How to Treat Addiction:
Video Introduciton to the Guide

In March Merritt Mental Health held a workshop on addiction in Marin County. The results are now available in a free PDF entitled Addiction Care Navigation in the Bay Area: A Guide to Programs & Professionals. Now you can download the free PDF or purchase the guide as a paperback on Amazon. In the above video, Dr. Merritt covers these six “pearls of wisdom” gleaned from the workshop:

1) Treat the patient and family, not just the patient
2) Avoid Either/Or thinking
3) Addiction is a treatable disease
4) Marijuana destroys lives
5) Good intervention always works
6) The key-person approach to treatment

Addiction Care Navigation in the Bay Area:
A Guide to Programs and Professionals

Addiction Care Navigation in the Bay Area: A Guide to Programs and Professionals brings together over fifty resources to aid patients, family members, health professionals, and educators seeking guidance in addiction treatment. The resource guide began at a Merritt Mental Health workshop entitled Addiction Care Navigation in the Bay Area: A Workshop for Health Professionals held in Marin County, California, in 2017. Expert panelists at this workshop included Howard Kornfeld, M.D., Rosemary O’Connor, C.P.C., David E. Smith, M.D., and Kristina Wandzilak, C.A.S.

Introduction to Guide

As a psychiatrist who has struggled for more than fifteen years to help patients with addictive disorders, I know firsthand what the challenges are. I know that assessment and diagnosis constitute only the first step, the easiest step. What is far more difficult is knowing who to recommend and where to send patients and families. To which doctors, therapists, interventionists, and family specialists? To what treatment centers, programs, and groups? If you are a health professional, I would be surprised if your experience is different from mine.

In the spirit of confronting this challenge head-on in a collaborative manner, Merritt Mental Health recently organized a conference at Green Gulch Zen Center in Marin called Addiction Care Navigation in the Bay Area: A Workshop for Health Professionals. It was not the first workshop I have put on, but it was the best. It was fun, informative, intellectually engaging, and unique.

What made the workshop most unique was not that it was case-based. It was not that that we debated and developed best treatment plans for patients and families. It was that at every step along the way we took out dedicated time to answer a key question: WHO? Specifically WHO does a patient or family member reach out to today for help?

We did not stop at the simple suggestion, “Refer the patient to an addiction specialist.” Instead, we generated specific Bay Area referrals for every issue and need we encountered during our five hours together. And, post-workshop, we have collected these 50+ referrals into this guide.

What made the workshop unique was the question WHO? What made it excellent was the presence of four addiction experts who shared their extensive expertise and poured out their passion for treatment. They were Howard Kornfeld, M.D., founder and director of Recovery Without Walls; Rosemary O’Connor, C.P.C., founder of ROC Recovery Services; David Smith, M.D., founder of the Haight Ashbury Free Clinics and now medical director of North Bay Recovery Center; and Kristina Wandzilak, C.A.S, interventionist and founder of Full Circle Intervention. I am extremely grateful for the insights, wisdom, and referrals they brought to the table.

In addition to the referrals we generated, we reached many important conclusions about the treatment of addictive disorders. Here I highlight six of the most impactful “pearls of wisdom” we discussed.

Treat the patient and the family, not just the patient. Treating the patient and the family represent the two fundamental keys to successful outcomes. Why? Why is a treatment plan for the family essential? The reason is that patterns of interaction between family members and the individual with addiction can either foster or hinder successful treatment of that individual. In their own treatment in Al-Anon or therapy, or work with a family recovery coach or interventionist, family members learn about the disease of addiction, and, vitally, they move every day towards the goals of 1) healthy decision-making and 2) healthy communication with the person suffering addiction. As family members achieve these milestones–healthy decision-making and communication–the effect on the loved one with addiction can be transformative.

Avoid Either/Or thinking. Instead embrace Both/And thinking. The second take-home message from the workshop relates to how to treat the person with the addiction. It is rare that a person with addiction does not also have co-occurring grief, depression, anxiety, another mood disorder, or trauma–that is, an underlying mental health condition. We debated extensively whether it is most prudent to start with the treatment of the mental health disorder or the addiction. There was also a second sticky question: Do you treat addiction with AA, psychotherapy, and other psychosocial interventions or with medications and other biological interventions? What was so refreshing and gratifying at the workshop was that we dispensed altogether with Either/Or questions and debates and simply answered, “Yes.” We adopted Both/And thinking. Treat addiction and anxiety and mood disorders. Treat addiction with AA, therapy, and medications. Comprehensive, multidisciplinary treatment is categorically the best treatment of all.

Addiction is a treatable disease. The third take-home message, related to the first two, was that addiction is a treatable disease. It can be fatal–we all know that–but we must never lose sight of the truth of successful treatment and recovery. Based on this understanding of addiction, one profound message family members can deliver to the addicted person is: “I love you, and I am not okay losing you to a treatable disease.”

Marijuana destroys lives. One of the most surprising conclusions of the workshop, ringing out loud and clear from every corner, was that marijuana destroys lives. There is a fallacy now pervasive in American culture that marijuana, or cannabis, is benign compared to alcohol, opiates, and other substances of abuse. Nothing could be further from the truth. Marijuana is now a more high-potency, addictive, and dangerous substance than ever. Marijuana addiction is not “addiction light.” Just blink and it descends rapidly into “addiction heavy.” Remarkably, several of our experts insisted that marijuana addiction is more difficult to treat than alcohol and opioid addiction.

Good intervention always works. This is a bold claim. On the face of it, since some 20-30% of addicted individuals decline to go into treatment after an intervention, it seems disingenuous or erroneous. However, the claim is in fact 100% correct when seen through the lens of the education and treatment of the family. The reason that good intervention always works is that first and foremost intervention is for the family; it is only secondarily a vehicle to get the addicted person into treatment. Intervention educates and sometimes deeply transforms the family. It aids the family to move towards healthy decision-making and healthy communication. Here is the key concept: “The family can get better with or without the addicted person.” The family should therefore move forward into maximal health, no matter what the addicted person decides or does.

The key-person approach to treatment. The last take-home message is my favorite. It is the “Key Person Approach to Treating Addiction.” At the workshop we often debated the question, “Where does a patient or a family start?” The answer is anywhere, anywhere at all. The reason for this overbroad statement comes back to the essential question of WHO? The question is not where, in fact. It is WHO? Find a key person–that is, a mental health professional with expertise in addiction–and latch on. The person can be a physician, a therapist, an interventionist, a recovery coach, or a sponsor from AA. Just make sure to start with someone who is broad-minded and experienced, and from that pivot point allow the rest of the treatment plan to develop and unfold. Stick with that key person through thick and thin until the patient and the family truly achieve health and wellness.

Addiction is everywhere. Statistics show that it is growing in prevalence, destroying more and more lives every year. Make sure to be on the lookout for it. And, when you see it, ask yourself WHO? Specifically WHO can a patient or family member reach out to today for help?

To aid in this critical pursuit, I have produced this guide. Please make sure to refer patients and family members to it. The guide contains 50+ answers to the vital question WHO?

Additionally, we plan to expand it into a second edition in early 2018. If you are an addiction expert, or an addiction-informed health professional, who works in the Bay Area, please contact us and tell us about the work you do. You can also instantly add your information to this online survey. We would like to include you in the second edition.

Eli Merritt, M.D.