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We need a sensible and compassionate approach to treatment for substance dependence. Our traditional methods for addiction recovery are simply insufficient to grapple with the variety and complexity of the issue as we now understand it. It is becoming increasingly clear that we can no longer afford to blindly adhere to vagaries and unfalsifiable claims, no matter how time honored, poetic or beloved.

I believe a lot of the common addiction recovery truisms and approaches were born out of confusion and frustration. They represent the best practices of their time, and continue to serve and save millions. How ever, if we contrast these truisms and approaches with our medical model, we can see how dangerous and irresponsible it is to blindly adhere to them.

What if we told a cancer patient that he or she has to go to church and hit rock bottom before they recover? What if we told the loved ones of cancer patients that the patient "did it to them selves" and "the patient has to do everything" and based on that flawless logic, to withdraw basic kindness and support in the name of tough love. Its pretty safe to say there would be less cancer survivors.

Imagine an emergency room doctor refusing to do CPR on a patient because he didn't want to work harder than the client. It's safe to say there would be lots more dead ER patients.

Fortunately, our culture is becoming more sensible and compassionate regarding substance dependence and treatment. People (clearly not all, but some) are abandoning slogans and shrill, dogmatic ideologies for a more rational, evidence based treatments.

There are quite a few good books for individuals suffering from substance dependence. Beyond Addiction is intended for their concerned significant others (CSO's). Although, the book is written for a general audience. There is a lot of hardcore research evidence undergirding the material. The authors do a good job of coupling a user friendly front end, with a pretty boss theoretical backend.

The book takes a "kitchen sink" approach (with the caveat that everything in this particular sink is intentional and valuable). They bring a lot of sensible and compassionate approaches together under one umbrella, borrowing heavily (and quite appropriately) from Motivational Interviewing (MI), third wave behaviorist approaches e.g. Acceptance Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT) and other humanistic, family therapy and CBT sources. But the book is primarily about a behaviorally oriented, systems level approach to addiction recovery called Community Reinforcement and Family Training (CRAFT).

The CRAFT model assumes that (A) individuals with substance use problems are often strongly opposed to treatment, and (B) that the concerned significant others (CSOs) of the substance abuser are commonly highly motivated to help them.

The fairly unique feature of CRAFT is that it also dares to posit the nearly heretical notion that CSOs can actually play a significant and positive role in their loved ones recovery, even when said loved one doesn't want to change.

The book even dares to challenge (or rather to clarify) time worn truisms such as enabling and codependent relationships. Not that these constructs aren't valuable or valid on some level. But that maybe they have been taken a little too far in our popular culture, i.e. maybe it's o.k. to tell your addicted son or daughter you love them and or make them breakfast once and a while. Maybe it could even help them recover.

One of the downright sensible rationale for treating your addicted loved one with kindness (aside from the obvious examples) is that people (like just about any other mammal) respond better to reinforcement than to punishment. Reinforcement draws you in. Punishment makes you (and me and everyone we know) want to leave the situation quickly (unless you're into punishment, in which case we in the behavioral analysis world call it reinforcement, even if it involves fetters and such, but I digress).

In the old days of recovery, inpatient setting approaches used to punish and humiliate patients. You have a little captive audience in that setting i.e. people can't leave. Nowadays we don't do that crazy, corny, sadistic stuff anymore. Particularly in outpatient settings. We treat people with kindness because if we abuse people seeking treatment, they leave. We figure people are better off in treatment than out of treatment so we just go ahead and be nice.

Additionally, there is great evidence that meeting people where they are at, and working with, rather than against them, motivates people better than treating them like trash. If treating substance depended people like shit worked, there would be a whole lot less addicted people out there. The inference being that so called "addicts" get treated badly all the time by cops, hospital staff, paramedics etc. Humiliation, coercion, guilt and confrontation make great reality t.v. But in reality reality it's a HUGE fail.

With CRAFT, CSO's are trained in various strategies, including positive reinforcement, various communication skills and natural consequences.

There are seven steps in the CRAFT model for implementing positive communication strategies.

1: Be Brief
2: Be Positive
3: Refer to Specific Behaviors
4: Label your Feelings
5: Offer an Understanding Statement
6: Accept Partial Responsibility
7: Offer to help

There is tons more to CRAFT. It's an exciting approach that I will be implementing in my work as a marital and family therapist and addiction counselor. In sum, I highly recommend this sensible and compassionate book.