Not ready for addiction treatment? No problem.
By Kevin Doyle, EdD
One of the most common misperceptions about health care for people with substance use disorders is that individuals must be “ready” in order for treatment to be successful. In fact, nothing could be further from the truth. It is relatively unusual for a person to decide one day to seek help because they are “ready.” Often, there are outside forces pushing the matter, such as the legal system, family members or an employer. Treatment programs are highly experienced with and accustomed to admitting patients in these circumstances. So much so that I sometimes wonder if they would know what to do with someone who showed up saying something along the lines of, “I am so happy to be here and know I have a serious problem, so let’s get to work!”
The reality is that people often arrive saying quite the opposite: “I don’t need to be here,” or “I am no worse than anyone else,” or “I can stop drinking/using any time — in fact, I’ve stopped lots of times.”
The terms that professionals tend to use are “intrinsic or internal motivation” (doing something for oneself) and “extrinsic or external motivation” (doing something for another person or reason). I would contend that some intrinsic motivation for recovery is important eventually, but that discovering or fully developing it may take weeks, months, or even years. More commonly, people come to rely on some combination of extrinsic and intrinsic motivation. The former, in my experience, is sometimes looked at by professionals judgmentally, as if it is not legitimate and a sign of intractable sickness. Realistically, though, we all do things for family members, loved ones, or even the legal system to produce the results we desire. Recovery behaviors should not be judged skeptically — or at all , for that matter— based on the source of a person’s motivation, especially early in the recovery process. As one sometimes hears in the rooms of recovery: “Do the behaviors; the attitudes will follow.” My question is, “Don’t we want people to do things like abstain from substance use, attend self-help meetings, and attend treatment, regardless of why they are doing so, at least at first?” Of course, we do!
A very helpful guide published by the National Institute on Drug Abuse (NIDA), called Principles of Drug Addiction Treatment (most recent version, 2014), offers this relevant passage:
Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.
At the end of the day, as has often been said, “there is no wrong door to treatment.” This is true now more than ever with opioids like fentanyl contributing to more than 107,000 overdose deaths in the U.S. last year. Any way that someone makes it to treatment is an opportunity for that person to get the lifesaving help they need. Let’s not judge folks on how motivated they are on day one of the long journey of recovery.