Did You Fail Treatment, or Did Treatment Fail You?

By The Fix staff 08/16/21

When those struggling with addiction or their loved ones call treatment centers, they are often oversold by the treatment professional or facility. 

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When patients say "I failed treatment," often it's the treatment that failed them.

The inability to complete treatment for addiction or remain sober after treatment can have a damaging impact on the individual seeking recovery. Failure, for whatever reason, in recovery can leave those struggling with addiction with a host of negative emotions and thoughts (also known as "stinking thinking" ): people might think that because they failed drug treatment, they are also incapable of succeeding in other areas of their life. They might also start believing that recovery programs are not a solution to addiction and there's no point in trying other treatment programs. Such thoughts can place an individual fresh from recovery in a precarious position that, in many cases, can lead to relapse and further danger to their physical, mental, and emotional wellbeing.

One significant component of the unsuccessful result of those in treatment is the overinflated promises attached to it. When those struggling with addiction or their loved ones call treatment centers, they are often oversold by the treatment professional or facility. 

Patients may believe that treatment is a "golden ticket" to instant sobriety, mental health healing, social rehabilitation, and more, without further work on their end once they leave the facility. Usually, this inaccurate message is not delivered with malicious intent on the part of the treatment provider, but more often than not, due to a lack of complete information and a need to affect positive change in a manner that may not be immediately available to both provider and patient.

"I believe it's really important for us as treatment providers to be realistic about what we can and cannot offer," says Clare Waismann, RAS/SUDCC and founder of WAISMANN METHOD®, an opioid treatment program and rapid detox center, and Domus Retreat on a recent episode of the Waismann Method podcast. "When patients say, 'I failed treatment so many times,' more often [than not], the treatment failed them. They failed the treatment because they and their families were promised that their personalities would change, their lives and their realities would change, and their mental health issues would be solved. So I think it's really important [for] treatment providers to tell [patients] exactly what you will be provided, exactly what your ability is as a provider, and what their responsibility [will be] not only during treatment, but after treatment."

What creates these inaccurate narratives between patient and treatment professional? The issue is often due to a lack of clarity regarding each individual's unique needs and the scope of what a recovery treatment can actually provide. Outlining the limits of a program and managing realistic expectations can be vital to connecting a patient with subsequent success. "My goal is to give people real, personal insight into some of the specific things that are causing [the] compulsivity," says David Livingston, LMFT and psychotherapist at Waismann Method, who joined Clare on the podcast. "And then we try to put together a plan that will address that. That often includes continued therapy, and we go through the positives and negatives­­­ of that. I'll even talk about the 12-step [programs]. I try to give them a realistic understanding of what treatments, the difficulties [that are inherent] in them, and what [they] need to look for in terms of finding and sustaining a successful treatment."

Another stumbling block for treatment professionals is the "one-size-fits-all" theory regarding recovery. For Waismann, this idea that one single recovery track applies to all patients is a "red flag." As she notes, "You're not treating the condition, you are treating a patient. Not every treatment is effective for everybody. People tend to push patients to receive what they have to offer. That's a mistake. It's really important to hear the patient's history and needs, and make sure that they – and you – know that there are different options."

Hand-in-hand with this peg-and-hole approach is the idea that treatment will completely "cure" the patient. "That's impossible," says Waismann, who notes that this particular perspective will always lead to unrealistic expectations that prove disastrous for patients and professionals. "Individuals often feel unseen, when professionals focus on a certain (addiction) diagnosis." she says.

As patients and families search for a solution in the face of an often challenging and intense situation, they lack an understanding of their condition, which causes them to lose the ability to distinguish credible from unreliable sources. Additionally, vulnerable situations lead people to seek hope or the impossible-to-guarantee promise of a positive treatment outcome, however unlikely those outcomes may be. 

"If you're just getting pushed into things that don't make sense to you, that don't feel helpful to you, and that you're resenting, that will drive up your frustration," adds Livingston. "I don't see that as productive treatment."

Livingston also suggests that the failure to provide a complete picture of recovery expectations – which sometimes involves challenges after treatment – can also lead to inflated expectations. "Compared to most [facilities], we have a shorter program, because we get people detoxed quicker, and they feel better faster," he says. "That is really the strength of our program. We do it to try and minimize the length of suffering involved – a suffering that I see as neurotic suffering because it does not help you grow. It's just suffering to get something done that needs to get done."

After the detox, the next level of work begins, and it's here that Livingston notes that attention and flexibility can produce actual results. "We go a step at a time addressing the most relevant needs as they surface," he says. "If you understand what those needs are, and you're not loading them up on your own program, and you're talking about the limitations [of the program], it's a great comfort – it actually aids in the treatment. 

"What's therapeutic for them is that patients actually feel what it means to have their needs met and to have a handle on their lives. But [as a therapist], you have to do your part and delineate and specify what exactly [needs to be done], and then make sure it's getting done."

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