Myth #1: “They have to want treatment to benefit from it”
Truth: In most cases, the impact SUD’s have on the brain make it unfair and unlikely to expect them to want treatment. Think of asking people to want radiation, chemo, or surgery as a qualifier for getting it or benefitting from it. *Living a life of long-term recovery is different.
Like most myths surrounding SUD’s, this is dangerous and keeps families and loved ones in the disease progression. There are a couple of pieces to unpack with this.
We know that someone’s attitude towards treatment has much less impact early on in the treatment process than basic compliance does. That is to say, an individual’s compliance with their treatment plan is a better predictor of outcomes than their attitude towards their treatment plan. To put it simply, here are two scenarios – someone expresses high motivation but lacks follow-through when it comes to their treatment recommendations OR someone strongly dislikes treatment but does what is advised by their professional team. You can see how in this instance, it makes sense that the attitude matters less than the participation in a treatment plan to address the disease process.
The impact that SUD’s have on brain processes make it almost impossible to access what you are hoping they will access. Without diving into the neurobiology of this too much – their limbic system (responsible for survival, avoiding pain/discomfort, and physiological drives) is driving the majority of their behavior. What you are hoping for is them accessing the part of their brain – the prefrontal cortex – that is being overridden by the disease process itself. That is the part of their brain that would help them identify and weigh risk, think about long-term consequences, delay gratification, and make decisions based on logic/reason.
Add to the above, by understanding that it would be completely unnatural to want SUD treatment. Often, the treatment warranted is both intense and long-term. We don’t apply the same expectations of patients with other chronic and progressive illnesses – I certainly don’t expect a patient with diabetes to want insulin and that be a prerequisite to receiving it or his/her body benefiting from it. I don’t expect anyone to want treatment, it’s just a bonus if they do. Often, I’m saddened by a client that wants treatment because it typically means their pain has been so overwhelming.
Here’s the thing, in my opinion, it is totally natural for a patient to bargain for a less rigorous treatment plan – the same way I’d ask if I can do something less invasive and still eradicate cancer cells – “Is there a way to do this with less impact? Less pain? Less money? Less discomfort?” To me, those are all normal questions and shouldn’t be seen as treatment resistance, but rather bargaining – which I find totally natural. Like with any other disease, we explain why the less rigorous treatment is not the effective treatment threshold to address the symptoms we see ..we don’t tell people to come back when they want it more or when their disease has progressed.
We have to banish this myth – it is based on ignorance of factors that affect treatment outcomes, it isn’t compatible with understanding the disease/medical model, and most importantly – it keeps families and identified patients from accessing treatment.
*I do have to add the disclaimer to the typical pushback I get on this – I’m talking about entering and early stages of treatment. If someone is to live a life of long-term recovery and thrive outside of treatment structure, their motivation will likely need to shift internally as they begin to feel the positive impact of recovery. It’s difficult to remain in recovery out of compliance only but the initiation of the recovery process is what we are addressing here.