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Expanding Addiction Treatment Choices in the United States

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

Beginning in the 1970s, the United States government began spending hundreds of millions of dollars each year to research addiction and addiction treatment. This resulted in a vast body of scientific literature. This research offers much guidance. Although these large sums of money for research are impressive, they are small relative to the cost of substance abuse problems in the United States.

Given the tremendous expense of this research, it is unfortunate that this information has not influenced the way addiction professionals conduct their practice in the United States. Most addictions treatment centers have not updated their treatment approach or otherwise benefited from this vast array of addictions research. Instead, they merely offer some version of 12-step facilitation. Few alternatives to this approach are offered. A 12-step approach is effective for some people. However, it is not a good match for others.

When it became evident that clinicians were not making good use of the government's investment in scientific research, the Department of Health and Human Services (a branch of the United State government) took action. The department launched a campaign to make this information more accessible and user-friendly. The Substance Abuse and Mental Health Services Administration (SAMHSA) began to create and publish treatment "kits." These kits included workbooks and other useful tools that enable clinicians and their clients to reap the benefits scientific research. This is an important first step because many addictions treatment professionals are not scientifically trained. Because of these governmental initiatives, the lack of diversity in addiction treatment is gradually improving. Still, the range of treatment options available in the United States does not yet match the diversity of individuals who could benefit from them.

The following statements clearly illustrate the importance of providing a diversified approach to addictions treatment. The National Institute on Drug Abuse published Principles of Drug Addiction Treatment in 1999, and revised it in 2009. One of the 13 principles, unchanged between editions, is: "No single treatment is appropriate for everyone (pg. 2)." Likewise, the Center for Substance Abuse Treatment (part of SAMHSA) hosted a National Summit on Recovery in 2005. The report of that conference identified 12 Guiding Principles of Recovery. The first principle states, "There are many pathways to recovery (pg. 1)." An even earlier statement (1955) can be found in a more widely read publication, the AA Big Book. "In all probability, we shall never be able to touch more than a fair fraction of the alcohol problem in all its ramifications. Upon therapy for the alcoholic himself, we surely have no monopoly" (Alcoholics Anonymous, 1955, p. ix). Fortunately, there are promising signs that the diversity of addiction treatment options in the United States is getting closer to the ideal suggested by each of these powerful statements.