Slowly but surely, the tides in mental health treatment in America are turning. Though when it comes to substance use disorders, there seems to be a driving force needed to push the system in the right direction. In an effort to right the course, last month the Center for Optimal Living, and its Boston based partner Ellenhorn, joined with renowned Canadian physician Gabor Maté for a groundbreaking daylong conference, Shifting the Paradigm of Addiction: A Sea Change…A Change in Seeing at the New School in New York City.
As pioneers in the harm reduction movement, Dr. Tatarsky, Dr. Ellenhorn, and Dr. Maté pointed to the glaring discrepancies in addiction treatment. Dr. Tatarsky cited research from the National Survey on Drug Use and Health that demands serious attention:100 million Americans struggle with problematic substance use, while only 2 million are accessing addiction treatment. He challenged the dominant brain disease model and posed a powerful indictment of abstinence only approaches by asking, “Might the dominant addiction models be contributing to the current opiate overdose crisis?”
All three addiction experts spoke to the lack of understanding on the role of traumatic experiences which later contribute to problematic relationships with substance use. According to Dr. Maté, prevention of addiction must become an integral part of early childhood development, by starting as early as the first prenatal visit. “Early childhood experiences of coping with stress become the very things that contribute to the development of pathologies,” he said, emphasizing the critical role of adverse reactions to early life trauma.
Dr. Ellenhorn criticized how despite increased awareness in the underlying effects of trauma in addictions later in life, dominant treatment models often blame the person suffering for not accessing care. “Trauma becomes the new branding. If you don’t come to treatment you’re not only irresponsible for not taking care of your addiction, but you’re also irresponsible for not taking care of your mental illness, and your trauma,” he said, lamenting this attitude.
Though for decades the harm reduction model has been embracing a more holistic approach to treating people with substance use disorders, the dominant treatment models actually contribute to trauma when people try to access care. Dr. Tatarsky mentioned two cases of patients he has treated who both confessed how they were either refused treatment because they wanted to stop using substances they had a problematic relationship with, but not one they felt they had a healthy relationship with, or they only came to him because they knew that a harm reductionist wouldn’t ask them to stop using before beginning treatment. He pointed to the need to embrace a patient-centered approach, honoring their goals for treatment and not placing demands on them. “We’re talking about a group of people who don’t want abstinence and a treatment system only offering abstinence as a goal, with very low rates of retention and abstinence,” said Dr. Tatarsky.
The conference signaled the need for more providers to embrace harm reduction over abstinence only treatment, and how this approach is gaining support as the gaps in the dominant models are widening. Tom Insel, former Director of the National Institute of Mental Health, blasted the state of psychiatric treatment when he asked, “Is there any other area of health care that would tolerate this low level of quality or quality control?” The pioneering work of Drs Tatarsky, Ellenhorn, and Maté over the last several decades have righted the course of addiction treatment, and now they look to shift the paradigm by citing their successes and teaching their colleagues and allies.
Kevin Franciotti is a graduate psychology student and writer based in New York City. He regularly covers topics related to psychedelics, harm reduction, and addiction. His writing has appeared in New Scientist Magazine, Reason.com, VICE, and The Huffington Post. For more, visit kevin.franciotti.net.