James Hillman once said in his provocative book of the same title, “We’ve had a hundred years of psychotherapy and the world’s getting worse.” Though many would take case with this satirical, yet telling title, one does begin to wonder how well we are doing in the grand scheme of things related to reducing pain and suffering in this world. And when this pain has to do with drug and alcohol addiction, how well do psychotherapeutic providers do in the final analysis of impact on changing behavior for the good? And does our cutting edge research from neuroscience have anything to say about it?
When the National Institute on Drug Abuse (NIDA) recently came out with their report NIDA InfoFacts: Treatment Approaches for Drug Addiction, they did a helpful synopsis in a meta-analysis sort of way on the key principles of effective treatment. Being the neuroscience-oriented change agent that I am, who has seen the practice of psychotherapy enhanced by understanding the secret world of the brain, I thought it would be helpful to view these classic research findings from the lens of your brain – to see if “it” sees things the same way we as outsiders believe behavior change works. Lets take a look at a sample of these points.
Addiction is a complex but treatable disease that affects brain function and behavior.
Brain’s Response: Neuroscience has shown a less than perfect linear “cause and effect” relationship here, and that the brain is affecting the addictive response and manifestation as well. It’s a fine line between a true addictive disorder and the fundamental “wishing that reality was something else than it is” response that colors most of everyday decision making of us all.
No single treatment approach is appropriate for everyone.
Brain’s Response: Because the brain is wired to “feel right” and not to necessarily be effective, we all have unique ways of reducing the anxiety and dissonance we feel of the “one approach” coming at us. Whether it is another approach being more effective or are defenses less effective in rationalizing the benefits away, remains unclear.
Treatment needs to be readily available.
Brain’s Response: Research on neuroplasticity and deliberate practice has shown us that it takes a lot more concerted effort and repetition to change behavior than we think. Being “readily available” allows the brain to practice at an exponentially higher level counter behaviors so as to rewire neural networks
Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
Brain’s Response: Research on why the best cognitive rehabilitation strategies work on the brain after a certain traumatic event seem to convey the importance of a “cross training” effect on boosting rewiring potentials. That is, working all the lobes and not just where the supposed injury occurred. Such is the case potentially with why a multidisciplinary approach works with addiction—-from a neuroplasticity angle, you increase the chances of enlisting the support on non-injured, healthy, and addictive-busting neural networks.
Remaining in treatment for an adequate period of time is critical.
Brain’s Response: Though time is indeed correlated to treatment success, I am curious what the exact correlation coefficient would be. Could it be a cognitive bias of ours that makes us think this is literally true but in reality the data could be something else, in much the same way that ? Do we not have examples of people who show insight potential around behavior change across the whole spectrum from one intervention to 10 times in rehab? The brain is an inadequate distinguisher between things that make sense and things that are literally true. My hunch on this one is that in actuality the correlation is mediocre at best; that time in treatment is a powerful variable when supported by many moderating variables (family support, level of pain experienced per intervention, accountability factors, etc).
Treatment does not need to be voluntary to be effective.
Brain’s response: Sure, on one level this is true. Behavioral compliance can come from both an involuntary or voluntary event. However, because the brain makes “one size fits all” emotional responses, it gets tricky to discern from words used–and even behavioral evidence– the committed from the compliant individual. The brain is masterful on reading the environmental needs around it and assessing the patterns to learn what it needs to do to fit. So, arguably from a brain training side, this statement is correct. The brain can learn from the environment thrown on it or co-created. The problem comes when “what gets you here doesn’t get you there” and the tipping point of life kicks in….and more is needed than just “compliance”
As you can see, when one looks at these common assertions of treatment efficacy with a more discerning light of neuroscience, once can’t help but question one’s thinking about one’s thinking. And is this troublesome? I think not. Ironically, perhaps it is this meta-cognitive stance that is most beneficial in building humility-based practitioners who use neuroscience as a knowledge helper and not a rule generator.