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American Addiction Centers National Rehabs Directory

Why Healing Underlying Core Issues is Key to Addiction Recovery

Did you know that according to the 2016 Surgeon General’s report Facing Addiction in America, more than 14% of the overall adult population in the United States – that is, 1 in 7 people – will struggle with substance abuse? It’s true. Addiction is no small-scale problem.

Yet despite the fact that so many people need help in this area, the Surgeon General’s report tells us that only 10% of people with a substance addiction will receive treatment. Even those who do go to rehab may not find it helpful. Unfortunately, relatively few rehab programs actually address the root causes of addiction.

All too frequently, people take the leap and try treatment programs only to find themselves back where they started, or even more discouraged and disheartened than before.

The Current State of Addiction Treatment in America

The 12-Steps model still reigns supreme in this country. At present, approximately 74% of residential rehabs in the United States are 12-Step based, according to data from American Addiction Centers. Non 12-Step programs comprise just 26% of residential rehabs.

Millions of Americans need treatment that works, yet the 12 Steps model – the prevailing modality in addiction treatment today – has a shockingly low success rate. While it’s absolutely true that this model has helped many people over the decades, it’s also true that many others have not found success with this healing model.

What is the 12-Steps success rate? Harvard researcher Dr. Lance Dodes estimates the actual Alcoholics Anonymous success rate is between 5% and 10%. Troublingly, 12-Steps catchphrases such as, “It works if you work it,” imply that those who struggle in AA are at fault. By contrast, Facing Addiction in America emphasized the idea that no single treatment is appropriate for everyone.

12-Step groups really do work for some people, but others – particularly those with mental health concerns – require different treatment approaches. The 12 Steps simply were not designed to address psychological conditions such as depression, anxiety, and trauma. Healing these underlying core issues is key to addiction recovery.

Dual Diagnosis: The Norm, Not the Exception

It’s hard to overstate the importance of addressing the underlying core issues that drive most substance addictions. Yes, some addictions are strictly physical dependencies. For example, some people become physiologically dependent upon painkillers after surgery. They don’t have strong underlying mental or emotional health issues driving their use; they just need a medical detox to help them break free.

However, in our experience, those cases do not represent the majority of people seeking treatment for addiction today. Most people who have long-term issues with drugs and alcohol are coping with what’s called a dual diagnosis: a substance abuse problem coupled with a mental health concern.

What are a few common companions in dual diagnosis? Some of the most frequent pairings are alcoholism and opiate addiction running alongside depression, anxiety, and unhealed trauma. These untreated (or inadequately-treated) mental health issues drive substance use.

What’s Missing from Many Rehab Programs

Today, there are plenty of rehab programs that focus on physical level changes. They emphasize behavior modification and treating the symptoms: stop using drugs, form new habits, and voila! Recovery is yours.

Increasingly, some rehabs also integrate mental level work, teaching people the basics of Cognitive Behavioral Therapy (CBT). This is important because mental-level work helps people to notice their automatic negative thoughts and then change their thought patterns – and ultimately, their behaviors – for the better. It empowers people to question their judgments and self-limiting beliefs.

However, human beings function on more than two levels. We believe the best recovery programs treat the whole person by working with all four levels of self:

  • The physical level (what we do)
  • The mental level (what we think and believe)
  • The emotional level (what we feel)
  • The spiritual or Authentic Self level (who we truly are)

Often we find that emotional-level support is severely lacking in addiction recovery programs. Why? Here are a few major reasons:

  • Emotional-level work requires well-trained, compassionate counselors to guide their patients in Person-Centered Therapy, Gestalt processes, and so forth. These therapists certainly do exist, but the current demand exceeds the supply.
  • Emotional-level work is time-consuming, and often recovery programs offer only the state-mandated minimum number of professional counseling hours.
  • Emotional-level work requires real willingness on the part of the person struggling with addiction, and many people just aren’t there yet.
  • Emotional-level work involves encountering past hurts and facing up to long-buried pain, which is almost impossible to do in a non-supportive, chaotic environment (such as an overcrowded rehab center, or a program with new people constantly entering and exiting). Without a deep sense of safety, individuals will have difficulty making progress in this area.

Human Beings as a System

As you can see, the deck is stacked against emotional level work in the current rehab system. Yet in order to heal from depression, anxiety, trauma, and loss – and thus stop using long-term – people simply can’t skip out on the mental and emotional-level work.

Why not?

Think of a human being as a system. The system wants to be in sync. When an individual stops using drugs, alcohol, opioids, or other substances, they create a more positive experience on the physical level.

But if the underlying mental and emotional issues that drove the substance abuse remain unhealed, then the levels of self are out of alignment.

At that point, the individual has two choices. They can either do the work with their mental and emotional issues so that they match up with the new, more positive physical alignment … or they can start numbing out and using drugs again.

Creating a Safe Space to Heal

The good news is, some programs dare to do things differently, helping people heal and gain alignment on all levels of self.  How do they do this?

First and foremost, they create a safe space, a program free of judgment and shame. They facilitate an environment in which honesty and vulnerability are rewarded, not punished.

In our own Program, we teach people the basic skills and counseling strategies they need in order to create these safe spaces for themselves and one another. For example, techniques such as Heart Centered Listening (listening to another person without judgment) and Conscious Sharing (the willingness to speak in complete honesty) allow people to connect to one another and also to their true selves.

What Holistic Recovery Looks Like

It’s time for treatment providers, counselors, and other addiction recovery professionals to provide concrete, measurable, professional supports and help people heal. It’s time for those in the recovery industry to remember how powerful it is to help people tell their stories, and then listen closely, with compassion.

As Dr. Martha Beck wrote in her book Breaking Point: “The links between one human being and another are forged when people tell their own stories to each other, without embarrassment or fear of condemnation.”



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