Toward a Philosophy of Choice: A New Era of Addiction Treatment

Summary and Analysis…

A fascinating article by William White describing the way choice relates to addiction treatment.

The article touches on factors which have tended to marginalize choice including an emphasis on the neurobiological: “Based on the work of Volkov and other scientists, one could posit addiction as a disease of the will marked by a progressive loss of volitional control over AOD use and related decision-making. Unfortunately, work to date reveals very little about the neurobiology of recovery.”

The articles calls out the phenomenon of spontaneous remission as part of the wide variety of existing options: “There is also growing scientific evidence that many people resolve AOD problems without professional or peer assistance (Cunningham, Sobell, Sobell, et al, 1995; Granfield & Cloud, 1995). Today, individuals and families seeking help have choices that vary widely in setting, philosophy, service elements, service personnel, and costs.”

White sees choice as a foundational aspect of recovery: “One of the most important arenas of choice within addiction treatment involves broad frameworks of recovery. The choice philosophy is based first on the recognition of multiple (secular, spiritual, and religious) pathways and styles of long-term recovery and the recognition of the right of each person to select a pathway and style of recovery that represents their personal and aspirational values.”

Choice, White tells us, is not merely a “nice-to-have,” but is vital: “…long-term recovery is not possible without choice. If there is no rehabilitation of the power to choose and encouragement of choice, we are left with, not sustainable recovery, but superficial treatment compliance.”

Excerpted from William White Papers

Being given choices of institutions, levels of care, treatment goals/methods, service personnel, and service duration has historically not been part of the personal experience of addiction treatment in the United States. This article describes why addiction treatment professionals have been reticent to offer choices to their alcohol and drug dependent clients and why that philosophy is now undergoing reevaluation.

Dr. Jekyl and Mr. Hyde

Addiction treatment has for more than 150 years been more a process of professional diagnosis, direction, and indoctrination than a process of guided self-reflection and self-change. Since the advent of program accreditation standards in the 1970s, clients entering addiction treatment have been asked to sign a treatment plan. This ritual has conveyed the illusion of participation and choice, but anyone familiar with the process knows that the choices available to clients have, until recently, been narrowly prescribed by each program’s treatment philosophy, available levels of care, coercive dictates from referral sources, or by the external care managers who governed reimbursement decisions. Another factor concerning limited choice in addiction treatment is the perception that those entering addiction treatment have lost the power of choice—that the state of addiction is the very antithesis of choice (Michael Flaherty, personal communication).