By Scott Kiloby
What really ends addictions? That’s the million dollar question. I hope to answer that question in this article.
The Problems with Using Medications Only to Treat Addiction
Although it is the million dollar question, actually billions of dollars have been spent and billions more will be spent in the future on research into medications that promise to end or substantially reduce addictions. Although I’m a big fan of any such scientific breakthroughs, I have my doubts as to whether medicine is the answer.
One of the central problems in using medications only to treat addiction is that it involves replacing one substance with another. Medications that treat addiction (just like the drugs to which people are addicted) are, by their very nature, temporary. They do not address the root of the problem. They do not forever change the brain. They provide temporary relief of cravings and other symptoms only or they positively adjust the brain’s circuitry only during the time the medication is being taken. This can certainly be helpful, especially in the beginning of recovery. But as a long term recovery plan, medications are not the best answer.
Naltrexone is one of several drugs within a certain class of medications that substantially reduces both the cravings and anxiety around certain addictive substances like alcohol and opiates. Naltrexone is usually taken in pill form or injected by way of a monthly shot. It’s been on the market for quite sometime. So why hasn’t addiction ended if this medication is so widely available? Doctors who prescribe the pill form will tell you that some, if not many, patients relapse by stopping the Natrexone pills. The montly injection, although more effective, has a similar drawback, in that the patient may simply forget or refuse to go into to his or her doctor’s office for the injection after the month ends. Relapse often happens after the failure to get the next injection. The Naltrexone Implant, discussed below, is a superb innovation and holds more promise than both the pill and injected forms of the drug.
Medications like Methadone and Suboxone have been hailed by many to be the best treatment for opiod addiction. Even President Obama insisted in a public speech in 2015 that treatment centers must expand their use of medication-assisted treatment through Methadone and other drugs within a similar class. I’m not arguing directly with President Obama, because treatment using these drugs has its place. But these drugs are habit-forming. There are thousands of people who not only become addicted to them but who hoard them, overuse them and sell them on the street. There are actually support groups for people who cannot break the habit of these drugs. These kinds of medications are short-term fixes only. Like Naltrexone (pill and injection forms), they only temporarily treat the symptoms such as cravings and anxiety.
Other drugs are being developed to stop or substantially reduce cravings and anxiety. But, to the extent these drugs will come out in pill and/or injectable form, they will likely suffer from the same drawbacks as the medications listed above. People will simply stop taking them whenever they want to feel the high of their drug of choice and/or when an emotional trigger gets the best of them.
The Problem with Using Thought-Based Therapies Only to Treat Addiction
Addiction is not simply a disease of the brain. Nor is it just about having uncontrollable thoughts about using. There is a substantial bodily component to addiction. Although science is slow to truly measure exactly what is happening in the body during a craving, anyone suffering from addiction will tell you that his body craves the addictive substance or activity. Test this out for yourself. Imagine your favorite addictive substance or activity (even if it is coffee, sugar, or porn). Once you have that image in your mind, bring your awareness into your body. Notice the intensity of craving, anxiety and/or contraction you feel in your body (in the pelvic area, stomach, chest and/or throat). There is a visceral DIS-ease happening with any craving, meaning that the body is distressed and yearning for the substance or activity. The word “DIS-ease” is used here not as a reference to a clinical diagnosis or disorder in your body, but rather to that distressful, anxious, contracted energy you feel during a craving. Addictive substances and activities temporarily relieve that distress. That’s why people go back to them over and over.
For this reason, therapies that engage only the mind are only partially helpful. This includes talk therapies that have no body (or somatic component) and some forms of the 12 step program and other programs that tend to engage only belief or thought-based strategies for abstinence and recovery. The Combine Study released in 2006 showed that a group of people who received various forms of therapies aimed only at changing thinking did worse than the group given only a brief intervention along with a placebo pill. In a 2013 edition of The American Journal of Medicine, there was a clinical research study conducted by Yale that concluded that patients receiving medication-assisted medical management along with cognitive behavioral therapy did not differ significantly from those receiving only medication-assisted medical management.” In short, the study is suggesting that CBT adds very little, if anything, to addiction recovery. Unfortunately, many of these therapies are thought to be “evidence-based” practices. Where is the evidence? The national average success rate for addiction recovery is still very low – around 10 to 15%.
These are pretty stark and surprising findings. But let’s not throw out the baby with the bathwater. There are many therapies out there that contain a body component, along with a mind component. This body-centered focus is likely to be more effective simply because it does not ignore the body, which is where we truly feel the powerful effects of thoughts of addictive substances and activities.
The Problem with the Idea that “Addicts Just Need Support.”
Johann Hari, a British journalist, has made the claim that the answer to addiction is unconditional love and support of the addict. Although Hari is stepping in the right direction, his view is partial, just as all the views above are partial. Support is only one element that is needed. It does not go far enough. Take, for example, the thousands of addicts who are actually triggered mainly when in groups and within one-on-one relationships. There are many people who go to recovery support meetings and then relapse precisely because they have no way of truly dealing on a fundamental level with the past trauma that resurfaces within these relational dynamics. Furthermore, much of our time as humans is spent alone, especially in the age of the internet which has created walls of separation between us as we bury our noses into screens. Feelings that often arise when we are alone are some of the most potent triggers leading to relapse. If no one is around, how do we deal with these feelings and cravings?
What Does Work?
Having had my finger on the pulse of research on addiction and having been directly involved with addiction recovery for many years as an author and speaker on the subject, it is my firm conviction that there is a way to end or substantially reduce addiction in a way that is not temporary. To irrevocably change one’s relationship to addiction is the key here. Quick fixes, medications, and mind-only based recoveries will not do, as stand-alone treatments. Simply supporting the addict is not enough. Here are a few examples of where I think recovery is headed, down a path of much more effectiveness.
1. The Multidimensional Approach. Approaches to recovery that integrate a number of useful dimensions likely hold the greatest key to recovery. For thousands of years, humans have been locked into “this or that” thinking. In other words, doctors tend to believe that medications are the answer. Therapists tend to think their therapies are the answer. But all of these are partial. Approaches that integrate the best of the best are most likely the best answer. There is very little research at this time showing the effectiveness of true integration precisely because researchers are often focused on medications only or they are unaware of the effectiveness of eastern based therapies such as mindfulness, bodywork and meditation.
At the Kiloby Center, we use an integrative mindfulness therapy that combines not only addressing thoughts, but also dealing with the deep-seated bodily sensations around cravings, anxiety, depression and trauma. We integrate that approach with the Naltrexone Implant in some cases and with TMS or medication in other cases. The Naltrexone Implant is an implant placed right underneath the skin through same day surgery. It produces Naltrexone into the system on a time-release basis for up to a year or a year and a half. Therefore, it is impossible for the person to skip a dose during that year and a half. During that time, the person is given the opportunity to deal with the underlying psychological, emotional and spiritual issues that led to the addiction in the first place. The Center uses other medications also, when necessary.
TMS is a cutting-edge non-medication brain technology that sends waves into the brain, stimulating parts of the brain that are inactive. This can be especially helpful when someone is suffering from depression or other disorders connected to addiction. The Center refers such clients to a local psychiatrist when TMS might be a good fit. There are many other ways the Center integrates approaches, including through the use of other therapies, yoga, meditation and trauma or other body work. All of the therapies we do in-house carry a central theme of mindfulness, as we find mindfulness to be the most potent therapy for addiction and its accompanying issues. We even suggest the 12 step program as an aftercare module so that people get the support they need to continue in their recovery. Many of our clients who take advantage of the 12 step program add our mindfulness approach into their 12 step work – another interesting integration.
2. True Spiritual Awakening. A deep and profound spiritual awakening can be a tremendously effective way of ending or substantially reducing addiction. I’m not referring here to the kind of spiritual awakening often touted in the West. I’m speaking of non-dual realization where one’s experience becomes completely grounded in present moment awareness and where one no longer identifies strongly with the thoughts, feelings and sensations that come and go through that present awareness. This kind of awakening is very transformative and substantially changes one’s relationship to addictive substances and activities, but only if the awakening includes a thorough awakening throughout the whole body, including uprooting and dissolving all past traumas and body contractions associated with addiction. At the Kiloby Center, this type of spiritual awakening is the focus of our work and it includes a thorough body component. Even though spiritual awakening can stand on its own as a powerful way to recover, it doesn’t hurt to integrate other treatments and modalities with it, including support, medicine and certain-types of body-centered therapies. Integration is never a bad thing if it is done wisely.
3. Thorough Trauma and Body Work. Any therapy, such as mindfulness or certain other therapies, that has a strong body component can be amazingly effective for the treatment of addiction. Trauma has been found in recent studies to be a major contributing factor in addiction. The idea is this: release the trauma and you’ll release the addiction. Although it may sound too good to be true, it really isn’t. Trauma (including PTSD) creates dense and persistent bodily contractions that virtually scream for relief through addictive substances and activities for some people. By engaging in an ongoing and thorough practice of dissolving past trauma and its concurrent bodily contractions, the body simply no longer screams for relief. It feels open, transparent and peaceful. Again, integration is important here. For example, getting support from others can be incredibly helpful even if one’s focus is on trauma and bodywork.
At the Kiloby Center, we use a model we created called RTS. RTS stands for readiness, transformation and support. This model is a super-integration of many approaches. The transformation aspect of RTS includes the integration of mindfulness, the Naltrexone Implant and TMS as described in #1, the spiritual awakening described in #2, the trauma and body work as described in #3 as well as support from family and friends and support from others in recovery (the importance of which was noted by Hari). This is an exceptionally rare and potent integration of various approaches, all centering around mindfulness. We firmly believe it is the best of the best in addiction recovery. Not many treatment centers are using the Naltrexone Implant. It is even rarer to find a treatment center that combines its addiction recovery approach with TMS. The spiritual (nondual) awakening described in #2 is not a part of any treatment program, except ours, as far as we know. And trauma and body work are largely ignored by many treatment centers.
There are many ways to integrate. The Kiloby Center doesn’t own the rights to integration. It is happening in many different centers and within doctors’ and therapists’ offices all over the world. Integration can happen from within any recovery program. For example, if one is involved with 12 step, by simply integrating mindfulness, body or trauma work, medication, TMS or other adjunct therapies, the chance of success can be much higher.
What really ends addiction? This million dollar question can be answered. It is being answered already by the Kiloby Center and by other centers and health care professionals who are stepping outside the box and using cutting edge therapies and wise integration. One major key to the answer is throwing away what hasn’t worked (or hasn’t worked well) and continuing to listen to the wisdom of the East, while combining it with the breakthroughs in the West. It is unlikely that there will ever be a cure for addiction because scientists are looking for a cure in a pill form. Pills generally don’t provide cures. They provide temporary relief or temporary stopping or changing of brain circuitry. The idea that there is a cure that is needed comes from the idea that addiction is only a brain disease. As Gabor Mate (a thought-provoking doctor and speaker in the addiction recovery field) has stated, thinking of addiction only as a brain disease is short-sighted. It overlooks genetics, child development, trauma and a host of other issues.
Join the Kiloby Center in changing the whole discussion around addiction recovery. Let’s step outside of our limited and partial views. Let’s move towards wise integration. There is plenty of room for change given the very low national success rate in addiction recovery. Not opening our minds is a very dangerous mistake. Millions of people are dying because we are locked into old methods of recovery that aren’t working and failing to integrate other treatments that are working.