Dispelling the Myth of Addiction Treatment Providers as the Gatekeepers of Recovery
There is a long held assumption among many that in order to recover from a substance use disorder, one must seek professional treatment.
In this editorial, an expert Keith Humphreys challenges the myth that addiction treatment professionals are the “gatekeepers” of recovery…
WHAT PROBLEM DOES THIS STUDY ADDRESS?
Professionally provided substance use disorder treatment is the focus of what author Keith Humphreys refers to as the gatekeeper myth.
The gatekeeper myth implies that the path to recovery from substance use disorder exclusively goes through a highly trained addiction treatment specialist.
The gatekeeper myth:
fails to acknowledge the path of “natural recovery” (i.e., recovery from substance use disorder without formal treatment and/or recovery support services) &
overlooks the role of mutual-help groups, recovery community centers, recovery homes, recovery schools, pastoral counselling, & community supervision programs operated by the criminal justice system in supporting recovery
The myth creates a harmful narrative that substance use disorder treatment is responsible for all the good and bad related to harmful substance in the US.
Ultimately, it can undermine the belief that individuals can capitalize on the resources already available to them to initiate or sustain remission.
WHAT DID THIS STUDY FIND?
The author explains that people with a substance use disorder can change for many reasons outside of professional treatment. He frames substance use disorder as a chronic behavioral health problem dynamically influenced by an individual’s motivation, skills, choices and environments.
For example, the influence of individual decisions should be considered as part of the process of how people with a substance use disorder change. Many people are able to capitalize on their existing resources to implement strategies that are often used in treatment as well. For many years, untrained and untreated individuals with a substance use disorder have practiced strategies to relax and have fun, created a social circle of people who do not use alcohol and other drugs, made concrete plans to change, and set limits on their behavior.
Non-professional recovery support services have facilitated change from a substance use disorder for many years and are often thriving both nationally and internationally, including mutual help groups, recovery community centers, recovery homes, recovery schools, pastoral counselling, and internet based support groups. Community supervision programs operated by the criminal justice system are among the most effective strategies to promote alcohol and other drug abstinence. These programs include HOPE probation and 24/7 Sobriety, which use drug testing and contingency management principles to require that criminal offenders do not use substances or, “face swift, certain but modest consequences (e.g., one night in jail).”
WHY IS THIS EDITORIAL IMPORTANT?
In light of the reality of how people actually change substance use when they do not receive treatment, the author proposes the importance of letting go of the gatekeeper myth and embracing a message that more accurately reflects the breadth of internal and external resources individuals rely on to recover from a substance use disorder, certainly including, though not completely limited to, professional services.
This is accomplished by promoting a menu of recovery pathways that are supported by scientific research, even if their source is not from addiction professionals.
- The most important limitation of this editorial, as with any editorial, is that it represents the opinion of the author and the conclusions are not designed to be derived from a single empirical test.
- This editorial cites empirical research when relevant to support or clarify a position to the reader, however, is not intended to be a comprehensive review of the literature.
The next steps will require a plan for dissolving the gatekeeper myth. Embracing a research agenda that seeks to understand all pathways and mechanisms of recovery, regardless of professional involvement, will help change the narrative around a single path to recovery filtered only through the professional treatment system.
- For individuals & families seeking recovery: There are many pathways to recovery that do not incorporate professional treatment such as mutual help groups, recovery community centers, recovery homes, recovery schools, pastoral counselling, and internet based support. It is important to remember that individuals use professional treatment as a pathway to recovery, or a combination of professional and nonprofessional services. If you or a family member is suffering from a substance use disorder, know that many pathways to recovery have worked for countless people, and ultimately recovery is the most likely outcome.
- For Scientists: The recovery research agenda is often skewed towards testing treatments that are implemented and managed by addiction professionals. Given that most individuals recover from substance use disorder without the help of professional treatment, consider adopting a more balanced research agenda that helps to strengthen the scientific knowledge base regarding a multitude of pathways to recovery.
- For Policy makers: This editorial seeks to increase the value of non-professionally provided recovery support services and “natural recovery” through dispelling the myth of the gatekeeper. For example, research on Twelve-Step Facilitation (engages patients with Alcoholics Anonymous and similar 12-step recovery organizations) has been shown to be as effective, or more effective, than traditional evidence-based treatments and reduce reliance on professional services while still enhancing outcomes, thus lowering health care costs. Consider ongoing funding for research that seeks to broaden the base of effective recovery support services.
- For Treatment professionals and treatment systems: It is recommended that providers continue to help patients in or seeking recovery because the path to recovery runs through treatment for many individuals with a severe substance use disorder. This editorial has called on providers to be conscientious of giving value to other recovery support services and natural recovery in our ongoing effort to help individuals initiate or sustain remission from substance use disorders.
Humphreys, K. (2015). Addiction treatment professionals are not the gatekeepers of recovery. Substance Use and Misuse, 50(8-9), 1024-1027. doi:10.3109/10826084.2015.1007678