Can People Change? The Case of Substance Abuse

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Substance abuse is a serious issue that concerns one’s mental health, family and caretakers alike. Being able to effectively treat and overcome substance abuse is a prominent field of study within medicine that deals with how well patients can go through treatment processes and come out as non-addicts. In evaluating four separate peer-reviewed journal articles about substance abuse and treatment, the evidence will show that people cannot ultimately change as a result of prolonged and interactive treatment strategies. Various forms of treatment and sources of evidence will be utilized in order to exemplify how patients tend to show little improvement over time and revert back to behavioral patterns that are still indicative of substance addiction. Ultimately, while symptoms and cravings can be temporarily subsided for substance abuse, people cannot change it over the long haul.

According to Greg Greenberg, Rosenheck, and Seibyl (2002) and colleagues, even long term care does not result in overcoming substance abuse, despite heavy treatment. Greenberg et al. (2002) conducted interviews, clinical assessments, case studies, and follow-ups of 1576 subjects from twenty-two separate clinics three months after patients were discharged. In the course of their empirical analysis, various indices, scales, and means were used in order to quantify the patients’ improvement over time. The researchers emphasized the value of long-term care and commitment to seeing recovery come to fruition. This source was a quality article because it represented a broad and adequate sample size that followed through over the course of an extended time period. Since various forms of measurement were used, there was little bias in the evidence and the results were forthcoming of possible limitations. The results of the research suggested that long-term treatment did not prove to be effective in terms of helping discharged veterans deal with their substance abuse issues, even months after treatment had taken place (Greenberg et al., 2002, p. 246). The core psychological problem of addiction and the need for a ‘fix’ was still evident. 

In relation, this evidence suggests that people cannot change their habits when it comes to substance addiction. The research article utilized a study that effectively tracked the long term effectiveness of intense care and treatment. Despite this, the researchers came to the conclusion that long-term intensive care had a minute effect on the overall outcome (Greenberg et al., 2002, p. 257). The evidence reflects the notion that substance abuse, like other things in life, simply cannot be changed and ‘fixed,’ as traditional medicine seeks to do. In fact, a secondary study by David Hawkins, Arthur, and Catalano (1995) agreed that it is difficult for individuals to ever overcome substance addiction, especially within high-risk groups (p. 406). Moreover, because of the vast nature of substance abuse in terms of many different options for victims, partial recovery from one substance can possibly be translated into other forms of substance abuse. For example, even if an individual overcomes an addiction to cocaine and painkillers, they would most likely displace their addiction into another substance. After all, drugs like caffeine and alcohol are legal substances that almost anyone can have ready access to. For a person to change their ways and truly overcome the addiction of a substance, that substance cannot be merely replaced with one that is more available. Ultimately, Greenberg et al.’s (2002) evidence showed that long term care did not suffice in changing patients’ addiction towards substances; consequently, people cannot change their behavior in this respect. 

Deborah Garnick, Horgan, Merrick, and Hoyt (2007) sought to identify the way in which medical health plans recognize and address both mental health and substance abuse conditions. The course of her 2007 study relied on evidence collected in 2003: 

We conducted a nationally representative survey of private health plans regarding behavioral health services. A total of 368 health plans (83% response rate) provided information about their managed care products: health maintenance organization (HMO), point-of-service (POS), or preferred provider organization (PPO) products (812 in total). (Garnick et al., 2007, p. 1060).

The researchers utilized a vast array of online and hospital provided databases as part of their research. The quality of the source and its research was very thorough because it was well-designed and utilized various organizations such as the National Institute on Alcohol Abuse and Alcoholism, American Medical Association and others (Garnick et al., 2007). Their research found that while health plans do utilize varied and effective means of screening for mental health screening, substance abuse screening was wholly neglected (Garnick et al., 2007, p. 1061).  Most health plans paid particular attention to mental health (around 78%) while only roughly (7%) really utilized robust means to screen and diagnose patients for substance abuse (Garnick et al., 2007). Furthermore, screening requirements were sometimes outsourced to exterior institutions at an additional cost to the patient. 

A lack of attention towards patient screening for substance abuse suggests a lack of standardization and cohesion among health plans; consequently, substance abuse does not fall under the normal scope of mental health care and requires specialized treatment that is not readily curable and treatable. Mainly, medical health plans focus on screening for conditions that afflict much of the population. Mental problems such as depression, anxiety, and other diseases issues are readily treatable with existing medical practices that most primary care physicians and hospitals can treat. However, in the case of substance abuse, it is not easily or readily treatable. This explains why most health plans do not cover it as part of their normal screening process. As a result, it is probable to argue that hospitals and primary care physicians do not have the capacity to effectively treat substance abuse. The underlying implication of this notion is that people cannot readily change and address the issue with traditional medical care plans. Moreover, specialized and intensive programs are required to effectively deal with substance abuse. Given that Garnick et al.’s (2007) analysis evaluated many diverse health plans, the underlying assumption is that physicians and hospitals undertake the responsibility of helping patients deal with treatable diseases, not cases like substance abuse where long-term intensive care is necessary. 

Michael Liepman, Silvia, and Nirenberg (1989) evaluated behavioral patterns of families in order to outline how substance addicts interact with their families during periods of drug abuse and recovery. The researchers conducted an in-depth study of two families of drug addicts to construct a “behavior loop map” based on observed instances of various substance abuse-related behaviors (Liepman et al., 1989, p. 285). While the evidence they collected was anecdotal and based on open-ended responses and observation, an empirical analysis was done in order to prioritize which behaviors were a trend versus which were simply unique to that family’s situation. The quality of this source was excellent in terms of the depth of information and attention to detail; however, the sample size of only two families was not sufficient to draw strong conclusions about how substance abuse families interact with the patient in question. The results were in the form of an actual map that outlined common behaviors during periods of abuse and recovery (see figure 1):

(Figure 1omitted for preview. Available via download).

The results indicated that there were few patterns between the two cases and more attention should be paid to the individual circumstances that each patient and family requires (Liepman et al., 1989, p. 287). Ultimately, behaviors were erratic and attempt to draw strong quantifiable correlations between the two cases were a formidable challenge.

Nonetheless, Liepman et al.’s (1989) evidence do support the notion that people do not change their behavior because of the fact that their research could not effectively isolate distinct symptoms, thus making distinct treatment just as difficult. For people to effectively change their behavior and treat substance abuse, patterns must be detected and isolated so that solutions can be holistically applied. Unfortunately for the case of substance abusers, family interactions show that it is possibly a moot point to even attempt to characterize and classify such abusers, given the complexity and scope of how we define terms like substance and addiction. Even if a family member were to be effectively treated and their negative behavior subsided, the underlying addiction and tendency to crave a drug (even a legal one), would still be there, albeit displaced in another drug.

Conclusion

Substance abuse is an example of an affliction that cannot be changed over time as a result of treatment. Research by Greenberg et al. (2002) showed that discharged veterans were not able to see effective recovery from substance abuse, despite long term care. This evidence showed that even intensive care was not effective in addressing substance abuse, thus suggesting that people cannot change this facet of their behavior. Similarly, Garnick et al.’s (2007) analysis of medical health plans suggested that because substance abuse screening was almost wholly neglected, it is not under the scope of traditional medicine and hospitals to effectively treat like other diseases. Substance abuse is then left as a condition that can only be cared for, not effectively treated where the person changes. Finally, evidence regarding behavioral patterns of families with substance abuse victims by Liepman et al. (1989) exemplified the notion that abusers behavior is difficult to control change and even characterize effectively. People cannot simply change this facet of their behavior as drug abuse is a condition that falls out of the scope of normal mental health and treatment for curable conditions.

References

Garnick, D., Horgan, C., Merrick, E., & Hoyt, A. (2007). Identification and treatment of mental and substance use conditions: Health plans strategies. Medical Care, 45(11), 1060-1067.

Greenberg, G., Rosenheck, R., & Seibyl, C. (2002). Continuity of care and clinical effectiveness: Outcomes following residential treatment for severe substance abuse. Medical Care, 40(3), 246-259.

Hawkins, D., Arthur, M., & Catalano, R. (1995). Preventing substance abuse. Crime and Justice, 19, 343-427.

Liepman, M., Silvia, L., & Nirenberg, T. (1989). The use of family behavior loop mapping for substance abuse. Family Relations, 38(3), 282-287.