An excerpt from Slow Dancing with the Devil: A Son’s Substance Use Disorder, A Mother’s Anguish.

The only time my anxiety was gone, or at least on pause, was when Luke was in a treatment center or sobriety house. I knew he was safe and surrounded by those who understood the game. Neurobiology is a part of addiction, and so is coming to grips with the fact that SUD is a chronic disease that demands abstinence, no matter the circumstances or social pressure. The best way to help maintain abstinence is by being with others who are in the same boat.

Back in 2012, the 12-Step Program of AA/NA totally changed my son from an angry youth into a responsible young man. Even though he had more than one relapse, a normal happening for those first in treatment, the program laid the foundation for Luke’s recovery. It taught him personal accountability, forgiveness for self and others, compassion, making amends for wrongs he caused to others, and being continually aware of his responsibility to humanity. Luke needed to get back into his AA program as his feeling of worthlessness was a significant trigger for relapse.

Being a part of the AA community was very important to Luke for many reasons. He knew working through the steps had saved his life by giving him the tools to forgive his past misdeeds. It also connected him to his AA brotherhood, aiding his sobriety. Being accepted in a group was vital to Luke; he was a very sociable person. His magnetic personality usually put him as the center of attention in any situation, and people just gravitated to him. He fed on that acceptance as it made him feel worthy and important. Being back in a house surrounded by a brotherhood solely focused on healing body, mind, and soul was imperative for Luke’s recovery.

However, the one thing that concerned me about many sobriety houses is that they only dealt with substance use disorder and did not take dual diagnosis or MAT/MOUD medicine-assisted therapy into account. This was disheartening as many physicians and government agencies now consider these medical treatments the gold standard of care for opioid addiction.

A significant problem is that those at the core of treatment centers still follow the science of the 1930s. That is when William G. Wilson—aka Bill W.—first published “The Big Book” of Alcoholics Anonymous. Luke had about eight copies marked up as he was religiously trying to stay the course. He had another five brand-new copies to give to new people he stumbled upon.

The Big Book is a great tool. If spirituality and prayer were all needed to heal addiction, Luke would have been a poster boy for recovery. Unfortunately, SUD is a lot more complicated.

Classic AA/NA considers the use of any mind-altering medication as taboo to the recovery process. This is an understandable concept, as during AA’s early years in 1935, there was little understanding of neurobiology. However, a more balanced approach is needed as addiction science has advanced. This conundrum left Luke getting great support but archaic treatment. Dr. Andrew Rosen wrote about this in an article titled “Not All Addicts are Alike.” He said, “Brain imaging, genetic advances, and careful epidemiological research have all contributed to a more holistic systems approach to recovery. Yet, these findings have had a slow trickle-down effect on those who need proper treatment.”

Why is that? I wondered. It was disheartening to discover that educational standards and treatment modalities had stayed the same 25 years after I left the psychiatric hospital.

Experts were calling for change, but few were listening. The New York Times reported, “While most medical schools now offer some education about opioids, only about 15 of 180 American programs teach addiction.” Dr. Kevin Kunz, executive vice president of the Addiction Medicine Foundation, which presses for the professionalization of the subspecialty, said, “The content in all schools varies, ranging from one pharmacology lecture to several weeks during a third-year clinical rotation, usually in psychiatry or family medicine.”

The National Center on Addiction and Substance Abuse report at Columbia University called out the medical profession’s failure at every level — in medical school, residency training, continuing education, and in practice to adequately address addiction.” Simply put, “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”

Sobriety houses are a good example. As excellent as Luke’s experiences there were, they are run by people with little formal training or educational background in addressing dual diagnosis issues. Many counselors are in recovery themselves, which means they understand the struggle but not necessarily the disease. Those without advanced clinical training tend to think everyone’s disease is identical to theirs. More than that, most treatment provider personnel carry the “addiction counselor” or “substance abuse counselor” credential, for which many states require little more than a high school diploma or a GED. If one is only dealing with straight SUD, the system mainly works. If patients are dual diagnosis, they are in jeopardy.

Unfortunately, people with mental illness are more likely to experience a substance use disorder than those not affected by a mental illness. According to SAMHSA’s 2021 National Survey on Drug Use and Health, approximately 9.2 million adults in the United States have a co-occurring disorder.

My son was dual diagnosis. That fact was not considered early on in his recovery. I knew Luke was in safe hands regarding his spiritual needs for recovery. My biggest concern was that Luke was told he only needed a commitment to the 12 steps to maintain his sobriety, and if he couldn’t maintain it, he simply didn’t try hard enough and was morally defective. The problem is you can’t pray away PTSD. You can’t tell someone with general anxiety disorder to meditate away a panic attack or clinical depression. Imagine telling a cancer patient they have a moral defect if they can’t pray their cancer away.

Susan Hertz Berrick is the author of Slow Dancing with the Devil: A Son’s Substance Use Disorder, A Mother’s Anguish.