Why substance abuse treatment is never 'one size fits all'

Few people are untouched by addiction. It cuts across age, socioeconomic status, gender and race, and has been with us for all of recorded history. 

Whether it be opioids, alcohol or other drugs, millions nationwide have succumbed to addiction and need help. Here in Massachusetts, there were almost 67,000 admissions to substance abuse treatment programs in 2019. 

Treatment can be challenging, though, as people entering recovery often need comprehensive and multifaceted care. Destinee Lucier, assistant clinical director at Lake Avenue Recovery and Addiction Treatment Center in Worcester, joined All Things Considered host Arun Rath to break down what evidence-based treatment is available. What follows is a lightly edited transcript.

Arun Rath: Is addiction treatment always complicated?

Destinee Lucier: Yes. So with addiction treatment, there is no “one size fits all” model, specifically because addiction treatment is typically coupled with mental health symptoms and, frequently, trauma. For addiction treatment, we look at the individual as a whole and not just the substance of choice.

Rath: For different kinds of substances, does treatment differ depending on the type of substance?

Lucier: Absolutely. So different substances will chemically have different effects on mental health and the brain as a whole. Based on the substance of choice, we are looking at different modalities that we can use for them. But again, we look at the individual as a whole person and not just solely based on their addiction.

Rath: Let’s focus on opioids because, obviously, that is the most horrendous problem right now. How is that multifaceted approach applied in the case of opioid addiction?

Lucier: So, what we’re looking at and what we’ve seen as best practice in dealing with opioid addiction and addiction as a whole is a multifaceted approach—not just the individual talk therapy that most people commonly think of when they think of substance use treatment.

It’s also a lot of group therapy. Group therapy is so healing and important because, typically, with addiction, the addiction separates the individual from a community, so with group therapy, they’re able to be with individuals who are also struggling with the same things, and they’re able to heal together.

We also couple that with family therapy because, as we all know, addiction isn’t just dealing with the individual but the family unit as a whole. And community engagement, getting them back to the community—whether that be church, different meetings, joining a running group—something that they can look forward to that raises the dopamine in a healthy way instead of introducing substances in order to do that.

Rath: Your center uses both cognitive behavioral therapy—or CBT—and dialectical behavioral therapy. Tell us about how they work in the treatment of addiction.

Lucier: On CBT, we look at shifting thoughts and behavioral patterns. The way that we do it specifically at Lake Avenue Recovery is we do a lot of mindfulness techniques and a lot of cognitive restructuring.

Here, we believe in a holistic approach, so that includes acupuncture, massage therapy, meditation, things where they’re able to look at their own thought patterns and be able to change and restructure them in a healthy format.

Rath: So similar to the way someone might use CBT for anxiety, you’re teaching them different mental habits.

Lucier: Absolutely. And also, being able to identify what negative thought patterns even are. Typically, we have individuals that come in, and they believe that their thought patterns are healthy; it’s the way they’ve been thinking their entire life. So we want to empower them to realize that maybe their thought patterns are negative and contributing to the different behaviors that we’re seeing, including using substances, in order for them to change their narrative a little bit.

Another technique we frequently use with CBT and DBT is narrative therapy, which empowers the individual to rewrite their story because, frequently, they are the villain of their story, right? So, in order for them to take back a little bit of their own life and take back their narrative to frame it in a more positive light, to make them happy and more motivated to have lasting recovery.

Rath: Do you have a sense of how much farther this really comprehensive, multifaceted approach tends to get people than just taking one of these modalities?

Lucier: I think it helps people to see themselves as a whole. With addiction, it’s not just a mental disease; it’s a physical component as well. So, adding things such as Reiki and physical movement in order for them to move their bodies in a healthy way, on top of looking at the cognitive restructuring and introducing the community back into their lives.

What I’ve found is that people are able to recognize themselves as a completely new individual. It’s not just rewriting a chapter in their story—it’s a completely different book. With these tools, they’re able to not only teach that for themselves and move forward in their recovery, but it affects everything in their lives, whether that’s work or relationships with themselves and others. I think using different modalities and different techniques is a way for us to best incorporate different areas.

Rath: One thing we do know with traditional approaches is that the relapse rate is terrible. The National Institute on Drug Abuse reports around 40 to 60% of individuals in treatment for substance use disorders will relapse. Does the multifaceted approach make relapse less likely?

Lucier: I do believe so. Relapse can—and does—happen, but I think using more of a multifaceted approach and, again, incorporating the community into this is huge because, eventually, they are going to leave treatment. So, it’s also giving them tools and skills that they can use for the rest of their lives, not just when they are in a treatment facility.

The hope is that I eventually work myself out of a job, that with the tools that I’m working with the individual with and that the treatment facility is working with them with, they’re able to utilize them on their own in order to sustain their recovery, and that they’ve built a community surrounding them where if they are struggling, having increased cravings or they’re just having a plain old bad day, they’re able to reach out to that individual on top of the skills that they’ve learned.

Rath: It’s nice to think about you, as you put it, working yourself out of a job. But for where we are right now, I have to imagine that the demand is pretty high. Can you talk about being able to get the kind of treatment that you’re talking about to everyone who needs it?

Lucier: Thankfully, in the Worcester County area, there are so many different facilities out there and different resources that we have due to this high demand. That is one positive thing that we have right now.

For us, at Lake Avenue Recovery, we have people out there that would be able to get somebody in the right level of care, because, maybe right now, partial hospitalization and intensive outpatient is inappropriate. Maybe this person needs detox. I really recommend an individual going through all of the levels of care, because the longer someone is in treatment, the more likely they are to be able to sustain long-term recovery.