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January 1, 2007
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Recovery, not just symptom management, should be treatment's goal

Treatment for chemical dependency historically (at least in those programs embracing the 12-Step tradition) has been singularly focused in terms of outcome. The goal of treatment, both short and long term, has been recovery. It's a term that may be elusive and vague, but it has been a sacred concept to those persons and organizations associated with the 12-Step tradition.

At the core of this recovery focus has been the understanding that the ultimate goal of chemical dependency treatment is greater than a focus on cravings, is more significant than a focus on the brain's pleasure zones, is about a total and complete change on the part of the person receiving treatment. Recovery has been more about an individual's total reorientation rather than adjusting brain chemistry. Putting it in more traditional language, treatment has been about a spiritual awakening.

Thus, 12-Step chemical dependency treatment has used individual and group interactions so that it is more likely that the individual receiving treatment might experience a spiritual awakening. Some of the trademarks of that spiritual awakening are that individuals come to realize that the world is bigger than them, that some force larger than them is in control of the universe—and they are not. It has been recovery, a total life reorientation, that has been treatment's ultimate goal. Treatment has been organized and designed to make it more likely, although not guaranteed, that recovery will occur. Anything short of this has been viewed as nonsuccessful treatment.

And then along came science, just as it did in the mental health arena some 25 years ago. In the past, mental health treatment was focused in the direction of helping persons achieve their potential and gain greater insight into themselves. Today the emphasis is on stabilizing persons and managing their symptoms. While the mental health treatment community is calling for a reevaluation of this approach and attempting to incorporate recovery language into their treatment, it remains to be seen whether those paying for treatment will respond!

Science is not the issue. In fact, science may well be the best friend that chemical dependency treatment has known. What is crucial is what we do with the science, how it is understood and, more importantly, how it is used by decision makers, policy makers, and those reimbursing treatment. As the science around chemical dependency has advanced, it has done so at the expense of neglecting the harder task of connecting science to recovery.

Science has given us the tools to better understand what transpires in the brain of someone with chemical dependency. Science has identified those brain areas associated with cravings and pleasure that make it so difficult for persons to experience sustainable recovery. Science has and will continue to teach us a lot, just as it has in the mental health field.

But a storm is brewing as we become enamored with science for the sake of science. Information on cravings, brain receptors, neurotransmitters, and pleasure release has a great deal to offer those involved in delivering chemical dependency treatment. But when science becomes both the beginning and the end, when science becomes more important than recovery, then we have lost our way.

Because we are impatient people, because policy makers want results today, and because those who reimburse for chemical dependency treatment (including the federal and state governments) want real outcomes for their dollars, some are tempted to believe, and in some cases mandating, that treatment's goal lies with reducing cravings and regulating and normalizing pleasure. They are settling on offering treatment, as opposed to recovery, as the final outcome.

Consider this meteorologic analogy: A deep low pressure system slowly is organizing and moving into the Great Plains, pulling up an abundant amount of moisture from the Gulf Coast and waiting to collide with cold air in the Northeast—and then, bingo!, a blizzard. Just as slowly, and just as unobserved by most, an emphasis on treating the symptoms of chemical dependency has become the object of treatment, as opposed to offering treatment that makes it more likely that persons will experience sustained recovery.

We need to demand that recovery, properly understood, must be the outcome and the goal of chemical dependency treatment. Persons with the disease of chemical dependency deserve to receive better than symptom reduction. They deserve to receive treatment that makes it more likely that they will participate in sustainable recovery.

Ronald J. Hunsicker, DMin, is President and CEO of the National Association of Addiction Treatment Providers. He is also a member of Behavioral Healthcare's Editorial Board.