I recently talked with a Huffington Post reporter about the Real Tab for Rehab: Inside the Addiction Treatment Biz. In our discussion, I pointed out that to a large extent we still have an addiction treatment system that provides short-term (acute) treatment for a long-term (chronic) problem (this key point did not make the article). In addition, the current system treats less than 10 percent of those who could benefit from some kind of intervention at a cost that will likely reach $34 billion by 2014, more than double the spending from 2005. In my opinion, a lot of money is being spent on helping a minority of those who struggle with addiction, and sadly being spent on expensive residential treatment stays that research indicates is not more effective than less expensive outpatient care. Bottom line, the billions being spent could be invested in those who struggle far more wisely.

Not too many years ago I was attending an addiction conference where a number of  treatment centers were advertising their services. I struck up a conversation with one of the marketing reps of a well-known residential program. She explained to me that because of the escalating cost of treatment, her team had developed a program that was only ten days in length, thus reducing the total treatment cost to about 15K while maintaining the effectiveness of a longer residential stay. As I always do in these situations, I asked her about proof that the program worked. She had a well-rehearsed answer, but like most treatment programs, no reliable and valid measures had been employed to measure outcomes. Even if some had been used, we know that 10 days hardly scratches the surface of what needs to happen to help someone with addiction.

Am I opposed to residential programs? Not at all. At times I believe these programs are life-savers and provide a strong foundation upon which to build a solid outpatient management plan. Many employ very skilled, compassionate, and hard-working counselors that know how to help patients stuck in addiction. Some charge reasonable rates for their services and avoid the “spa-like” add-ons that contribute nothing to long-term outcomes. What I am opposed to is marketing that feeds on the vulnerabilities of the populations that seek out their help. Many parents will go to the ends of the earth to help their addicted child and not think twice about mortgaging their home and draining their savings if someone tells them their program will save their kid. Even for those with money, the idea that one can “buy good outcomes” if just the right program is utilized is simply not true.

What can you do? You can spend your time understanding the nature of addiction, what science has to say about treatment interventions, and then spend your money wisely on what will result in the best possible long-term outcomes. What are some of the best financial investments in treatment? This slide from a recent presentation provides you a quick reference point for understanding how a number of treatment interventions rank in terms of scientific evidence. Notice that brief interventions, addiction medications (Campral, Revia), the Community Reinforcement Approach (CRA) and motivational enhancement interventions all rank very high in terms of evidence. Also notice what ranks far down the list: residential treatment, Alcoholics Anonymous (AA) and 12-step facilitation therapies, and general counseling. Note that it is not that these things cannot be useful in overcoming addiction, they can be very helpful. But when you compare their effectiveness through the lens of science to other options, and take into consideration the cost of each, it is clear we could be spending the billions of treatment dollars far more wisely.

The goal is to maximize the best possible intervention outcomes over many years (and for some a lifetime), not a few weeks or months. To do this, we need to employ the best interventions at the lowest cost. Combining free community resources, outpatient therapists, medications, self-help groups, and motivational incentives will give you the biggest bang for your buck.

I learned recently that the number one online  activity is watching videos. My initial guess was email, but as I thought more about how we have grown-up watching television, and that the average American now spends more than five hours a day in front of a screen (TVs, computers and mobile devices, non-worked related), this outcome is hardly surprising. Email actually ranks third behind online banking. These statistics got me thinking about the most effective way to provide you science-based, easy-to-understand information about addiction and how to overcome it as a problem. Call me a little slow, but if watching videos is where all the action is online, then it seems to make sense that I go there as well. So I am excited to tell you that I have taken the leap and completely updated this site with lots of video! You will now find many short snippets, most just a few minutes long, on a wide range of addiction-related topics.

A few words about the clips. Last year I joined the Board of Shangri-La, a nonprofit organization dedicated to helping Oregon’s most vulnerable populations with housing, employment, and a multitude of other needed services. What an amazing group of people! I can’t say enough great things about how they are making a difference in the lives of so many people at a time when so many are struggling. One reason for my involvement has been the increasing prevalence of addiction among the populations they serve. To help out, I presented some material about addiction to about 80 of their managers and staff, and in return, they taped it so I could use it on this site. Thanks again guys!

The first set of clips I am posting are primarily aimed at helping you better understand addiction. Here is one of them focused on addiction being about relationships.

Last week I watched the independent film Race to Nowhere that has won numerous awards for its strong messages about our broken educational system. Through interviews with students, parents, teachers, and others, the movie illustrates the dark side of being a kid in school. The race to nowhere for students is paved with an over-scheduling of activities, too much homework, too little sleep, and increased stress that is resulting in health problems, drug abuse, eating disorders, and suicide. What is even more troubling, is that for all the effort kids are putting into their school work and extracurricular activities, many are being churned out of our educational system lacking some of the most important qualities of a good education, including:  the ability to reflect deeply on topics, handle difficult emotions in the face of stress, and successfully engage in a wide range of healthy relationships. The film points the finger at numerous perpetrators, but in the end, fails to hit home that no one individual person or group is to blame, but rather it is the entire educational system that we must examine more carefully if we are to find the truth behind the worrisome outcomes.

When I think about the fact that over 80 percent of those who end up struggling with addiction begin their behaviors prior to the age of 15, this film frightens me even more. When did school become so competitive and stressful? Much of the over-scheduling of extra-curricular activities and hours of homework is in response to the demands, both perceived and real, associated with getting accepting into a college or university. What is sad is that the stress and pressure begin long before high school. My wife and I spent a couple of years tearing our hair out (the little I have left) trying to identify and enroll our son in the best possible elementary school. I put more time and effort into researching options, attending open houses, completing enrollment packets that included writing lengthy essays, than I ever did applying to graduate school! The process was absolutely crazy, and I know we were not alone. And now I know it was just the beginning.

Race to Nowhere illustrates painfully many of the current antecedents to addiction, and why we absolutely must reexamine our understanding of what education means and how we are going about educating our children. Failure to do so will only lead to a new generation of addicts.

Last year I dedicated a post to the work of Dr. Bruce Alexander, a psychologist from Canada who wrote a great book about the globalization of addiction. I am now extremely excited that my good friend Jari Chevalier, from Living Hero, recently completed an interview with him that you can access here. There are so many wonderful things in this podcast that I encourage you to take the time to hear what Dr. Alexander has to say about addiction and our society. Just to wet your appetite, here are a few things I found most insightful:

• Addiction is a problem on the rise all over the world, and the factors perpetuating this problem are similar
• Addiction is a window into our lives, culture, and the many problems we face day-to-day, and thus can teach us a lot about ourselves
• Addiction is an adaptive response to the increasing breakdown in community (dislocation) and intimate social ties necessary for a good life
• There is no formula or recipe for how best to intervene at the societal/community level and reverse the trend of addiction, but we should look to other countries that are further along in their efforts to curb addiction problems (Scandinavia, parts of South America)

Our government is currently very invested in promoting addiction as a brain disease, and the development of medications and psychosocial interventions that can treat the addicted brain. Unfortunately, however successful these interventions may be, they do not move our society in the direction of what addicts so badly need: human bonds, intimacy, and community. What I really get out of listening to Dr. Alexander is a message of Hope that we can change our ways. We can return to a way of life that is more grounded in relationships and not so consumed with materialism.

Also, check out Dr. Alexander’s website and  let me know what you think of the interview!

As a young boy, I remember venturing out on summer evenings to play hide-and-seek with the other neighborhood kids. We made up teams, sought out secret hiding places, and took full advantage of the local woods that surrounded our corner of the world. Our parents all knew each other, and while we were expending our energy running around in the dark playing games, they were talking around tables and sharing food and drink. There was no internet, cell phones, or other multimedia distractions competing for time. Life was simpler, slower.

Now, more than thirty-five years later, I find myself married with a young son and challenged to provide him the same care-free childhood that I experienced. Despite living in a pleasant, middle-class neighborhood, it is rare to see large groups of kids playing together outside. There are no local woods within walking distance, and even if there were, most parents (myself included) would be hesitant to allow their children to play unsupervised. Although everyone I encounter on my daily dog walks is friendly, there is a lack of deep intimacy among neighbors. Some have never even met despite living within blocks of each other for decades.

The stark contrast between life today and just a few decades ago is surreal. The year I was born the handheld calculator was invented, and today, handheld devices are minicomputers capable of video-conferencing around the world. But for all the benefits technology affords, there is a cost that gets lost in the frenzy of Facebook, YouTube, and Amazon.

In 1985, researchers set out to understand the degree to which people have family and friends they can rely upon to discuss matters that are personal in nature. A national survey was done, and in 2004, the same group decided to repeat the study to determine how core discussion networks had changed over two decades. The results are frightening.

• 25% of all Americans in 2004 reported they had no one in their life to discuss personal issues, compared to 10% in 1985
• The modal (most frequent) number of discussion partners in 1985 was three, but in 2004 that number plummeted to zero
• The average social network size has dropped from 3 confidants to 2
• The number of people who reported that their spouse was the only person they trust with personal issues increased by almost 50 percent since 1985

These outcomes paint a sobering picture of the price we may be paying for our technology-enhanced life. The lead researcher has said, “we know these close ties are what people depend on in bad times. We’re not saying people are completely isolated. They may have 600 friends on Facebook.com and email 25 people a day, but they are not discussing matters that are personally important.”

Source: Social Isolation in America: Changes in Core Discussion Networks over Two Decades, American Sociological Review, June 2006 71:353-375