@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM Prob. a good time to tell you I don't believe in treatment in it's current form. I would never work in a treatment facility. Much less, for-profit. The therapeutic tactic you refer to is not very useful and may be harmful. Yet, "denial" is still a chief symptom. Debate is how.
@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM There are scientific reasons why people develop "denial." The question is how to identity, and puncture hardened denial structures w/o causing harm. The "old way" of confrontational tactics and shaming can cause more harm than good and is usually contraindicated. Tx has few tools
@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM Establishment of newer methods- unconditional positive regard, honest information sharing, all work, provided you have meaningful clinical offering. People really want a better life. Forcing them to be aware of a problem while offer little in the way of a solution, is a failure.
@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM Still, it would be unscientific to pretend that people do not develop extremely sensitive mechanisms of resistance to truth about their lives. Ask any family members who have tried to talk with their person about their usage. It's a survival instinct to deny there's a problem.
@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM So two things have to occur: people have to be made aware of their harmful behaviors while simultaneously offering them a meaningful pathway to a new and better life that is comprehensive and addresses ALL their issues, now just substances. Our treatment system fails in both.
@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM All of this, of course is reliant on the assumption that people who actually require treatment are ending up there, which isn't the case currently, people who don't want or need it end up there all the time, because $, not because they clinically warrant treatment.
@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM So ability to pay overides clinical necessity all the time. Treatment ideally, should be upon demand, open to all who want it, locally accessible and free. Then it is not necessary for clinicians to force upon people what their truth may or may not be.
@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM So, to go back to my original point. The critique of how denial is treated is valid. To say it doesn't exists, unscientific. The solution, as you can see, requires a lot more than Twitter activism and calling it out. The whole basis of treatment has to change.
@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM *identify (I hate Twitter for these conversations d/t lack of editing)
@Matthew60323922 @maiasz @BenLevenson @DrSarahWakeman @UnhealthyAlcDrg @theNASEM *not just substances*
