Last year, our own Anna David reviewed Ending Addiction For Good, by Cliffside Malibu founder Richard Taite and addiction researcher Constance Scharff, Ph.D. Now that the book is in its second edition, we decided to catch up with Dr. Scharff, who was in Athens, Greece for the International Conference of the Association of Psychology & Psychiatry for Adults and Children.
EL: Congratulations on the second edition!
CS: Thanks. We didn’t want the book to languish and be another book gathering dust on the shelf; we wanted to update the science of it and really let people know we were doing that.
EL: Last year at the International Academic Forum (IAFOR) conference in Osaka, Japan, you mentioned that you had worried about this book getting some pushback from the medical community—which didn’t end up happening. But why were you concerned about getting pushback from doctors?
CS: The concern was that addiction is firmly placed in the medical community. Academics and physicians define it as a disease. We send addicts to doctors and “treatment” centers, and we have trained the public to think of addiction as a disease. At Cliffside Malibu we don’t use a disease model, we use a behavioral model to understand and treat addiction, and what I was concerned about was that doctors would say, “Hey you’re taking this treatment away from us,” and marginalizing them in the process. What I have found, especially at these conferences overseas, is that doctors respond to evidence. If the science shows that our protocol can get people sober seven out of 10 times, that’s more than what they can do. I think most doctors become doctors because they want to help people. So many physicians have come to me and thanked me because they didn’t know what to do. It’s great feedback. We give them not only hope, but also more tools to offer their patients. It doesn’t matter if you go to our treatment center or not. That’s not the point of the book; the point was to outline the treatment protocol we use that’s so effective that we literally have an efficacy rate at least seven times the standard for addiction treatment. Physicians have overwhelmingly supported it. I’ve only had one researcher, though not a physician, give negative comments, and he has been doing funded research on methadone for more than twenty years.
EL: Which makes a lot of sense.
CS: Yes. But where we’ve had pushback that I didn’t expect is from the 12-step community. The part of the Big Book that says to seek outside help when you need it seems to have been forgotten by some in AA. If you have medical problems, see a doctor. If you have a psychological problem, see a therapist. If you have a spiritual problem, see a member of the clergy. That’s all in the Big Book. And we have no problem with 12-step—we use 12-step in the treatment program—but it doesn’t resonate with everyone, and it was never meant to be primary treatment. There was no Cliffside Malibu when I got sober. I got sober in 12-step treatment programs, but I needed a lot of outside help. A lot! So it surprised us that there would be such a pushback.
EL: I’m surprised too, because to me the two approaches are completely compatible and complementary. You’re not saying that 12-step programs are useless or harmful; you’re saying they’re not always enough because many people have really deep-seated trauma that those programs don’t address directly. That seems perfectly sound to me, and it seems like your science is really at the forefront of this and should be welcomed by everyone invested in recovery.
CS: We’re certainly at the forefront of treatment centers pushing for evidence-based treatment to become standard practice. To our knowledge, I’m the only addiction researcher who is full time at an addiction center. There are some therapists who do research at treatment centers; there are treatment centers that have advisory panels, which means they may talk to researchers a couple times a year. There are university professors who conduct forms of treatment as part of their research, but not in an ongoing fashion. That’s not Cliffside. I do research and development full time, though my job is not to conduct primary research. We don’t do experiments on site.
EL: Right—that would be strange.
CS: Exactly. My job is to comb through the research from other people and find out what might apply to addiction treatment. There’s a huge disconnect between what happens in research and what happens in treatment centers. One area that hasn’t been getting nearly enough attention is neuroscience. There are some amazing, cutting-edge neuroscience findings that have practical application to addiction treatment.
EL: What are some of the most promising new advances that you see as having a lot of potential?
CS: I think the best study was about a year and half ago from McGill University. What they believe—and have the brain scans to back up— is that the brain is much more malleable than we ever imagined. It develops new neural-pathways depending on what we do. The brain kind of gets exercised like a muscle. If you lift a weight over and over again, your arm gets stronger. If you walk around a carpet a thousand times, you wear a pattern in it. To combine these two ideas, addiction both wears and strengthens a pattern in the brain. When you use drugs again and again, new neural-pathways begin to develop, and they become so strong that you’re essentially locked in an addiction feedback loop that you can’t get out of unaided. It’s not that you don’t want to show up for your daughter’s wedding or your son’s Little League game, it’s that your brain essentially will not allow it. You get high instead. You have to. That’s your job. This is why the McGill study calls addiction a disorder of decision making. There’s research going on in this vein all over the world, and we’re looking for research partners who will continue to do this research. Because what we think is happening is, if addiction creates new neural pathways, recovery likely does the same.
We’ve developed a treatment protocol that works synergistically for mind, body, and spirit. You can’t sit in psychotherapy all day; you’ve got to do something that engages a different part of the brain: a walk, or some meditation or whatever. We’re constantly trying to activate different parts of the brain to get you off of that addiction pathway and essentially rewire the brain to create a recovery feedback loop. I’ve seen one study that seems to show this happening, but it was very small, not nearly enough to really prove it. Your brain wants to be in its cycle, this healthy cycle. Unfortunately, though—and this is something a 12-stepper can validate—once a brain is wired a certain way it doesn’t get unwired. When they say your addiction is doing pushups in the back corner, it’s not really getting stronger; it’s actually that you’re older and your body isn’t accustomed to it, but the wiring is still there. If I were to pick up a drink now after 16 years, my brain would think I was still drinking two liters a day like I did when I was 20. That’s why people who relapse after long periods of sobriety, like Philip Seymour Hoffman, frequently die. However, we do believe we can create alternative pathways through working different parts of the brain. That seems to be what is occurring, but the science has not proven it yet.
EL: Do you see a future down the line where every rehab center is using the protocol you describe in this book?
CS: That’s the goal. I speak all over the world to academics and to researchers and clinicians because I want to change the conversation that we’re having about addiction. Most researchers are not addicts themselves. Before getting my Ph.D., I worked as a volunteer with men and women from the VA. People were coming back from the war and were relapsing or killing themselves, and I thought, There has to be something we can do about this. It can’t just be 12 steps and medication. It has to be better than that. Addicts who want to get clean deserve to live productive, healthy lives. That’s why I speak around the world and why I wrote this book with Rich. Every treatment center should be using this protocol. And it’s not just me advocating this, for evidence-based treatment in addiction treatment centers. Tom McLellan, who works for the Obama administration, is calling for this. There are other authors and activists, but it should be everyone.
Most people discount addicts, but addicts are not people just to be brushed off—we can have amazing lives. I want us to talk about addiction the same way we talk about depression. Compared to 20 years ago, there’s so much hope for depression treatment. I want to see the same kind of hope for addiction. The treatment protocol is there, and the more we understand how the brain works, the more we can own it.
Recovery is for everyone. Rich is starting an affordable treatment center in the next few months. The 1000-count sheets and the views of the ocean aren’t what get people sober at Cliffside. We do that to attract a specific clientele. The reality is that the treatment protocol works. That’s why we’re committed to having an affordable treatment center. At the end of the book, we tell people who run other treatment facilities to wholesale rip us off. If you run another treatment center, please, take what we have to say and use it to benefit your clients.
EL: Steal this book, basically.
CS: Right now we have a very limited number of beds. Our affordable center might have 100 more. I’m in Greece right now and did this research before I came—there are about three times more addicts in the US than the whole population of Greece. So with 10, 20, 100 treatment centers, we can’t meet the need. We want the people who are in a position to do so to meet that need. Statistics say that 10% of Americans are addicts, only 13% will seek treatment, and of those only 10% recover. That’s why we say in AA that we’re miracles, because almost nobody recovers, yet we know we can get a 70% recovery rate or better with our protocol. That’s why we need to keep pushing this. The people who run less effective treatment centers are not bad people. They just don’t know or they’re afraid to try something new. We have proven that it works, and we want them to take it and run with it.
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