could impact the effect of addiction on individual families and society as a whole.

“The issue with the alcohol and drug problem around the world is that we don’t have enough resources to help them get sober, to hire more therapists and train them in the positive programmes,” Professor Meyers says.

Increasing the reach of programs aimed at relatives would help, but so would policies recognising that people relapse or may not be ready to quit, and which offer safe consumption sites with clean syringes and medical professionals who can reverse overdose or recommend treatment. Offering medication-assisted treatment to those who are ready would also be helpful.

 

Ten years ago, Claudia discovered the Sinclair method and used prescription medication to reduce her cravings for alcohol. Today, she abstains from alcohol but knows that she can take an opiate-blocker before drinking, should she desire that. She now runs an international nonprofit organisation to publicise the effects of the Sinclair method, and her relationships with her parents and her best friend have improved.

“I don’t feel like I have to be the police anymore,” Evans says. “She’s taking better care of herself, [and] she’s got her [act] together.”

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