Community Health & Wellness

Making the case for a new approach to substance-use treatment

For decades, research into substance use treatment has found that a rigid focus on abstinence-only models has caused just a small fraction of those in need to seek treatment.

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But as the opioid epidemic surges in Kitsap and across the country, Wayne Swanson, director of Subacute Recovery Services at Kitsap Mental Health Services, says providers are beginning to examine new approaches to substance-use treatment, including ways to lower barriers and better engage those in need.

Swanson will give a free lecture at Olympic College in Bremerton on Thursday titled “Rethinking Approaches to Substance Use Recovery,” outlining how providers are embracing a more compassionate treatment model. They are shifting away from an all-or-nothing mindset of abstinence and instead focusing on how harm reduction can be included in treatment.

Harm reduction vs. abstinence

“Overdose deaths are higher than they’ve ever been, and we recognize the need to engage people in treatment more effectively,” Swanson said in a recent interview. “We’ll talk about the problem and then about how we’ve traditionally done treatment and ways we can expand or even redesign that to catch more of the people who need treatment.”

Wayne Swanson, director of Subacute Recovery Services at Kitsap Mental Health Services

The talk is the first of what Kitsap Mental Health Services says will be a series of educational events addressing community topics. It comes as and regional leaders are investing more effort in addressing the opioid crisis. 

Overdose deaths, primarily driven by fentanyl, have skyrocketed across the state, the Washington State Standard reported earlier this year. 

Traditionally, treatment for substance use disorders has meant getting a patient to abstain from drug use. It was seen as separate from harm reduction, such as safe injection sites or free Narcan, Swanson said, which were used in the field to keep people alive.

However, Swanson says providers are increasingly seeing that the philosophy of harm reduction, positive change, and safety can be effective components in better treatment outcomes. For patients, treatment may not mean abstinence, but it could be reduced use or ceasing use of one substance in favor of another that’s less harmful, he said.

A novel approach

Non-abstinence-based treatment of substance use disorders is a relatively novel approach, gaining momentum across the country in the last 20 years, according to a 2022 review of the model’s history co-authored by psychologists at the University of North Carolina and University of New Mexico.

The evolution of substance use disorder treatment was heavily shaped by the 12-step model of Alcoholics Anonymous, a nonprofessional support group for those looking to quit drinking or narcotics. That model generally argued for an abstinence-only approach that remains pervasive among modern providers, the authors note, while research and implementation of non-abstinence approaches have lagged behind.

The idea behind non-abstinence models is to not force people into unwanted change but allow them to address their own goals and make positive improvements. 

Patients often come into substance use treatment with varying readiness for change, Swanson said. Rather than total sobriety, the majority of patients say their top priorities from treatment are things like reduced use of drugs, a better relationship with loved ones, or holding down a job.

“As a field, we need to recognize that,” Swanson said. “It doesn’t mean abstinence might not best serve those people in the long run. It means that (for) engagement, we have to look at all the other factors — the whole person — and see how we can get closer to that goal by working on what they’re coming to us with.”

Rethinking treatment

A Kitsap Mental Health patient, for example, could have both a mental health and substance use disorder, but may only be ready to seek treatment for their mental health challenges. 

“Again, (it’s) about lowering that barrier. You could be ready to work on mental health, but not ready to work on substance use,” Swanson said. “But that (therapist) sitting with you has an eye on it and can help you develop some motivation to maybe work on the substance use or at least increase your understanding of how substances are affecting your mental health.”

The “Rethinking Approaches to Substance Use” talk is from 5 to 6:30 p.m. Thursday, April 25, at Olympic College (1600 Chester Ave. in Bremerton), Building 4, room 129.

Conor Wilson is a Murrow News fellow, reporting for Gig Harbor Now and the Kitsap Sun, a newspaper in Bremerton, through a program managed by Washington State University.