July 29, 2011

Should she have gone to rehab?

"Rehab video" Winehouse
Rehab for addictions: does it work? 

It's assumed that addictions and mental health treatment require willpower and motivation to get better and that the ultimate in care is choosing to seek residential treatment: rehab. I remain skeptical of both ideas. I think it is worth asking whether "rehab" works as a treatment or is simply a resuscitation and even a way to keep the cycle of recovery and relapse active. I sincerely question whether willpower and motivation should be the price of admission to good care.
"Does overcoming addiction really depend on a person's decision and willpower to do so?"

"It's a complete myth. And it's one of the myths that has to be dispelled. One of the presumed tragedies of Amy Winehouse,—if this turns out to be related to drug and alcohol use—is that she didn't want to go to rehab. But rehab might not have been necessary. Maybe medical treatment from a personal doctor would have been an option.

The key to addiction treatment is that anyone who wants treatment gets effective treatment. And it doesn't depend on any power—higher power, lower power, willpower. It takes the level of compliance of anyone going to a doctor to get checked out.

When people realize it might be possible to get treatment without superhuman power, maybe it will make people want to seek treatment. It's a message of hope."

Another good piece on the medicine of addiction and changing professional approaches.

6 comments:

  1. Laura, is there a difference between willingness and compliance?
    Are willpower and willingness the same thing? Different?
    Rhetorical questions....
    You wrote, "the key to addiction treatment is that anyone who _wants_ treatment gets effective treatment.
    The key is the word "want."

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  2. I should clarify that that was a quote from the article linked above.

    Interesting question about the distinction between willingness and compliance! I personally believe that willingness should not be required but always welcomed and celebrated. I think because most mental illness messes with motivation we ought not fail to act or wait around for it. Treatment should always be available and family and clinicians shouldn't treat it as a willpower or motivation problem when the patient isn't well.

    I disagree with that doctor's use of the word "want" and wonder if that's what he meant, actually.

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  3. Previously I worked in a residential chemical dependency treatment center and this was a very prevalent issue. The first step of a 12 Step program is "admitted that we are powerless over mind/mood altering substances and that are lives have become unmanageable". The key word that was the frequent focus during didactics, groups and reportedly AA/NA meetings is ADMITTED. The first step is admitting and oftentimes this first step would not take place until other pre-liminary steps occurred i.e. a family member/loved one aiding the individual in getting appropriate help and treated so as to get sober and recognize the aforementioned. Other times it took legal intervention as a consequence of use or ongoing and severe medical issues. Sadly not everyone has further to drop in order to hit "rock bottom". Six feet under is too late. As a society and medical field we need to raise the bottom. One does not want to get better to start on the path of healing. Call it what you will "force feeding", "blackmail" as a 20 year old that I work with referred to it this week, contingency management as I like to refer to it or something else but as long as the illness (ED, CD, Addiction) is alive and kicking the person that we/you love and know if unable to make effective, informed, educated and sound decisions regarding their health, safety and welfare.

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  4. Good piece, though guaranteed to raise the hackles of a percentage of 12 steppers (of which I am one).

    As an atheist in a 12 step program for most of my adult life I'm use to raised hackles. ;-) Love your blog.

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  5. BTW, to me compliance is meeting the letter of the law to satisfy the expectations or requirements of someone or something else.

    As in: John was in compliance with the program requirements to get everyone off his back.

    Willingness in this context means meeting expectations or requirements because, whether you like it or not, doing it is going to be in your own best interest.

    As in: John's willingness to follow the program requirements demonstrates his desire to recover.

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  6. TdB - these are the questions we all need to be asking! I suspect there are a lot of things yet to learn about all this and continue to believe we will soon have a very different view!

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