How Alternative Addiction Treatment Can Work for You
Koorosh Rassekh, MMFT, is a licensed therapist and founder of Evo Health and Wellness in Venice Beach, California. His mission is to break the stigma around mental health and create a world of healthier people, families, and communities. I recently connected with Koorosh and invited him to share about how he helps his clients change their addictive behavior. Read more about my collaboration with him about sex and porn addiction here.
1) Evo's website states “we respect where you are and where you want to go." What does this mean for how you think about and treat addictions? Taking inspiration from one of my mentors and one of Evo’s key advisors, Dr. Gabor Maté, I would say that Evo understands that addiction is never the primary issue. It is a secondary response to something deeper happening for a person - trauma, marginalization, the impact of being different, bullying culture, rape culture, etc. When people suffer, they turn to whatever is available to address their suffering. With substances, people often use as a coping mechanism, and this coping mechanism becomes a problem within itself. Because we look at addiction this way, our goal is to address issues on the clients’ terms. When we say we respect “where you are,” we mean that we don’t demand that people stop using to get help. We don’t pathologize and we are here to help without demanding that clients handle things before they get to us. It’s a completely non-judgmental approach. When we say we respect “where you want to go,” we mean that there are many pathways to recovery. Some people may want complete sobriety, and we work with people toward that goal. Others say that they have a drinking problem and want to learn how to have a healthy relationship with alcohol. Or that they drink too much but that they don’t have the same problem with pot. We don’t meet clients with, “You can’t do that!” Instead of starting with ideas that we come up with ourselves, we work side-by side with each client to identify the best outcomes for their lives, with regard to substances, their relationships, their careers, and beyond.
2) "You don't have to stop to start." It sounds like you don't require clients to stop their addictive behavior. What does this mean for how you work with clients? How have you found this "alternative" approach helpful? We believe people “don’t have to stop to start” because many people want to stop, but they can’t. When addiction comes up in people’s lives, it’s a real struggle. It’s a place full of shame, self-loathing, loneliness. Nobody is walking around like this and feeling completely satisfied with what’s happening. Something is getting in the way. I think this alternative approach helps lower the pain threshold for people to get help. They don’t have to adopt ideas that aren’t congruent with who they are or feel judged. It is also helpful because it has helped us really think hard about what success means. Many of our clients have said that this is the hardest program they have ever been in because they have to set goals themselves. They are learning what they really value and what deep, lasting changes they want to make in their lives.
3) How do you help people who haven't reached their goals with traditional approaches? What's your understanding of why they've relapsed multiple times? We do often work with people who have tried many forms of traditional treatment and it hasn’t worked for them. I think a big part of this is that traditional treatment tries to fit everyone into a single idea of recovery and that if you are not part of that idea, you are a failure. To us, that doesn’t make sense. I’m also not a big fan of the idea of “relapse” because it comes with a lot of shame and negative connotations that often impede long-term recovery. Recently, I worked with a client who was really distraught because they had gone back to smoking. They had cut down quite a lot, but were frustrated that it started again. They said, “I was doing so well!” Instead of treating this as a relapse, I wondered, what is this a response to? We mapped it out and the person was having a really tough time in their relationship and with recent life stressors. Almost immediately after this session, they also started smoking less. Just taking the attention away from the smoking made a huge difference. Rather than feeling a sense of shame and failure, they started to have a greater awareness about what was bringing up these feelings made a huge difference.
4) Trying an alternative approach can feel risky or uncertain, as opposed to traditional approaches. Can you share some data that supports why you think about addiction as you do and how you help? Sure, of course it can feel risky to try an alternative approach. The reality is that the research is really not on the side of traditional treatment, which has very poor outcomes. Many aspects of Evo’s model emerge from the latest thinking on root causes and solutions to addiction. We know that “tough love” just doesn’t work. Analysis of over 40 years of research on addiction treatment (White & Miller) found that not a single study supported confrontational approaches as better than kinder and less harmful treatments. Instead, we know that things like empathy in the therapeutic relationship and collaboratively setting goals are key to making treatment effective (See also Scott Miller’s post on “Valuing What Works”). We also know that the dominant, single story of recovery is standing in the way of people getting help. According to SAMHSA’s National Survey on Drug Use and Health, only 1 in 10 people dealing with addiction receive treatment. And of those who did not seek help, 25% say it’s because they are not ready to stop using. People need more options.
5) I'd love to hear about a success story from Evo. We worked with one young person who had been kicked out of multiple treatment facilities for aggression. He showed up high to sessions, punched walls, and graffitied offices. This behavior kept pushing him to higher and higher levels of psychiatric care. And I think what we did differently is that we just stayed with him and didn’t give up. He was able to set the treatment plan on his own terms. On several occasions, he came in angry, saying, “You guys are making me come here!” We worked with him and asked, “Ok, which groups do you want to attend? Do you want to stop entirely?” And he decided on his own that no, he didn’t want to stop or cut down his attendance at all. He had never been given the opportunity to call the shots himself. Little by little the aggression subsided. He went from exploding at just the mention of his parents to going on vacations with them. He went from not being able to envision his future, thinking he would be dead in a year, to starting to entertain ideas about how he would get closer to some of his goals. He went from 24-hour companion care to 3 days a week. He still uses substances, but the way he uses them is not lethal. He stopped using all substances except for cannabis, and eventually discharged himself into individual therapy.
About the Author
Jeremy Mast is a licensed marriage and family therapist, a Certified Sex Addiction Therapist, and the founder and director of the Center for Integrative Change. He is passionate about helping those struggling with substance use and problematic sexual behaviors and their loved ones find lasting healing. In his spare time, he enjoys reading, rock climbing, health and fitness, and trying out new recipes while cooking at home.