Reprinted from "Self-Management" issue of Visions Journal, 2003, 1 (18), pp. 12-13
An increasing body of literature supports treating addiction as a chronic relapsing disease, a move which is paralleled by similar shifts in our understanding of several mental disorders. Self-management is recognized as providing an appropriate framework for the treatment of a wide range of chronic illnesses. It encourages individuals to take responsibility for their own recovery and to utilize available resources effectively to achieve healthier lives.
There are many parallels between addictions and conditions where self-management approaches have been effective, such as adult onset diabetes, asthma and hypertension:1
multiple factors contribute to the onset of the disorder: genetic, biological, behavioural and environmental
behavioural choices play a part in both the onset and severity of the disorder, regardless of whether a biological or genetic predisposition exists
rates of successful treatment are similar across all disorders (as with other chronic diseases, the success of addictions treatments is measured in terms of improvement rather than complete recovery)
rates of compliance with pharmacological or behavioural treatment regimes are comparable across all disorders
factors such as low socio-economic status, comorbid psychiatric conditions, and lack of family or social supports are most commonly associated with lack of treatment compliance and relapse after treatment for all disorders.
In treating a chronic disease, supporting the person’s self-management ability is an important factor, and involves a number of aspects. The person must be informed about their condition, and they must learn strategies for improving their health and avoiding a relapse. Often there is a treatment regime that must be followed, and the patient must understand the importance of maintaining it. These principles can be applied to addictions, to various mental disorders, and to other chronic diseases.
For instance, an asthma sufferer must take daily preventative medications, exercise regularly, ensure they always have emergency inhalers with them, and avoid aggravating situations (such as dusty environments or a park in springtime). Similarly, a recovering addict must comply with a treatment regime, such as regular counselling, daily methadone doses, or nicotine patches. Improving other areas of their lives, for instance, spending time with family and exercising regularly, are also valuable in the course of recovery. Like the person with asthma, and like an individual with diabetes who must avoid sugary foods, recovering addicts may also need to avoid potential aggravating situations, such as friends they used with or situations that may make them want to use again. In each of these examples, self-management allows individuals with a chronic relapsing condition to take an active role in their recovery.
Applying self-management principles to problem substance use has the added benefit that it fits with a harm reduction approach. This philosophy recognizes the value of achieving improved overall health, reduced use, a stabilized living situation, an improved employment situation, and other gains that work towards the individual’s stabilization and reintegration into society.
Self-management allows and encourages individuals to participate in setting their own goals and determining the type of intervention that is likely to be helpful for them. A variety of goals are supported under this approach, which is an advantage since the same goals may not be appropriate for everyone. For instance, one problem drinker may adopt strategies to limit their use to within-moderate drinking guidelines, while another may find that abstinence is their preferred goal.
The question of competence or capability is an important consideration when applying self-management principles to addictions treatment. An addicted individual’s competence varies over time; it is not constant. There are a range of factors that can constrain the choices available to an individual at a given time.2 Examples of such constraining factors include:
past or present abuse
lack of a supportive home environment
undesirable peer or social influences
physical or psychological cravings
The more such factors are present, the more difficult (although not impossible) it may be for the individual to make healthier choices.
When an individual’s ability to choose is constrained by circumstances such as these, self-management can be more challenging. If there are too many constraints limiting the choices available to the individual, a great deal of support will be required. In some situations, for example, when a person is overdosing, they may be incapable of any action and require professional intervention. However, if all interventions are informed by a self-management approach, they can work with the aim of supporting the person into a more empowered position and improving their ability to make healthy choices.
There is evidence that specific self-management techniques are valid and effective in addressing the problem of addictions. A recent study found that providing people with self-help materials in a written format was as effective as more intensive counselling in reducing at-risk and harmful drinking among problem drinkers who self-referred, as opposed to those who were referred to treatment by others.3
While this particular intervention is only one among many self-management techniques, this finding reinforces the idea that self-management approaches, in general, may be a cost-effective way of addressing substance use problems. While extensive research has not yet been undertaken into the effectiveness of such techniques for addictions of varying type and severity, it appears a promising route to pursue. After all, many people with substance use problems have been successfully self-managing to a more healthy state. Nevertheless, there is a need for both the development of a range of self-management tools for addictions and for broad evaluations of their efficacy.
About the authorLisa is Marketing Assistant for the Kaiser Foundation, a BC addictions charity
- McLellan, A.T., Lewis, D.C., O’Brien, C. P., & Kleber, H.D. (2000). “Drug dependence: A chronic medical illness.” Journal of the American Medical Association, 284, 1689-1695.
- Committee on Addictions of the Group for the Advancement of Psychiatry. (2002). “Responsibility and choice in addiction.” Psychiatric Services, 53(6), 707-713.
- Apodaca, T.R. & Miller, W.R. (2003). “A meta-analysis of the effectiveness of bibliotherapy for alcohol problems.” Journal of Clinical Psychology, 59(3), 289-304.